formula feeding

How to feed your

baby safely

1
 This resource includes information, used with kind permission, from
Department of Health, the Food Standards Agency and UNICEF.
The content of this resource has been approved by UNICEF UK Baby
Friendly Initiative.

2
Contents
Introduction 3
What you need for formula feeding 4
Cleaning bottles 5
Sterilising bottles 6
Making up a formula feed 10
Signs that your baby is getting hungry 20
Feeding your baby 21
Your baby’s growth 24
Storing a feed 26
Feeding your baby while away from home 28
Types of infant formula 32
Further information 34
Quick reference step-by-step guide 36

1
 This booklet will give you the up-to-date national guidance
on how to make up a formula feed safely, including the
most recent changes to the information on preparing and
storing feeds.

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and formula feeding, then
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family and
friends

2
Introduction
Infant formula is processed, powdered cow’s milk, which
has been treated to make it suitable for babies. There are
regulations in the UK to make sure that all infant formulas
readily available in this country have the basic ingredients
your baby needs.

Key messages for keeping safe

Make sure that you wash and dry your hands thoroughly
before making up a feed. It is important to clean and disinfect
all surfaces before using sterilised equipment.
Formula powder is not sterile and when made up it provides
an ideal medium for bacteria to grow. Using boiled water
of at least 70°C to make up the feed will reduce the risk of
your baby becoming unwell with infections like sickness or
diarrhoea. Any harmful bacteria present will be killed at this
temperature.
Feeds should be made up one at a time. This is because the
risk of bacteria growing in formula increases with storage
time, even in a fridge.
To reduce the risk of injury, make sure your baby is not near
the hot water when you are making up a feed. Take care not
to scald yourself.
Adding too much or too little formula powder to the
measured amount of water can cause your baby to become
ill. If you add too much powder your baby can become
dehydrated, if you add too little powder your baby will not get
enough nutrients.

3
 What you need for
formula feeding
It is important to make sure you clean and sterilise the equipment
to prevent your baby getting infections and stomach upsets.
You’ll need:

bottles with teats

and bottle covers

formula powder

bottle brush, teat brush

sterilising equipment such

as a cold water steriliser or
steam steriliser (microwave
or electric)

4
Cleaning bottles
1 2

Clean the bottle and teat Rinse all your equipment

in hot soapy water as in clean-running cold
soon as possible after a water before sterilising.
feed, using clean teat and
bottle brushes. Make sure
you clean inside the screw
cap and around the rim of
the bottle.

! safety first
Dishwashers will clean bottle-feeding equipment
but will not sterilise it.

Why? The temperatures reached in a dishwasher are not

high enough for sterilisation – so you need to both clean
and sterilise bottles.

5
 Sterilising bottles
There are two different ways to sterilise: cold water sterilising
and steam sterilising.

Store all sterilising equipment safely out of the

reach of children.

Cold water sterilising

1 Make up a new sterilising

solution every 24 hours.
Place the equipment that
you have already washed
and rinsed into the
sterilising solution.

2 Make sure there is no air

trapped in the bottles or
teats when putting them
in the sterilising solution.

6
 ! safety first
Change the sterilising solution every 24 hours.

Why? The solution is only sterile for 24 hours. Bottles that you
have not used within 24 hours will no longer be sterile. They will
need to be re-sterilised in new solution before you use them
for a feed. Keep your steriliser clean by washing in hot, soapy
water and rinsing before adding new solution every day.

3 Keep all of the equipment

under the solution with a
floating cover.
Leave the feeding equipment
in the sterilising solution for
at least 30 minutes.

You can sterilise more than one bottle at a time as long as

they are kept in the steriliser.
Bottles can remain in the sterilising solution for up to 24 hours
until they are required.

Always wash and dry your hands before

taking the equipment out of the steriliser.

7
 Steam sterilising (electric or microwave)
Make sure the feeding equipment has been thoroughly
washed in hot soapy water and rinsed before sterilising.
Follow the manufacturer’s instructions.
The manufacturer’s instructions will tell you how long
equipment can be left after sterilising before it will need to
be re-sterilised. It is important to stick to any recommended
‘cooling period’ before removing the bottles.

