Bottle feeding safely: a calm, step-by-step guide

Whether you are bottle feeding from day one, combining breast and bottle, or leaving expressed milk while you go back to work, the bottle deserves the same care as any other part of your baby's day. Formula feeding is not second best love. It is love with a kettle and a bottle brush. Here is the routine that keeps it safe.

Step 1: Choose the right milk

• For most babies, a first infant formula is suitable from birth and can be used for the whole first year.
• Follow-on milks, "hungry baby" milks and "goodnight" milks are not needed. Switching brands often is unnecessary too.
• Specialist formulas (for reflux, allergy or prematurity) should only be used on the advice of your doctor or health visitor.
• Never give cow's milk, evaporated or condensed milk, goat's milk or plant milks in place of formula before 12 months, and never make homemade formula. These do not have the right balance of nutrients and can make a baby seriously unwell.

Step 2: Clean and sterilise

Babies' immune systems are still developing, so bottles, teats and caps should be sterilised until your baby is at least 12 months old.

1. Wash your hands and clean the surface you will use.
2. Wash bottles and teats in hot soapy water straight after feeds, using a bottle brush and turning teats inside out. Rinse well.
3. Sterilise using a steam steriliser, a cold-water sterilising solution, or by boiling in a covered pan. Follow the instructions for whichever method you choose exactly.
4. Leave bottles in the steriliser or assemble them with clean hands until you need them.

Step 3: Make up each feed fresh

1. Boil fresh water. If your tap water is not safe to drink, ask your clinic which water to use, and boil it all the same.
2. Let it cool for no more than 30 minutes, so it is still hot enough to kill any bacteria in the powder.
3. Pour the water into the bottle first, then add the exact number of level scoops the pack tells you, using the scoop that came with that tin.
4. Never add extra powder to "fill them up" or extra water to make the tin last. Feeds that are too strong can make a baby dehydrated or constipated; feeds that are too weak do not nourish them.
5. Put the teat and cap on and shake well.
6. Cool the bottle quickly under a cold running tap or in a bowl of cold water.
7. Test a few drops on the inside of your wrist. It should feel warm or cool, never hot.

Never warm a bottle in the microwave: it can heat unevenly and leave scalding hot spots. Throw away any milk left after a feed, and any made-up formula not used within two hours. Ready-to-feed liquid formula is sterile until opened and is handy for outings.

Step 4: Feed responsively

• Hold your baby close and fairly upright, supporting their head, and look into their eyes. Feeding is connection, not just calories.
• Gently brush the teat against their lips and let them draw it in.
• Hold the bottle only slightly tilted, so milk fills the teat but flows at a pace your baby controls.
• Pause every so often and offer a chance to burp.
• Watch for fullness signs and let your baby stop. It is fine to leave milk in the bottle.
• In the early weeks, try to keep most feeds with you, your partner or one or two close carers, so your baby builds trust.

Never prop a bottle

Do not leave a baby alone with a bottle propped on a pillow or rolled blanket, and do not put them down to sleep with a bottle. Milk can flow too fast and cause choking, and it can also lead to ear infections and tooth decay later.

When money is tight

If formula is stretching your budget, please do not water it down. Speak to your health visitor, doctor or clinic about help available where you live (in the UK, you may be eligible for the Healthy Start scheme), and let trusted friends or your church family know. Asking for help is wisdom, not weakness.

When to get medical advice

• Your baby is regularly sick with force after feeds, or the vomit is green or contains blood: get urgent help.
• Fewer wet nappies, a dry mouth, a sunken soft spot or unusual sleepiness: these can be signs of dehydration, so seek help the same day, or urgently if your baby is floppy.
• Blood in the poo, ongoing diarrhoea, or a rash or swelling after feeds.
• Your baby refuses feeds or is not gaining weight.

If your baby is struggling to breathe, turns blue or is floppy, call your local emergency number straight away.

Meat in due season

The psalmist looks around at all creation and says, "The eyes of all wait upon thee; and thou givest them their meat in due season" (Psalm 145:15). At two in the morning, with a bottle cooling under the tap and a hungry cry rising, you are part of that picture. Your hands are how God is answering your baby's need tonight. And while you wait on the kettle, you can wait on him too, for strength, patience and a little sleep.

Prayer at the kettle

Father, thank you for the milk in this bottle and the hands that prepare it. Keep my baby safe and well, and give me peace about the way we feed. When I am tired, be my strength; when I worry, be my rest. Amen.