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Bottle-Feeding: Care Instructions

Your Care Instructions

Your reasons for wanting to bottle-feed your baby with formula are personal. You and your partner can make the best decision for you and your baby. 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. Formulas can provide all the calories and nutrients your baby needs in the first 6 months of life.

There are many types of iron-fortified infant formulas for you to choose from. Most of the time, parents start with formulas made from cow's milk. Talk to your healthcare provider before trying other types of formulas, 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 healthyparentshealthychildren.ca 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. Do not worry about the exact timing for the first few weeks, but feed your baby whenever they're 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. Look into your baby's eyes and talk or sing while you are giving the bottle. Enjoy this special time you have with your baby.

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 call 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?

  • If you decide to bottle-feed, prepare your supplies for bottle-feeding before your baby is born, if possible.
    • Have a supply of small bottles (usually 4 ounces or 120 mL) 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 using bottles and nipples the first time, wash them in hot water and dish soap and rinse 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.
  • Ask your healthcare provider which formula to use. You can buy formula as a liquid concentrate or 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 healthcare provider says not to.
  • Make sure you have clean, safe water to mix with the formula. For babies under 4 months old, boil the water—even bottled water—for 2 minutes. Let the water cool before mixing it with formula.
  • Wash your hands before preparing 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 will not get the right nutrition. Do not add water to ready-to-feed formula.
  • Cover the prepared formula and store it in a refrigerator. Use it within 24 hours.
  • Soak dirty baby bottles and nipples in water and dish soap. Wash bottles and nipples in the upper rack of the dishwasher or hand-wash them in hot water with dish soap. For infants, sterilize the washed bottles and nipples by boiling in an open pot of clean water for 2 minutes or use the sanitation cycle on an NSF-184 approved dishwasher. Let the bottles and nipples air dry.

To bottle-feed your baby

  • Warm the 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. 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 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 him or her hold it alone. This increases 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 breastmilk or formula left in the bottle after 2 hours. Bacteria can grow in the leftover breastmilk or formula.
  • It can be helpful to hold your baby upright for about 30 minutes after eating to reduce spitting up.

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 call 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?

Go to https://www.healthwise.net/patientEd

Enter P111 in the search box to learn more about "Bottle-Feeding: Care Instructions".

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