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Key takeaways

• Always sterilise feeding equipment until your baby is 12 months old.
• Feed your baby responsively, following their hunger and fullness cues.
• Paced bottle feeding helps your baby control milk flow and avoid overfeeding.
• Mixed feeding offers flexibility and can help share feeding responsibilities.

Choosing your bottle feeding equipment

When bottle feeding, it is very important to clean and sterilise all equipment. This helps prevent your baby from getting infections and stomach upsets.

You will need several items for bottle feeding.

• Bottles – with teats and bottle caps.
• Brushes – to clean the bottles and teats.
• Sterilising equipment – such as a cold-water steriliser, microwave, or steam steriliser.
• Formula milk – powder or ready-to-feed liquid formula.

Simple bottles that are easy to wash and sterilise are often best. There is no evidence that one type of teat or bottle is better than another.

Types of bottles and teats

The types of bottles and teats you choose depend on your baby. Many parents use smaller bottles for newborns and move to larger ones as your baby grows.

Teats come in two main shapes: rounded and natural. Natural teats mimic a nipple. You can try both to see which one your baby prefers.

Teats also have different flow rates: fast, medium, and slow. A slower flow is generally recommended for newborn babies. This can prevent too much milk from entering their mouth too quickly.

As your baby gets used to bottle feeding, you can move to a faster-flowing teat. Always let your baby lead this choice.

Types of formula

If you decide to use infant formula, first infant formula (first milk) should always be the first type you give your baby. You can use it throughout their first year.

Other types of formula are available:

• Goats milk formula – suitable from birth. It has the same nutritional standards and allergy risk as cows milk formula, so it is not suitable for babies with a cow's milk allergy.
• Hungrier baby formula (hungry milk) is suitable from birth, but seek advice first. It contains more casein protein, which is digested slowly, though there is no evidence it aids settling or longer sleep.
• Comfort formula is suitable from birth, but seek advice first. It contains partially broken down cows milk proteins; however, no evidence supports its use for colic or constipation, and it is not suitable for babies with a cows milk allergy.
• Anti-reflux (staydown) formula – suitable from birth, but only under medical supervision. It is thickened to help prevent reflux, and preparation instructions may differ from standard formula.
• Lactose-free formula is suitable from birth, but only under medical supervision, for babies with rare lactose intolerance. Symptoms can include diarrhoea, tummy pain, and wind; it may also cause bloating.
• Hypoallergenic formula – suitable from birth, but only under medical supervision. For cows milk allergy, a GP will prescribe a special fully hydrolysed formula; comfort formula is unsuitable.
• Soya formula – suitable from 6 months, but only under medical supervision. Use it only if a doctor recommends it, due to concerns about natural hormones and potential dental harm.
• Follow-on formula is suitable from 6 months, but seek health visitor advice first, and never feed it to babies under 6 months. No benefits are shown for switching at 6 months; first infant formula is fine until 1 year.
• Growing-up milk (toddler milk) is suitable from 1 year, but seek health visitor advice, as children aged 1-5 do not need formula. Pasteurised whole or semi-skimmed cows milk is suitable as a main drink from age 1.

Safe and responsive bottle feeding

It is vital to protect your baby from infections by always cleaning and sterilising your feeding equipment. Sterilise bottles and teats until your baby is at least 12 months old. This protects against infections like diarrhoea and vomiting.

Preparing formula feeds

Always wash your hands thoroughly before handling sterilised bottles and teats. If you are expressing breast milk, wash your hands before handling your breast pump and bottles.

When making formula feeds, carefully follow the manufacturer's instructions. Use the correct amount of formula and water. The water must be hot enough (at least 70°C) to kill any germs in the powder. Screw the top tightly onto the bottle before feeding. This ensures the teat is properly attached.

Sterilising equipment

Before sterilising, always wash your hands well with soap and water. Clean your work surfaces with hot, soapy water. Check that the bottle and teat are not damaged.

Clean the bottle and teat in hot, soapy water using a clean bottle brush. You can also use a dishwasher to clean equipment, but it will not sterilise it. Rinse all equipment in clean, cold running water before sterilising.

Methods for sterilising

There are several ways to sterilise your baby's feeding equipment:

• Steam sterilising – uses an electric steriliser or microwave. Follow the manufacturer's instructions, ensuring bottle and teat openings face down.
• Cold water sterilising solution – Follow the instructions for cold water sterilising solution, leaving equipment in for at least 30 minutes and changing the solution daily. Ensure all items are fully submerged with no trapped air.
• Sterilising by boiling – Sterilise by boiling equipment in water for at least 10 minutes, ensuring all items remain submerged. This method can damage teats faster, and hot pans must never be left unattended.

Responsive feeding

Responsive feeding means feeding your baby when they show signs of hunger. You do not need a strict feeding schedule. Babies usually feed little and often. Never force your baby to finish a bottle.

Signs of hunger include:

• Putting hands or fingers into their mouth.
• Making sucking motions (rooting).
• Moving their eyes around.
• Wriggling and getting restless.
• Opening and closing their mouth.

Crying is a late sign of hunger. Try to feed your baby before they cry. If your baby is upset, try soothing them before feeding.

Paced bottle feeding

Paced feeding gives your baby more control over feeds. Babies usually take small amounts of milk, rest, and then take more. This mimics how they would breastfeed.

