Patient education: Bottle feeding your baby (The Basics)

What is bottle feeding? — Bottle feeding is a way to feed a baby breast milk or formula. Baby bottles have a special nipple made of latex or silicone for babies to drink from.

Should I give my baby breast milk or formula? — Doctors recommend breastfeeding your baby for at least 1 year (12 months) if possible. For the first 6 months, breast milk is the only food that a baby needs. Breast milk has many benefits for a baby.

●To bottle feed with breast milk, you can pump your breasts and store the milk until you are ready to use it. If you do this, doctors recommend waiting until you and your baby have gotten used to breastfeeding before starting the bottle. That's because some babies prefer drinking from a bottle, which can make it harder to go back to breastfeeding.

●If it is not possible for the baby to have breast milk, they can have formula instead. Formula comes as powder or liquid that you mix with water, or as a ready-to-feed mixture. It contains very similar nutrients to those in breast milk. Use only store-bought baby formula, not homemade formula. That's because homemade formulas usually do not have enough of certain important nutrients, even if the ingredients seem healthy. This can be dangerous for babies.

●You can also feed a baby breast milk sometimes and formula other times. But your body will make less milk if you also feed formula.

The amount of breast milk or formula a baby needs changes as they grow.

How often should I feed my baby, and how long should a feeding last? — Feed your baby when they show signs of being hungry. A baby can show that they are hungry by:

●Waking up from sleep

●Moving their head around as if they are looking for the breast

●Sucking on their hands, lips, or tongue

Babies can feed on different schedules and for different amounts of time. For example, some babies finish a feeding in 5 minutes, but others might take 20 minutes or longer. Newborn babies feed about 8 to 12 times each day.

How do I prepare a bottle?

●Wash your hands before touching the bottle, breast milk, or formula.

●Start with a clean bottle and nipple. There are different styles of bottles and nipples. You might want to try a few different kinds to see what works for your baby. You can also ask your doctor or nurse for advice about how to choose.

●To prepare a bottle of breast milk:

•You can use freshly pumped breast milk or milk that was stored safely. Breast milk can be stored in the refrigerator for 3 to 5 days, or in the freezer. Milk that was frozen should be thawed out in the fridge overnight. Or you can thaw it in warm water for 20 to 30 minutes. To do this, run warm water into a pan or bowl, and sit the bottle in the water. Do not let water get into the bottle. Do not use a microwave to thaw the milk. Make sure to use breast milk that was frozen within 24 hours of thawing. Do not refreeze it after thawing.

•If milk was stored in a bag, carefully pour it into a bottle and put the nipple on. Breast milk separates after some time, which is normal. Swirl the bottle gently to mix it, but do not shake it.

●To prepare a bottle of formula using powder or a liquid:

•Check the expiration date on the formula. Do not give expired formula. Be sure to use powdered formula within 1 month of opening the container. If your baby is younger than 2 months old or has a weak immune system, talk to your doctor about how to feed them safely. It might be safer to use liquid formula instead of powdered formula.

•To know how much formula and water to use, follow the directions on the container, or your doctor's instructions.

•Use clean water to mix the formula. Run the tap for about 30 seconds before adding water to the bottle. If you are not sure if the water is safe, talk to your doctor or nurse. If your tap water is not safe, you can use bottled water. Or if the problem is bacteria (germs), you can boil water from the sink for 2 to 3 minutes. This kills any germs. But it will not remove other harmful substances, such as lead. Then, allow the water to cool to body temperature before using.

•Put the nipple on the bottle, and shake well to mix the formula and the water.

●To prepare a bottle of ready-to-feed formula:

•Check the expiration date on the formula. Do not give expired formula.

•Pour the formula in the bottle and put the nipple on. Do not add water or any other liquid.

●You can feed milk or formula at room temperature or slightly warmed. If the milk was in the refrigerator, warm it before feeding it to the baby. To do this, hold the bottle under running warm water or set the bottle in a pan of warm water for a few minutes. Do not microwave it. Then, check that it is not hot before feeding the baby. First, swirl the milk or formula in the bottle to make sure that the temperature is even. Then, put a few drops on the inside of your wrist or back of your hand to check the temperature. It should feel slightly warm, not hot.

If you are using formula, follow the container's instructions for how to store it safely. You might be able to prepare bottles of formula ahead of time and store them in the refrigerator. Do not store prepared formula for more than 24 hours.

How do I give a bottle? — To give a bottle to the baby:

●Hold the baby close to your body in a cradle hold. This is when their head is resting on the inside of your elbow, and they are facing up toward you. Their head should be slightly higher than the rest of their body. Support their head and neck (figure 1).

●Stroke the baby's lips or cheek near their mouth with the nipple. This will help them open their mouth. Place the nipple in their mouth.

●Hold the bottle horizontally or at a slight angle, not straight up and down.

●Hold the bottle the entire time you are feeding. Do not prop it up.

●You might need to take breaks to burp the baby during the feeding. This is because babies swallow air as they drink.

●Watch for signs that the baby is full. If they are full, stop the feeding, even if they have not finished the bottle. Signs that a baby is full include:

•Turning their head away

•Sucking more slowly

•Closing their eyes

•Relaxing their hands or arms

●Throw away any milk or formula that the baby does not finish within 1 hour from starting the feeding, or if it has been sitting out for 2 hours.

How do I clean the bottle? — Clean bottles and nipples after every feeding:

●Wash the bottle and nipple in hot, soapy water. You can use a bottle brush to help. Rinse with clean water.

●Some bottles can go in the dishwasher, but not all can.

●Check the bottle and nipple each time you clean them. Do not use bottles that are chipped or cracked.

Does my baby need any other food or drink? — For the first 6 months, most babies need only breast milk or formula.

Babies who drink breast milk need to take extra vitamin D to help them grow strong bones. Babies who drink formula might also need extra vitamin D, depending on how much formula they get each day. Vitamin D comes as a liquid that you give your baby using a dropper. Your baby's doctor can talk to you about how to do this and how much to give.

When a baby is between 4 and 6 months old, they can start eating and drinking other things, too. Ask your doctor or nurse which foods to feed your baby and when. You can continue to give breast milk or formula after your baby starts eating solid foods.

Should I see a doctor or nurse? — Call for advice if:

●You have questions about bottle feeding.

●You are worried that your baby is not getting enough to drink.

●You are breastfeeding and have any problems or discomfort.

●You are pumping breast milk and have any problems.

●You are feeding formula and have trouble finding it in stores.

●Your baby:

•Has signs of dehydration – These include having only a small amount of urine for more than 6 to 8 hours, no tears when crying, dry mouth, cracked lips, dry skin, sunken eyes, lack of energy, or seeming very sleepy.

•Spits up after almost every feeding, or spits up with a lot of force

•Has a rash

•Has very loose or bloody bowel movements, or has trouble passing bowel movements

•Cries a lot, and draws up their legs like they are in pain

More on this topic

Patient education: Deciding to breastfeed (The Basics)
Patient education: Pumping and storing breast milk (The Basics)

Patient education: Deciding to breastfeed (Beyond the Basics)
Patient education: Pumping breast milk (Beyond the Basics)