Make sure the openings of

the bottles and teats are
facing down in the steriliser.

Always wash and dry your hands before

taking the equipment out of the steriliser.

8
 ! safety first
All equipment must be cleaned thoroughly with
hot soapy water and then rinsed before sterilising.

Why? Sterilising will not work unless all equipment

is thoroughly cleaned and rinsed first.

Store all sterilising equipment safely out of the

reach of children.

9
 Making up a formula feed
Before making up a formula feed, it is really important that
you wash your hands with soap and hot water and then
dry them. Make sure that the surface you are going to use
is cleaned and disinfected with an antibacterial cleaning
product using a clean cloth or detergent wipes.

1 Always wash and dry your

hands before making up
a feed.

2 If you are using a cold water

steriliser, shake off any excess
solution from the bottle and
the teat, or rinse the bottle
with cooled boiled water from
the kettle (not the tap).
Drip-dry or dry only the
outside with a clean cloth.

Always make sure your hands and all surfaces are

clean before using sterilised equipment.

10
3 Use fresh tap water to fill
the kettle with 1 litre of water
to make the feed (do not
use water that has been
boiled before).

! safety first
It’s important to make up a formula feed safely:
cleaning and sterilising bottles and preparing
each feed carefully.

Why? Formula powder is not sterile and can sometimes contain

harmful bacteria. Although this is rare, these bacteria can
cause infections and make your baby seriously ill. Make sure
that water is at least 70°C to kill any bacteria in the formula
powder when you make up a feed (see page 13). Once you have
made up the formula with boiled water, it will be safe to cool the
formula before giving it to your baby.
Harmful bacteria can also enter the formula from surfaces,
equipment or your hands. To reduce the risk of infection when
preparing a feed, always make sure your hands and surfaces
are clean.
11
 It is better to use tap water, but if you need to use bottled
water remember that any bottled water that is labelled
‘natural mineral water’ might contain too much sodium or
sulphate for babies. Check the label to make sure:
• the figure for sodium (also written as ‘Na’) is no higher
than 200 milligrams (or ‘mg’) a litre
• the figure for sulphate (also written as ‘SO’ or ‘SO4’) is
no higher than 250 milligrams (or mg) a litre.
Make sure that you use still water (not sparkling) and that
the seal is not broken. Once opened, store the bottled water
in a fridge and use within the recommended time, for
example, ‘use within 3 days of opening’.
Bottled water also needs to be boiled before
you prepare the feed (see pages 30–31 for
more information).

✓
12
✗
 After the water for the feed is boiled, it should be at a
temperature of at least 70°C when the formula powder is
added. Do not let the water cool for too long after boiling it. A
kettle with 1 litre of boiled water should cool for no more than
30 minutes. A kettle with 500 ml of boiled water 90 should cool
for no more than 15 minutes.
80

70

12 60
11 1
50
10
cool 1 litre 2 90
40
9 of water for 3 80
no more than 30

8 30 mins 4 70
20
12 60
11 17 5 10
6
50
10 2 0
40 water should
9 3
30
be at least
70°C
8 4 20

7 5 10
6
0

Check the manufacturer’s instructions to find out how

much water and powdered infant formula you will need.
Different types of formula come with different scoops.
Make sure that you use only the scoop that comes with
the powdered infant formula that you are using.

Always take care as, at this temperature, the water is

still hot enough to scald adults and children.

13
 4 Stand the bottle on a clean
surface. Keep the teat and
cap on the upturned lid of
the steriliser to avoid putting
them on the work surface.

5 Before adding the formula

powder, pour the boiled
water into the bottle up to
the required mark.

! safety first
Always pour the water into the bottle before
adding the formula powder.

Why? Pouring the water in first allows you to measure the

water accurately. If the formula powder was added first,
it could mean that too little water was added to make up the
feed, and this could be dangerous.

14
6 Always check the water level
is correct.

7 Loosely fill the scoop

provided with formula
powder and level it off with
the flat edge of a clean, dry
knife or the leveller provided.
Only use one scoop of
powder to 30 ml or 1 oz of
water.

! safety first
It is important to use only the scoop provided with
the formula you are using, as different products
have different scoop sizes.

