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Bottle-Feeding: Care Instructions

Your Care Instructions

A lot of people bottle-feed their babies. Sometimes it's a personal decision. Sometimes there's a medical reason, like HIV infection or certain cancer treatments. Many adoptive parents bottle-feed. You can bottle-feed with your own breastmilk, pasteurized donor human milk, or infant formula. At first, preparing the bottles and formula can seem confusing, but it gets easier and faster with practice. You may decide to bottle-feed your baby formula only or feed them both formula and breastmilk.

Formula can provide all the calories and nutrients your baby needs in the first 6 months of life. Most babies start with a cow's milk–based formula with iron. Talk to your doctor before trying other types of formula, which include soy and lactose-free formulas. Do not give homemade formula because it does not have the right nutrition and can make your baby very sick. To learn more about formula feeding your baby, including choosing and preparing a formula, go to and search for “bottle feeding.”

Your baby is born knowing how much food they need. Your newborn baby probably will want to eat every 2 to 3 hours. Don't worry about the exact timing for the first few weeks, but feed your baby whenever they are hungry. Signs that your baby is hungry include opening their mouth, sucking on their hands, and smacking their lips. In general, your baby should not go longer than 4 hours without eating during the day for the first few months. Sit in a comfortable chair with your arms supported on pillows.

Follow-up care is a key part of your child's treatment and safety. Be sure to make and go to all appointments, and call your healthcare provider or nurse advice line if your child is having problems. It's also a good idea to know your child's test results and keep a list of the medicines your child takes. At each routine visit, talk to your healthcare provider about your baby's nutritional needs, which change as he or she grows and develops.

How can you care for yourself at home?

Getting ready to bottle-feed

  • If you decide to bottle-feed, prepare your supplies for bottle-feeding before your baby is born, if you can.
    • Have a supply of small bottles [usually 120 mL (4 ounces)] for your baby's first few weeks.
    • Choose a low-flow bottle nipple with a single hole. Low-flow nipples help your baby coordinate their sucking, swallowing, and breathing.
    • Before you use bottles and nipples the first time, wash them in hot water and dish soap. Then rinse them with hot water. For babies under 4 months old, you need to boil bottles and nipples or clean them in an NSF-184 approved dishwasher with a sanitation cycle.

Using infant formula

  • If you plan to use formula, ask your doctor which kind to use. You can buy it as a liquid concentrate or as a powder that you mix with water. Formulas also come in a ready-to-feed form that do not need water. Always use formula with added iron unless the doctor says not to.
  • Make sure you have clean, safe water to mix with the formula. If you aren't sure if your water is safe, you can use bottled water. Or you can boil tap water. For babies under 4 months old, boil the water—even bottled water—for 2 minutes. Let the water cool before mixing it with formula.
    • Boil cold tap water for 1 minute, then cool the water to room temperature.
    • Use the cooled boiled water to mix the formula within 30 minutes.
  • Wash your hands before you prepare the formula.
  • Read the label to see how much water to mix with the formula. If you add too little water, it can damage their kidneys. If you add too much water, your baby won't get the right nutrition.
  • Cover the prepared formula, and store it in a refrigerator. Use it within 24 hours.
  • Soak dirty baby bottles in water and dish soap. Wash bottles and nipples in the upper rack of a dishwasher. Or you can hand-wash them in hot water with dish soap.

Using breast milk

  • If you plan to use a bottle to feed breast milk to your baby, you can safely store pumped milk in plastic bottle liners, small freezer bags, or glass bottles.
  • Wash your hands before you touch the containers. If you use bottles, make sure they are clean.
  • Thaw frozen breast milk carefully. Run warm water over the container. You can also thaw breast milk overnight in the refrigerator. Don't refreeze thawed milk.
  • You can keep breast milk at room temperature for 6 to 8 hours if the milk was collected under clean conditions. This means using properly washed hands and properly cleaned pump parts and containers.

How to bottle-feed

  • Warm the breast milk or formula to room temperature or body temperature before feeding. The best way to warm it is in a bowl of heated water for no more than 15 minutes. Do not use a microwave oven. It can cause hot spots in the liquid that can burn your baby's mouth and can destroy the immune factors in breastmilk.
  • Before feeding your baby, check the temperature of the breast milk or formula by dripping 2 or 3 drops on the inside of your wrist. It should be warm, not cold or hot.
  • Place a bib or cloth under your baby's chin to help keep clothes clean. Have a second cloth handy to use when burping your baby.
  • Hold your baby almost upright in your arms with your baby’s cheek to your chest to feed. Keep your baby's head higher than their chest.
  • Stroke the centre of your baby's lower lip and let your baby seek the nipple. When your baby is ready, put the nipple deep enough into their mouth until they have a wide latch. They should not gag.
  • Tip the bottle so the liquid just fills the nipple. This helps reduce how much air your baby swallows. Let your baby control the flow, and follow their feeding cues. Your baby should not gasp, cough, or cry while bottle-feeding. If your baby drinks too fast, tip the bottle down to slow their feed or take the bottle away. You can tell if your baby is swallowing too fast when:
    • They’re not taking a breath between swallows.
    • Their eyes are open wider than usual.
    • Their nostrils are flaring.
    • Their arms and legs are stiffening as they struggle to breathe and feed at the same time.
    • Breastmilk or formula is leaking from the sides of their mouth.
  • Do not prop the bottle in your baby's mouth or let them hold it alone. Avoiding those things can reduce your baby's chances of choking or getting ear infections.
  • Burp your baby partway through and after they’re finished feeding. This helps get rid of swallowed air and reduces spitting up.
  • You will know your baby is full when they stop sucking. Your baby may let go of the nipple, turn their head away, or fall asleep when full. Babies will usually feed for 15 to 30 minutes. It’s okay if they don’t finish the whole bottle.
  • Throw away any breast milk or formula left in the bottle after 2 hours. Bacteria can grow in the leftover breast milk or formula.
  • To reduce spitting up, try holding your baby upright for about 30 minutes after they eat.

When should you call for help?

Watch closely for changes in your child's health, and be sure to contact your healthcare provider or nurse advice line if:

  • Your child does not seem to be growing and gaining weight.
  • Your child has trouble passing stools, or his or her stools are hard and dry.
  • Your child is vomiting.
  • Your child has diarrhea or a skin rash.
  • Your child cries most of the time.
  • Your child has gas, bloating, or cramps after drinking a bottle.

Where can you learn more?

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