To pace a feed:

1. Touch the teat on your baby's top lip to invite them to take it.
2. Keep the bottle almost horizontal, just slightly tipped. This prevents milk from flowing too fast.
3. Watch your baby for signs they need a break or are finished. This helps them feel full and avoids overfeeding.
4. If your baby gets upset, try tilting the bottle down while the teat is still in their mouth. This slows the milk flow but still feels comforting.

Never force your baby to finish a feed. This can be distressing and lead to overfeeding.

Hold your baby close in a semi-upright position. Look into their eyes and talk to them during the feed. If the teat flattens, gently pull on the corner of your baby's mouth to release the vacuum.

Winding your baby

Your baby may take short breaks during a feed and may need to burp. Air bubbles can become trapped in their tummy and cause discomfort.

When your baby has had enough milk, hold them upright. Gently rub or pat their back to bring up any wind. You do not need to spend long winding your baby; a couple of minutes should be enough.

Some burping positions include:

• Over your shoulder – support your baby's head and shoulder with one hand. Gently rub and pat their back.
• Sitting on your lap – sit your baby on your lap facing away from you. Support their chin and jaw with your palm, lean them slightly forward, and gently rub or pat their back.
• Lying across your lap – lie your baby face down across your lap. Support their chin and gently rub or pat their back.

Never use a prop for the bottle. Leaving your baby alone with a bottle is a choking risk.

Navigating mixed or combination feeding

Mixed feeding (also called combination feeding) means giving your baby both breast milk and formula.

Reasons for mixed feeding

There are many practical, physical, or emotional reasons to choose mixed feeding. You may:

• Find it difficult to breastfeed exclusively.
• Need someone else to feed your baby when you are away.
• Want to share feeds with your partner.
• Prefer to give your baby expressed breast milk from a bottle.
• Want to start breastfeeding after bottle feeding.
• Be returning to work or study.
• Be struggling with breastfeeding and need to give your baby some formula.
• Be unable to produce enough milk.

Tips for introducing a bottle

It is generally a good idea to wait until breastfeeding is well established. This usually takes about 6 to 8 weeks after birth. Exclusively breastfeeding helps stimulate your milk production.

When introducing a bottle:

• Offer the first bottle feed when your baby is calm, not tired or hungry.
• It may help if someone else gives the first bottle feed. This is because your baby will not be near you and smelling your breast milk.
• Use a slow-flow teat to mimic the flow when breastfeeding.
• Express your milk regularly between bottle feeds to help maintain your milk supply.
• To maintain familiarity, some parents copy their breastfeeding positions when bottle feeding.
• Alternatively, you might want to try using a different position for bottle and breastfeeding. This can help your baby distinguish between the two feeding methods.
• If you are going back to work, start a few weeks beforehand to give you both time to adjust.

Gradually introducing formula

If you choose to introduce infant formula, do it gradually. This gives your body time to reduce milk production.

This also helps lower your chance of getting uncomfortable or swollen breasts and reduces the risk of a painful breast infection (mastitis). If your baby is 6 months or older, they may be able to drink from a cup. In this case, you might not need to introduce a bottle.

Troubleshooting common issues

Bottle refusal

Your baby may take a while to get used to the feel of a bottle teat. It is best to try bottle feeding when your baby is calm and happy. Babies are less likely to try something new if they are tired or hungry.

If your baby becomes upset, stop for a few days. You can let the bottle be a toy during this time. You can also try:

• Keeping the bottle horizontal so your baby controls the milk flow.
• Wrapping the bottle in a piece of your clothing.
• Having your partner or another person offer the bottle when you are not in the room.
• Try cup feeding with either an open cup or a spouted cup that has no valve.
• Offering milk on a spoon, letting your baby take it without pouring it into their mouth.

It is unlikely that you are missing the perfect teat or bottle. Many parents try many teats without finding one that works.

Gas and wind

If your baby swallows air while bottle feeding, they may feel uncomfortable and cry. Burp your baby during or after feeds. If your baby seems uncomfortable while feeding, take a break to wind them.

To help prevent air intake, keep the bottle horizontal. This allows milk to flow steadily. Some parents use a fast-flow teat, which may help your baby swallow less air.

Spit-up and reflux

It is normal for babies to bring up a little milk during or just after a feed. This is called posseting, regurgitation, or reflux. Keep a muslin square handy.

To help reduce reflux:

• Hold your baby upright during feeding and for as long as possible afterwards.
• Burp your baby regularly during feeds.
• Make sure your baby sleeps flat on their back. They should not sleep on their side or front.
• Do not raise the head of your baby's cot or Moses basket.

Check that the hole in your baby's teat is not too big. Drinking milk too quickly can make your baby sick. Do not force them to take more milk than they want.

When to seek advice

Contact a healthcare professional if you have concerns about your baby's feeding. This includes professionals like your midwife, health visitor, or GP.

Seek medical advice if:

• Your baby is under 8 weeks old and has not had a poo for 2-3 days. This is especially concerning if they are also gaining weight slowly.
• Your baby is vomiting with a lot of force, seems to be in pain, or you are worried for any other reason.
• Your baby has difficulty feeding or refuses to feed.
• Your baby keeps vomiting during or after feeding.
• You think your baby might be allergic to, or intolerant of, formula.
• Constant crying could be due to food allergies, such as cows milk allergy. Talk to your GP before making any changes to your baby's diet.

For confidential breastfeeding information and support, you can call the National Breastfeeding Helpline on 0300 100 0212.