Why? Making up a feed with too much powder can give

your baby constipation and can cause your baby to become
dehydrated. Too little powder will not provide your baby with
enough nutrition. By using the scoop provided, you can be sure
you are adding the correct amount of formula powder.
15
 8 Add the formula powder
to the measured water.

9 Holding the edge of the teat

with your fingers or using
the tongs provided with the
steriliser, put it on the bottle.
(The tongs should be clean
and sterilised too.) Screw the
retaining ring on to the bottle.

Never add anything to infant formula. This includes

sugars and cereals such as baby rice or rusks.
Research shows that babies need nothing but
breast milk or formula for the first six months
of life.

16
10 Cover the teat with a cap.

11 Shake the bottle until

the formula powder has
dissolved.

! safety first
Never use a microwave to heat up infant formula.

Why? There is a danger of overheating the formula feed. It can

also heat the feed unevenly and could scald your baby’s mouth.

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 12 Cool down the feed using
one of the following methods:
• holding the bottom half
of the bottle under cold
running water
• putting it in a bowl of
cold water
• leaving it at room
temperature until it is cool
enough to feed your baby.
Make sure the cap is
covering the teat, whichever
method you choose.

! safety first
Make sure the made-up formula is cooled down
properly before giving it to your baby.

Why? If the formula is not cooled down properly, there is a

danger that the feed would be too hot and may scald your
baby’s mouth.

18
13 To prevent scalding, test the
temperature of the feed by
dropping a little on to the
inside of your wrist. Before
giving it to your baby it
should be body temperature,
which means it should feel
warm or cool, but not hot.

Any infant formula not used during the feed must be

thrown away after two hours. This is because bacteria
multiply very fast at room temperature. This increases
the risk of infection for the baby.
Any unused boiled water should also be thrown away.
Remember to ask your midwife or health visitor if you
are not sure about making up a feed.

19
 Signs that your baby is
getting hungry
• They begin to move their head and mouth around.
• They find something to suck, usually their fingers.
It’s important to feed your baby when they are hungry rather
than trying to develop a regular routine. Keeping your baby
close will help you to learn and interpret your baby’s needs.
This will help you to pick up on the signs that they are hungry.
If you can spot these before they cry for food, your baby will be
more calm and will be easier to feed.

Hand to
mouth

Turning
head

Mouth Stretching
opening
20
Feeding your baby
Feeding your baby is a special time. It’s a time to be close,
to get to know your baby and to build a close and loving
relationship. Before you start, make sure that you are
sitting comfortably. It is
important to look for the
signs that your baby is
ready to feed – the photos
on page 20 will give you
an idea of what to look
for. Responding to your
baby’s needs will make
feeding more enjoyable
for you both.
Hold your baby close but
in a fairly upright position,
with their head supported
comfortably. Brush the teat
against your baby’s lips and,
when they open their mouth wide,
allow them to draw in the teat. Hold the
bottle horizontal to the ground, tilting it just
enough to make sure the baby is taking in feed,
not air, through the teat.

If your baby takes in air instead of feed, this can give

them a sore tummy or colic. Babies feed in bursts of
sucking with short pauses to rest. Holding your baby in
the upright position means that the feed will stop flowing
when your baby pauses. This will allow your baby to have
a short rest before starting to suck again.

21
 Always hold your baby while feeding and never leave
them alone with a bottle as they might choke.

You will see bubbles in the bottle as your baby feeds. If you
cannot see any bubbles, move the teat slightly to the side
of your baby’s mouth. You should then see bubbles rushing
back up into the feed.

Let your baby set the pace for feeding – look out for the signs
(cues) that they need a rest, need a burp or have had enough.
Never force your baby to finish a feed if they appear full.

Stopping the feed from time to time also gives your baby a
chance to see how ‘full’ they are and to learn to control how
much they drink. This will help them develop a sense of their
appetite. It will also give you the chance to start to recognise
your baby’s cues that they are full.

Try to keep the number of people who feed your

baby as low as possible – mainly the baby’s parent(s).
Always hold your baby close, look into their eyes
and talk to your baby soothingly when feeding.
This will help your baby to get to know your touch,
smell and voice, which will make them feel loved,
safe and secure.

