«The Baby Friendly Initiative in this booklet About this booklet 1 What is infant formula? 2 What you need for formula feeding 5 How to sterilise ...»
how to prepare
infant formula and
equipment to minimise
the risks to your baby
The Baby Friendly Initiative
in this booklet
About this booklet 1
What is infant formula? 2
What you need for formula feeding 5
How to sterilise feeding equipment 6
How to make up a feed 9
Feeding your baby 17
Breastfeeding, giving infant formula
and introducing solid foods 19 About this booklet The information in this booklet comes from the Department of Health and the Food Standards Agency. It will help you bottle feed your baby safely.
It is very important that you follow the instructions in this
booklet when you are:
• sterilising feeding bottles;
• sterilising feeding equipment; and • preparing infant formula feeds.
If you need more information about bottle feeding your baby, speak to your midwife, health visitor or GP.
What is infant formula?
Most infant formula is made from cow’s milk that has been treated to make it suitable for babies. Cow’s-milk-based infant formula is the only infant formula your baby needs. You should not feed your baby other formulas unless your midwife, health visitor or GP recommends you to.
If you think a particular brand of infant formula disagrees with your baby, ask your GP, midwife or health visitor for advice.
Different types of infant formula
Infant formula is available in two forms:
• ready-to-feed liquid infant formula, sold in cartons, which is sterile; and • powdered infant formula, which is not sterile.
First infant formula This is often described as suitable for newborns and should always be the first formula you give to your baby.
Your baby can stay on this formula when you start to introduce solid foods at around six months, and continue on it throughout the first year.
When your baby is one year old, they can start to drink whole cow’s milk.
K�Y �A�T Unless your doctor or health visitor gives you different advice, first infant formula is the only type of formula your baby needs until they are one year old.
‘Hungry baby milks’ or ‘second milks’ These contain more of a protein called casein than first infant formula and this is thought to make your baby feel more full. However, there is no evidence that babies settle better or sleep longer when fed this formula.
Unless your doctor or health visitor gives you different advice, there is no need to switch to these milks. Babies can drink first infant formula until they are one year old.
Follow-on formula Other milks are available that are labelled as being suitable for babies aged six months and over, such as ‘follow-on milk’, ‘toddler milk’ and ‘growing up milk’. They should never be fed to babies under six months old and there is no need to switch to these milks after six months. Your baby can have first infant formula up until the time when ordinary cow’s milk can be introduced (at one year old). However, the labels on these milks can look very similar to those on first infant formula, so read them carefully to avoid making a mistake. Like powdered infant formula, follow-on formula is not sterile.
Other formula Some follow-on formula has cereal added to it, and is described as a ‘nighttime feed for babies’. This type of formula is not necessary and there is no evidence that babies settle better or sleep longer when fed this. It should never be given to babies under six months.
If you think your baby might be allergic to cow’s-milk-based formula, talk to your GP. They can prescribe special formula feeds for babies with cow’s milk allergy. Some formulas in the shops are labelled as being ‘hypoallergenic’ but they are not suitable for babies diagnosed with a cow’s milk allergy.
You should not give your baby soya-based infant formula unless your GP or a dietician has advised you to.
Goat’s-milk-based formulas should not be given to babies under one year.
Remember, if you have any questions about the infant formula you are giving your baby, you can ask your midwife, health visitor or GP for information and help.
K�Y �A�T Cow’s milk should not be given as a main drink to infants under one year, but it’s okay to use small amounts of pasteurised whole cow’s milk when cooking and preparing foods for your baby from six months onwards.
Other full-fat dairy products such as yoghurt or fromage frais can be given after six months, once your baby is used to eating solid foods.
What you need for formula feeding You need to make sure you clean and sterilise the equipment to prevent your
baby from getting infections and stomach upsets. You’ll need:
• using a cold-water sterilising solution;
• steam sterilising; and • sterilising by boiling.
The following instructions apply to all feeding equipment you use for your baby – whether you are using expressed breast milk or infant formula.
Remember to first wash your hands well with soap and water and clean the work surfaces with hot soapy water Before sterilising, always clean and rinse • Clean the feeding bottle and teat in hot, soapy water as soon as possible after a feed, using a clean bottle brush.
• Rinse all your equipment in clean, cold running water before sterilising.
K�Y �A�T All feeding items must be thoroughly washed and rinsed before they are sterilised. Dishwashers will clean bottle feeding equipment but will not sterilise it. This is because temperatures reached in a dishwasher are not high enough for sterilisation, so you need to both clean and sterilise the bottles.
Cold-water sterilising solution • Follow the manufacturer’s instructions.
• Change the sterilising solution every 24 hours.
• Leave feeding equipment in the sterilising solution for at least 30 minutes.
• Make sure that there is no air trapped in the bottles or teats when putting them in the sterilising solution.
• Keep all the equipment under the solution with a floating cover.
Steam sterilising (electric steriliser or microwave) • As there are different types of steriliser it is important to follow the manufacturer’s instructions.
• Make sure the openings of the bottles and teats are facing down in the steriliser.
• Manufacturers will give a guide as to how long you can leave equipment that you are not using straight after sterilising before it needs to be resterilised.
Sterilising by boiling • When you use this method, you must take care to ensure safety and prevent scalds or burns. Never leave hot pans and liquids unattended, especially if children are present.
• Make sure that whatever you sterilise in this way is safe to boil.
• Boil the feeding equipment in water for at least 10 minutes, making sure that all items stay under the surface of the water.
