How to Bottle-Feed

Newborns need nutrition and plenty of loving. These are both things you can supply while bottle-feeding. Both breastmilk and formula can be given to your baby in a bottle.

Be sure to place the nipple on the tongue and well into your baby's mouth.

Safety tip

You don't need to heat breastmilk or formula before offering it to your baby. Never use a microwave if you want to heat breastmilk or formula. A microwave heats unevenly. Hot milk might burn your baby's mouth. Instead, warm the bottle by putting it in a bowl of warm (not hot) water. Using hot water to heat formula or breastmilk can burn your baby's mouth or throat. Too much heat can also destroy parts of breastmilk that help your baby. Test the temperature of the milk by dripping a few drops on your wrist. Make sure it's not hot before giving it to your baby. 

Bottle care

No matter if you use breastmilk or formula, the bottles, nipples, and tools you use to get the formula ready must be clean. Below are suggestions for bottle care. But talk with your healthcare provider about how to care for bottles:

• Wash your hands with clean, running water before you mix formula, fill a bottle, or offer a bottle. Do this every time. Use an alcohol-based hand cleaner if soap and water aren't available.

• Clean glass bottles and nipples in the dishwasher. Use the hot water setting with a hot drying cycle. Or wash the bottles and nipples with hot, soapy water. Be sure to rinse both completely. If you don't have a dishwasher, sanitize them by boiling them for 5 minutes. Cool them before using.

• Make sure all bottle parts are completely dry before putting them together to store. This will prevent mold.

• You will still need to make sure the bottles and nipples are clean if you use plastic bottles with disposable liners.

• Store clean, unused bottles with the cap on. This will keep the nipples clean.

Facts on formula

Most infant formulas are made from cow's milk. All formula used should include iron. Make sure to look for one with iron. Discuss your choice of formula with your baby's healthcare provider. This is to make sure it's the best fit for your baby.

Ready-to-feed formula

Ready-to-feed formula is the easiest to use, but it also costs the most. Brand names cost more than store-brand formulas because these companies spend more money on advertising. 

• Pour the desired amount of ready-to-feed formula into the baby's clean bottle. Ask your healthcare provider how much formula to offer your baby at each feeding.

• Use opened, prepared formula quickly or store it safely. It can spoil if left out at room temperature. It must be used right away. Or, if unused, store it in the refrigerator.

  • If you don't refrigerate the prepared formula right away, use it within 2 hours of preparation and within 1 hour from when feeding begins. If your baby doesn't finish the bottle within 1 hour, throw away the unfinished formula. 

  • If you don't start to use the prepared formula within 2 hours, put the bottle in the fridge right away. It can only be stored for 24 hours. After that, it must be thrown out.

• You can fill bottles with the formula up to 24 hours ahead of time. You must keep them refrigerated until you use them. 

Concentrated liquid formulas

Concentrated liquid formulas need to be mixed with water before using. Follow the directions on the can closely. Using too much or too little water may harm your baby. Follow these tips:

• Use fluoridated tap water that has been boiled and then cooled. Or use distilled bottled water.

• Pour the whole can of concentrated liquid formula into a clean pitcher.

• Fill the can with water to the top and add it to the pitcher. Mix well.

• Pour the desired amount of formula into your baby's clean bottle.

• Store the pitcher of mixed formula in the refrigerator. Keep it for only 24 hours. If not refrigerated, the formula is only safe at room temperature for 1 hour. After that, it must be thrown out. 

• Ask your healthcare provider how much formula to offer your baby at each feeding.

Concentrated powder formulas

Powdered formulas must be mixed with water before using. Liquid formulas have no germs (sterile). But powdered formula can get germs (bacteria) in it when you make it or when you store it. Follow these tips to protect your baby from getting sick from these germs:

• Concentrated powder formulas need to be mixed with clean water from a safe source. This can be distilled bottled water or fluoridated boiled tap water. If you're not sure if your tap water is safe to use for preparing infant formula, call your local health or water department.