22
Winding your baby
Formula-fed babies need to be winded during and at the end
of their feed to stop wind being trapped in their tummies.
You can do this by:
• gently sitting your baby up,
supporting them under
the chin and rubbing their
back until they burp
• or by leaning them against
your shoulder and either
rubbing or patting their back.

As well as a burp, your baby might also bring up a little feed.

This is normal – so make sure you have a clean, dry cloth
handy.

If your baby brings up anything that is a different

colour from feed you should speak to your midwife
or health visitor.

23
 Your baby’s growth
How much your baby grows and what is in their nappies will
tell you whether they are getting enough to eat.
You should avoid overfeeding, as giving lots of formula in one
feed might make your baby sick, or make them put on too
much weight. Do not try and make your baby finish the feed if
they do not seem to want it.
If your baby is bringing a lot of feed back up, this may mean
that they want smaller amounts (but more often) than the
guidance information on the tin or packet suggests.

You can talk to your health visitor about how your

baby is growing.

• Your baby should be producing one or more wet nappies

a day for the first two days. This will gradually increase to
five or six wet nappies a day by the end of the first week.
• Babies should produce at least six heavy, wet nappies a
day after the first week.
•  For the first few days, your baby will pass dark sticky
stools (meconium). This will change (and become paler)
during the first week.
•  After the first week, your baby should pass pale yellow
or yellowish-brown stools.

Formula-fed babies will normally need to pass

stools at least once a day to feel comfortable.

24
How much formula should I give my baby?
Remember, breast or formula is the main source of nutrition
for the first year of life. Newborn babies may drink small
amounts to start with, but by the end of the first week
of life most babies will drink around 150–200 ml of formula
per kg of the baby’s weight per day until they start solids at
around six months old. This will vary from baby to baby. As
solid food is introduced, your baby will gradually take less
formula feed.
After their first birthday babies can move on to full-fat cow’s
milk instead of formula feed. Ask your midwife or health
visitor for more information.

You should feed your baby as much or as little

formula as they want, and as often as they want.
This is the same way that breast-fed babies feed
and it will help your baby learn to control their
appetite. It is important not to encourage your
baby to take on a bit more formula so that they
will go longer between feeds. This can lead to
them overeating.

25
 Storing a feed
Storage of formula powder
It is very important to follow the storage instructions on the
package and to use the powdered formula before the use-by
date. Once opened, store the powder with the lid on in a cool,
dry place (not in the fridge).

Storage of a made-up formula feed

Make sure you follow the instructions on the formula
powder packaging. It is recommended that feeds are made
up one at a time. Feed that has not been used and has been
kept at room temperature must be thrown away after two
hours.
If there are occasions when you have no choice and need to
store a feed, it should always be stored in a fridge and for
no more than 24 hours. Even at fridge temperatures (0–5°C)
bacteria can still multiply, although at a slower rate. This
means the longer the prepared feed is stored, the greater the
risk of infection. That is why it is safer to make up the feed
with freshly boiled water each time your baby needs it.

! safety first
Formula powder should not be added to cool
water, even if it has been boiled and then stored
in the fridge.
Why? The water needs to be boiled and at a temperature
of at least 70°C when the formula powder is added. If
the water is cooler than 70°C, the bacteria that might be
present in the formula powder will not be killed.
26
Ready-made formula
Ready-made formula is available in cartons so you do not
have to worry about mixing it when you are out and about,
but this is normally more expensive.
If using ready-made formula, it is very important to prepare
and store it following the manufacturer’s instructions. Do not
open these formula cartons and feed them to your baby if
they are out of date.

! safety first
Once these ready-made formula cartons are opened,
any unused formula needs to be stored in the fridge
in the carton with the cut corner turned down, or in a
sterilised container, for no more than 24 hours.

Why? Ready-made formula is sterilised already. However,

once the carton is opened it is possible for bacteria to get into
the formula and grow, even in a fridge. Any unused formula
stored in the fridge should be thrown away after 24 hours to
minimise the risk of infection.

