Formula feeding

Your baby may need formula when:

• You do not have enough breast milk, even after help.
• You cannot breastfeed for a medical reason, or you choose not to.
• Your doctor advises extra milk, for example for low blood sugar or too much weight loss.
• Your baby has a rare condition called galactosemia. These babies cannot digest milk sugar and need a special formula.

If you give both breast milk and formula, keep giving the breastfeeds you can.

Most babies do well on a standard first infant formula made from cow’s milk. It can be the main drink for the whole first year. Changing from one brand to another has no proven benefit.

• You do not need follow-on formula. Never give it before 6 months.
• Use formulas sold for hunger, comfort or reflux only if your doctor advises it.
• Soy formula is for medical reasons only, on your doctor’s advice.
• Premature babies may need a special formula. Follow the neonatal team’s plan.

Never give plant drinks such as soy, rice, oat or almond drinks instead of formula. Never give cow’s or goat’s milk as a main drink before 1 year. Check the expiry date, and use only tins that are sealed and undamaged.

Powdered formula is not sterile. Good hygiene and hot water protect your baby from germs.

1. Clean the work surface. Wash your hands with soap and water.
2. Wash bottles and teats in hot soapy water. Then sterilize them, by boiling or with a sterilizer.
3. Boil fresh water. Let it cool for no more than 30 minutes, so it stays at 70°C or hotter.
4. Pour the water into the bottle first, up to the line you need.
5. Add the powder with the scoop from that same tin. Level each scoop with a clean knife. Do not press the powder down.
6. Close the bottle and shake until the powder dissolves.
7. Cool the bottle under cold running water. Test a few drops on your wrist. It should feel lukewarm.
8. Make each bottle just before the feed. Throw away any formula left after the feed.

Always use the number of scoops the tin gives for the amount of water. Never add extra water to make formula last longer, and never add extra powder. Too much water leaves your baby hungry and can upset the body’s salt balance. Too much powder can make your baby dehydrated.

For premature or sick babies, your doctor may suggest ready-to-feed liquid formula. It comes sterile in the pack.

These amounts are a rough guide. Your baby may take more or less.

• First week: about 30 to 60 mL per feed.
• By the end of the first month: about 90 to 120 mL per feed, every 3 to 4 hours.
• By 6 months: about 180 to 240 mL per feed, 4 or 5 times a day.
• Most babies need no more than about 960 mL in 24 hours.

Feed when your baby shows hunger. Stop when your baby shows they are full. Never push your baby to finish the bottle.

Paced feeding lets your baby set the speed, a bit like at the breast.

• Hold your baby close and fairly upright, with the head supported.
• Keep the bottle almost flat, tipped just enough to fill the teat.
• Touch the teat to your baby’s lips and let them draw it in.
• Every few sucks, tip the bottle down so your baby can pause.
• Switch sides halfway through the feed.
• Stop when your baby slows down, turns away or relaxes their hands.

Never leave your baby alone with a propped bottle. Your baby could choke.

Babies swallow some air when they drink. Burp your baby halfway through the feed and at the end. Hold your baby upright against your shoulder, or sit them on your lap with the chin supported. Gently pat or rub the back. If no burp comes after a few minutes, you can stop. A little milk coming up with a burp is common.

Do not switch formula on your own. Many babies spit up a little, have gas or cry in the evening. These are usually normal and a new formula rarely helps. Talk to your doctor first. If your baby needs a special formula, your doctor will choose it with you.

Call your doctor if your baby:

• Vomits often or forcefully.
• Has blood or mucus in the stool.
• Gets a rash or hives after feeds.
• Has fewer wet diapers than usual.
• Is not gaining weight.
• Seems in pain at most feeds.

Call the Red Cross on 140 if your baby has swelling of the lips or face or trouble breathing.