• Wash and dry the top of the formula can before you open it. Make sure the can opener, spoons, scoops, and other tools you use to make the formula are clean.

• Don’t mix the formula with water until right before you are going to feed your baby.

• Add the right amount of water to the bottle. Then add the right amount of powdered formula. It’s important to add the water to the first. Adding the formula first may make it too strong and cause constipation.

• Mix the water and formula well.

• If you don’t plan to use the prepared formula right away, put it in the refrigerator and use it within 24 hours.

• It's important to keep the dry powder in the formula can clean to prevent bacteria from growing.

• Ask your healthcare provider how much formula to offer your baby at each feeding.

Holding baby and bottle

To hold your baby and feed them with a bottle, follow these tips:

• Cradle your baby in your arm, holding your baby’s head slightly higher than their bottom.

• Using the correct position can lower the chance that your baby will choke.

• Stroke your baby’s lower lip. When your baby’s mouth opens, place the nipple on the tongue and feel them pull the nipple into the mouth.

• Tip the bottle slightly so that the nipple fills with milk. Your baby should then suckle to remove the milk from the nipple. If your baby is choking or having trouble "keeping up" with the flow, tilt the milk out of the nipple. This will give your baby a chance to breathe and "catch up" to pace the bottle-feeding. It's important that the feeding happens at the baby's pace, and not too fast.

• For safety's sake, never prop the bottle. Your baby can choke if you leave them alone with a propped bottle. Propping bottles can also raise your baby's risk for ear infections and tooth decay.

• Feeding your infant can be a time of bonding and building trust. Hold your baby close to your body, make eye contact, and talk to your baby. These are important ways to help them develop.

• Don't let your baby fall asleep while sucking on a bottle. This can lead to tooth decay when they are older.

If your baby seems hungry but isn't eating well, you can try a different shaped nipple. You might also check the nipple opening. Some babies prefer a faster flow of milk. They can get frustrated when the flow is too slow. If your baby is gagging and choking, you might need a nipple with a smaller hole. The smaller hole slows the flow. 

Experiment with bottle nipples. Let your baby choose which bottle nipple is best for them.

Burping your baby

It's easy for babies to swallow air while bottle-feeding. Burping helps your baby get rid of that air. Tips on burping your baby include:

• Burp your baby when they act restless, tries to turn away from the nipple, or slows their sucking. This is usually after eating every 1/2 to 1 ounce of formula and when they are finished feeding. 

• Your baby can be burped sitting up while you hold the baby’s jaw, lying face down across your lap, or upright with their belly against your shoulder.

Don't overfeed

Follow these tips for not overfeeding your baby:

• Don't overfeed or force your baby to finish the bottle if they show signs of being full. This can lead to your baby eating more than needed and can cause fussiness. Burp your baby several times during and after feeding. This will allow passage of gas. But also to space out the feeding and allow time to digest.

• Keep your baby in an upright position during feeding and for 20 to 30 minutes after each feeding.

• Wait at least 2 to 3 hours between feedings so your baby's stomach can empty. Or give smaller amounts more often.

Feeding cues

• Don't wait for your baby to cry before feeding. Crying is too late of a sign that your baby is ready to eat.

• Your baby is ready to feed when your baby flutters their eyes and moves their hands to the mouth as they wake up.

• Respect cues that your baby is finished. These include letting go of the bottle, turning the head away, looking sleepy, or stopping feeding.

Offer a pacifier if your baby acts like they want to suckle after finishing the amount of formula your healthcare provider advised. Babies enjoy sucking. But bottle-fed babies may feed so fast that they don’t get enough suckling time.

Formula shortage

There is currently a shortage of infant formula in the U.S. Here are resources and advice about infant formula:

American Academy of Pediatrics at www.healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/Are-there-shortages-of-infant-formula-due-to-COVID-19.aspx

U.S. Department of Health and Human Services at www.hhs.gov/formula/index.html

Talk with your baby's healthcare provider if you have any questions or concerns.