27
 Feeding your baby while
away from home
If you need to feed your baby when you are out, plan ahead.
It is always best to use freshly made formula feed. You can
do this by:
• boiling some water
• putting it in a clean vacuum flask to take with you.
Make the feed up when your baby
needs it by:
• pouring the correct amount of hot
water from the vacuum flask into
a sterilised bottle
• adding the formula powder.
Remember to cool the formula
feed down by holding the bottom
half of the bottle under cold running
water, with the cap covering the teat.

! safety first
Make sure the flask is full and securely sealed.

Why? This will ensure the water stays above 70°C. The vacuum
flask needs to be clean but does not need to be sterilised
before use. The boiling water will kill any bacteria present in the
vacuum flask.
28
If there are occasions when you are unable to take boiled
water with you to make up a fresh feed and you have no
choice, you can make up one feed just before going out.
However, you will need to cool it as rapidly as possible and
then keep it chilled in a cool bag until you need it.
Remember that in the cool bag bacteria can still survive and
multiply, although at a slower rate than at room temperature.
This means that the longer the prepared formula is stored, the
greater the risk of infection. Always make sure that the bottle
stays cool and that you use the feed as soon as possible.
When you are ready to use it, place the bottle in a container
of warm water to heat it up.

! safety first
Never use a microwave to heat up infant formula.

Why? There is a danger of overheating the formula. It can also

heat the feed unevenly and could scald your baby’s mouth.

29
 If you are abroad, you will need to use bottled water that
has been boiled and is still over 70˚C. Do not use tap water.
Remember that any bottled water that is labelled ‘natural
mineral water’ might contain too much sodium or sulphate for
babies. Check the label to make sure that:
• the figure for sodium (also written as ‘Na’) is no higher
than 200 milligrams (or ‘mg’) a litre
• the figure for sulphate (also written as ‘SO’ or ‘SO4’)
is less than 250 milligrams (or ‘mg’) a litre.

✓
30
✗
You should choose water that has the lowest sodium content
you can find.
Make sure that you use still water (not sparkling) and that the
seal is not broken.
Once opened, store the bottled water in a fridge and use within
the recommended time, for example, ‘use within 3 days’.

! safety first
Check that bottled water contains no more than
200 mg a litre of sodium (Na) and no more than
250 mg a litre of sulphate (SO or SO4).

Why? This is because babies’ kidneys are not properly

developed yet, which means that they cannot get rid of too
much sodium or sulphate from their bodies. If they eat or
drink too much sodium or sulphate they can become ill.

31
 Types of infant formula
Formula can be bought:
• 
as formula powder, which
needs to be mixed with water
• 
ready-made, which is
ready to use.

First formula milks

Babies should only drink first milks (whey-based formula)
until they are 1 year old. Read the label carefully.
Unless your doctor or health visitor gives you different advice,
this is the best type of infant formula for your baby until the
age of 1 year. If you are formula feeding, first milk is the only
food your baby needs for the first six months of life.
There are different brands of infant formula but there is no
real difference between them. No one brand is recommended
over another. Speak to your health visitor if you are not sure.

First milk is the most suitable type of formula

for your baby for the first year of life.

32
Follow-on formulas
Other formulas are also available for babies aged six months
and over, such as ‘follow-on formula’, ‘toddler formula’ and
‘growing-up milk’. There is no need to switch to any of these
formulas – babies can drink first milks until they are 1 year old.

These follow-on formulas are not necessary for

babies. First milks are recommended until babies
are 1 year old.

‘Hungry baby milks’ (casein-based formulas) are also

available and state that they are suitable for use from birth.
Unless your doctor or health visitor gives you different advice,
there is no need to switch to these formulas. First milk
(whey-based formula) is the best type of formula for your
baby until the age of 1 year.

Soya formula
This is made from soya, not cow’s milk. You should not give
soya formula to your baby unless your doctor advises you to.
Other soya-based drinks should be avoided until your baby is
1 year old.

Goat’s milk-based infant formula

Goat’s milk infant formula is now permitted for sale in the UK.
However, goat’s milk formula is not suitable for babies with a
cow’s milk protein allergy and should therefore not be given
to them, unless directed by a health professional.

