Bottle feeding - safety issues

If you are not breastfeeding your baby, you need to feed your baby infant artificial formula. Do not use any type of milk, powdered or otherwise, that is not recommended by the manufacturer as suitable for babies.

Milks that should never be given to a baby less than 12 months of age include cow, skim, evaporated, sweetened condensed, goat, sheep, rice and soy. These milks do not contain the correct balance of nutrients for your baby’s needs – using them instead of commercially prepared infant artificial formulas will put your baby’s health at serious risk.

It is important to remember that bottle-feeding equipment can harbour disease-causing bacteria and other germs if not properly handled, cleaned and sterilised.

Infant artificial formulas explained
Most infant artificial formulas are based on cow’s milk. They are suitable for the majority of healthy full term infants. It is important to choose an artificial formula that is appropriate for your baby.

All artificial formulas sold in Australia conform to the Australia New Zealand Food Standard Code (Standard 2.9.1 – Infant Formula Products). There is little difference in nutritional value or quality between differently priced brands. There are a variety of artificial formulas available. They include:

• Standard infant artificial formula – labelled ‘suitable from birth’, this is for babies up to 12 months of age. It is usually cow’s milk based, but may be soy or goat’s milk based. Soy may be preferred by vegan mothers or if the baby cannot tolerate cow’s milk protein. However, unless there a compelling reason against using cow’s milk based artificial formula (such as family history of diary allergy or intolerance), it is the recommended choice.
• Follow-on infant artificial formula – labelled ‘suitable only for babies over six months’, this is for babies aged six to 12 months. There is no research to show that these products are any better than standard artificial formula and they are not considered nutritionally necessary.
• Thickened artificial formula – is sometimes recommended for babies who frequently ‘posset’ or regurgitate large amounts after feeds. However, a thickened artificial formula may not solve the problem and should not be used without guidance from a qualified health professional.
• Premature infant artificial formula – is specifically designed for the nutritional needs of a premature baby. This is not suitable for healthy full term babies.

• Check the expiry date before you buy any artificial formula.
• Discard any artificial formula you have not used a month after opening the tin.
• Wash your hands thoroughly before preparing artificial formula.
• Make up artificial formula using sterilised bottles and teats.
• Use cooled boiled water to make up artificial formula until the baby is 12 months old.
• Make up the artificial formula according to the manufacturer’s instructions printed on the side of the tin.
• Always use the scoop provided in the artificial formula tin. A scoop from another brand of formula may be larger or smaller.
• Do not add more or less powder than recommended. You risk dehydrating or underfeeding your baby.
• Avoid adding anything extra to the milk, such as baby rice cereal. If you think your baby needs more food than recommended, talk to your Maternal and Child Health nurse about offering extra bottles.
• If you decide to switch brands, make sure to double-check the manufacturer’s instructions on the powder to water ratio. The new artificial formula may have different instructions.

• Ensure the teat is right for your baby’s age. Most teats are labelled according to age. The flow will then be suitable for your baby. For example, a teat designed for an older baby can flood a newborn’s mouth with too much milk and may lead to choking.
• Test the flow by holding the bottle upside down – milk should drip out at a constant, steady rate. If it drips too slowly, the baby will get tired before the feed is finished. If it pours out in a stream, the baby may dribble and splutter during feeding.
• Adjust the flow rate by tightening or loosening the cap. Loosen the cap a little if the teat flattens during feeding. Air bubbles should rise through the milk as the baby drinks.
• Do not buy ‘orthodontic’ teats – they are no better than regular-shaped teats and there is some evidence to suggest they may not be good for later tooth development.

• Don’t prop the bottle in your baby’s mouth and leave your baby to feed unattended, as your baby may choke.
• Do not put your baby to bed with a bottle. This can be tempting for older children, who can hold their own bottles, but it can damage their teeth. Milk sugars called lactose (which are found naturally in all milks) can cause very serious tooth decay. This can start soon after the first teeth appear.
• Take the bottle away as soon as your baby has had enough.
• Cuddle your baby close to your body, facing you, and hold the bottle while your baby feeds. Feed time should be an enjoyable time for everyone.

• Store bottles at the back of the fridge where it is coolest, not in the fridge door.
• Use a fresh bottle every time you feed your baby. If your baby does not finish the bottle, discard what is left and give your baby a fresh bottle at the next feed. If you keep the used bottle for later, bacteria will grow which may make your baby ill.
• Discard any refrigerated artificial formula that is more than 24 hours old.
• Refrigerate all made-up bottles of artificial formula. If you are going out for the day, carry the water and artificial formula separately then prepare it just before it is needed.
• Carry fridge-cold bottles in an insulated pack with a frozen block to keep them cool.

• Use chemical solutions or sterilisers strictly according to the manufacturer’s instructions.
• Steam can cause severe skin burns, so be careful when boiling equipment on the stove or using the electric plug-in steamer.
• Place all equipment out of reach of children.
• Wash your hands thoroughly with soap and water before handling sterilised equipment.
• Avoid unnecessary handling of sterilised equipment and do not touch the inner surfaces of the bottles or teats.

• Your doctor
• Maternal and Child Health nurse – contact your local council for the name of your nearest centre
• Maternal and Child Health Line (24 hours) Tel. 132 229

• Do not use any type of artificial formula that is not recommended by the manufacturer as suitable for babies.
• Make up the artificial formula strictly according to the manufacturer’s instructions printed on the side of the tin.
• Clean equipment and store artificial formula carefully to prevent the growth of bacteria.

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