• Remember that teats tend to get damaged faster with this method.
K�Y �A�T� Be careful to prevent anyone, especially children, from being burned or hurt if you are using the boiling method.
Regularly check that teats and bottles are not torn, cracked or damaged.
• Wash hands thoroughly. Clean and disinfect the surface where you will put together the bottle and teat.
• It is best to remove the bottles just before they are used.
• If you are not using the bottles immediately, put them together fully with the teat and lid in place to prevent the inside of the sterilised bottle and the inside and outside of the teat from being contaminated.
K�Y �A�T To reduce the risk of infection, make up each feed as your baby needs it, using boiled water at a temperature of �0oC or above. The step-by-step guide shows you how to do this.
Water at this temperature will kill any harmful bacteria that may be present. Remember to let the feed cool before you give it to your baby.
A baby’s immune system is not as strong nor as well developed as an adult’s.
This means that babies are much more susceptible to illness and infection.
Therefore, good hygiene is very important when making up a feed.
All equipment used to feed your baby must be sterilised. Bottles, teats and any other feeding equipment need to be cleaned and sterilised before each feed to reduce the chances of your baby getting sickness and diarrhoea.
It is best to use drinking water from the tap that has been freshly boiled (and cooled slightly to 70˚C or above) to make up a feed. Do not use water that has been previously boiled or artificially softened water.
This is because the balance of minerals in previously boiled water and artificially softened water may not be suitable for making up formula feeds.
K�Y �A�T Do not boil water in advance and store it in sterilised bottles in the fridge for later use. The water needs to be hot when the powdered infant formula is added, to kill any harmful bacteria that may be present.
Bottled water Bottled water is not recommended to make up a feed as it is not sterile and may contain too much salt (sodium) or sulphate.
Water labelled as ‘natural mineral water’ may contain too much salt (sodium) or sulphate. If you have to use natural mineral water to make up a feed, check the label to make sure the sodium (also written as Na) level is less than 200 milligrams (mg) per litre, and the sulphate (also written as SO4) content is not higher than 250 milligrams (mg) per litre.
Like tap water, bottled water is not usually sterile, so if you have to use it you will still need to boil it before you prepare the feed.
A step-by-step guide to preparing a powderedformula feed
1. Fill the kettle with at least 1 litre of fresh tap water from the cold tap (don’t use water that has been boiled before).
K�Y �A�T Manufacturers’ instructions vary as to how their formula should be made up so it is important to follow the instructions on the packet very carefully.
K�Y �A�Ts Different types of formula come with different scoops.
Make sure that you use only the scoop that comes with the powdered infant formula that you are using.
Making up a feed with too much powder can make your baby ill (for e�ample they can become constipated) and may cause dehydration. Too little powder will not provide your baby with enough nourishment. By using the scoop provided you are adding the correct amount of powdered formula.
K�Y �A�T� Do not add anything else (including sugar, cereals or chocolate powder) to the feed in the bottle.
Never warm up infant formula in a microwave as it can heat the feed unevenly (causing ‘hot spots’) and may burn your baby’s mouth.
1� Ready-to-feed li�uid infant formula Ready-to-feed liquid infant formula is sterile. This can help to reduce the risk of infections. It is suitable for high-risk infants – for example, those that are pre-term, low-birthweight or particularly vulnerable to infections.
Ready-to-feed liquid infant formula should be prepared and stored according to the manufacturer’s instructions. Remember that all feeding equipment will still need to be sterilised if you are using ready-to-feed liquid formula.
Storing a feed A feed should be freshly made up when it is needed to reduce the risk of infection that can make your baby ill. If you have no choice and need to store a feed, it should always be stored at the back of the fridge and for no longer than 24 hours.
Any infant formula left in the bottle after a feed should be thrown away.
Infant formula that has not been used and has been kept at room temperature must be thrown away within two hours.
Bacteria multiply very fast at room temperature. Even if a feed is kept in a fridge, bacteria can still survive and multiply, although they do this more slowly. The risk of infection increases over time so that is why it is important to make up the feed each time your baby needs it.
1� Feeding away from home If you need to feed your baby away from home, a convenient choice is to use ready-to-feed infant formula milk with an empty sterilised feeding bottle.
However, if you are using powdered infant formula this is the safest way to
make up a feed to take with you. You will need:
• a measured amount of infant formula powder in a small clean and dry container;
• a vacuum flask of hot water that has just been boiled; and • an empty sterilised feeding bottle with cap and retaining ring in place which can be removed when you are ready to make up the feed.
Make up a fresh feed only when your baby needs it. The water must still be hot when you use it, otherwise any bacteria in the infant formula may not be destroyed.
Remember to cool the feed before giving it to your baby by holding the bottom half of the bottle under cold running water. Move the bottle about under the tap to ensure even cooling. Make sure that the water does not touch the cap covering the teat.
The vacuum flask does not need to be sterilised but should be clean and only used for your baby. The boiling water should kill any bacteria present in the flask. If the flask is full and securely sealed, the water will stay above 70˚C for several hours.
K�Y �A�T Remember to make up a feed only when your baby needs it.
Transporting a feed If it is not possible to make up a fresh feed by following the advice above or if you need to transport a feed – for example to a nursery or childminder – you should prepare the feed at home and cool it, for at least one hour, at the back of the fridge.
Warming a feed When you are ready to use the feed, place the bottle in a container of warm water to heat it up. Always test the feed on the inside of your wrist to make sure if it isn’t too hot before you give it to your baby.