Ordinary cow’s milk

Full-fat cow’s milk can be given as a drink once your baby is
over 1 year old. Pasteurised full-fat cow’s milk can be used
in cooking from six months onwards, for example, to make
custard or in mashed potatoes.
33
 Further information
At around six months your baby is ready to eat solid food
(weaning). Babies should never be weaned before four months.
Further information on weaning can be found in Fun First Foods:
www.healthscotland.com/documents/303.aspx
You can also get a copy of the booklet and discuss weaning
with your health visitor.

Protecting your baby’s teeth

Once your baby is six months old, try giving them feed in
a free-flow cup (non-spill cups are not recommended).
Free-flow cups are given out by your health visitor as part of the
Childsmile programme. You should aim for your baby to stop
using a feeding bottle by their first birthday. For advice on how
to look after your baby’s teeth, go to www.child-smile.org.uk
For information and advice about feeding your baby, please
ask your midwife, health visitor or GP.

! safety first
If you are giving your baby infant formula, you should
continue with this until they are 1 year old, after
which time full-fat cow’s milk can be introduced.

Why? Cow’s milk is not suitable for babies as their main drink
until the age of 1 – it does not have the right mix of nutrients. It
can be used in cooking from the age of six months.

34
Websites
Ready Steady Baby! www.nhsinform.scot/readysteadybaby
Ready Steady Toddler! www.readysteadytoddler.org.uk
You can ask your midwife for a copy of these books too.

You may be entitled to Best Start Foods. Ask your

midwife or health visitor for more information.
www.mygov.scot/best-start-grant-best-start-foods

Breastfeeding is the healthiest way to feed your baby. It

has a range of health benefits for both baby and mother,
and is the natural and most convenient way to feed
babies. It is always available at the right temperature
and with the right ingredients, wherever you are,
and does not cost any money. Formula feeding has
associated costs for the formula itself and for bottles,
teats and sterilising equipment. Exclusive breastfeeding
is recommended until babies are six months old.
If you decide not to breastfeed or to stop breastfeeding,
it is possible to restart but it will be difficult. Giving infant
formula to a breast-fed baby will reduce your breast milk
supply.
You do not need to eat any special foods while
breastfeeding, but it is a good idea for you, just like
everyone else, to eat a healthy diet. Eating a healthy diet
during pregnancy prepares your body for maintaining
breastfeeding.
It is recommended that all pregnant and breastfeeding
women take a daily supplement of 10 micrograms (mcg)
of vitamin D. Visit the Healthy Start website or ask your
health visitor for more information.

35
 Quick reference
step-by-step guide

1 Clean, rinse and sterilise formula feeding

bottles, teats and covers.
See pages 4 to 9.

2 Clean and disinfect surfaces, wash and dry

your hands.
See pages 10 to 11.

3 Boil 1 litre of fresh tap water and leave to

cool for no more than 30 minutes.
See pages 11 to 13.

4 Read the formula powder instructions

carefully.

5 Pour the boiled water into the sterile bottle

and check the water level is correct.
See pages 14 and 15.

36
6 Add the correct amount of formula
powder using the scoop provided.
See page 15.

7 Put the sterile teat and cover on to the

bottle and shake well.
See pages 16 and 17.

8 Cool the bottle quickly under cold running

water and check temperature.
See pages 18 and 19.

9 Hold your baby close in a fairly upright

position, support their head. Feed your
baby from the slightly tilted bottle at their
own pace and check for bubbles.
See page 21.

10 Throw away any unused boiled water

and formula.

37
This guide will tell you how to safely make up infant
formula milk powder for bottle feeding your baby. It
will explain what different types of formula milk there
are and what equipment you will need. It will also tell
you how to clean and sterilise bottles, how to make
up and store formula milk, and how to feed your baby
while away from home.

This resource may also be made available

on request in the following formats:

0131 314 5300

[email protected]

Published by NHS Health Scotland

1 South Gyle Crescent
Edinburgh EH12 9EB
© NHS Health Scotland 2020
First published 2011
All rights reserved. Material contained in this
publication may not be reproduced in whole or part
without prior permission of NHS Health Scotland
(or other copyright owners). While every effort is
made to ensure that the information given here
is accurate, no legal responsibility is accepted for
any errors, omissions or misleading statements.
NHS Health Scotland is a WHO Collaborating Centre
for Health Promotion and Public Health Development.
3314 1/2020

www.nhsinform.scot/readysteadybaby