milk splashFormula milk (bottle) feeding your baby

There is a wealth of research evidence on the health benefits to mothers and babies that breastfeeding confers (see our article Breastfeeding your baby). However, in practice, many women choose not to breastfeed and instead replace their breast milk with other substitutes; commonly, this is infant formula milk. The important thing is to make sure that you are making an informed choice and your decision is based on what feels right for you and your baby, and your personal circumstances. You may feel that breastfeeding is not for you, or you have given it a try but have found that it is not how you’d thought it would be?  It is important that you speak with your maternity health care professional about how you are feeling. Deciding that breastfeeding isn’t right for you does not make you a second-rate mother or a bad parent. You need to be able to enjoy your baby and if you are finding that you are dreading each breastfeed and/or counting down the hours until their next feed is due, then perhaps you need to re-think things? Whatever method of infant feeding you prefer the maternity staff will fully support you in your decision and will offer you all the help and advice that you need.


What does the research tell us?

Research studies show us that powdered formula milks are associated with an increased risk of infection and other illnesses in babies who are formula fed rather than breastfed (see our article Breastfeeding your baby). Formula milks, feeding bottles and sterilising equipment are also recognised as being additional expenses. As midwives and evidence based practitioners, we will always advocate breastfeeding whenever this is possible; however, we firmly believe that women should never be coerced into choosing their preferred method of infant feeding. It is your baby, your body and your choice. We would therefore, like to reassure you that we have written this article in a context that totally respects and supports your decision about how you wish to feed your baby. We simply aim to provide you with objective, reliable information to support you in bottle feeding your baby safely to safeguard their health and wellbeing.


What is infant formula milk?

cows faceThe majority of infant formula milks available are made from cow’s milk which has been specially treated to make it suitable for babies to digest. Other formula milks are also widely advertised – milks for hungry babies, follow-on milks etc. – however, formula milk that is cow’s milk based is the only infant formula that your baby actually needs. If you do feel that your baby needs other formula milks, it is most important that you discuss this with your midwife, health visitor or GP first. Similarly, you might be worried that a certain brand of formula milk is upsetting your baby’s tummy and perhaps disagrees with them? Where this is the case, it is important to talk through your concerns with your health care professional first.

Infant formula milk is available in two different forms:

  • Powdered infant formula milk; this is not sterile
  • Liquid infant formula milks (ready-to-feed); these are available in bottles and cartons and the milk is sterile.


Which formula? There are so many to choose from!

With so many milks on sale to choose from it can feel quite daunting when deciding which one to use. In many cases, you will be guided by the formula milks that your friends and family have used, or where this is a second or subsequent baby, the brand you used last time.

Your newborn baby should be given ‘First infant’ formula milk, which is the only formula milk that your baby needs until they are one year-old. The only exception to this is where your GP or paediatrician has advised otherwise. First infant formula milk is suitable for newborn babies and your baby can continue to have this even when you begin to introduce solid foods into their diet (weaning) when they are around six months of age. Once your baby has reached their first birthday, formula milk can be replaced with ordinary cow’s milk – NB. This should be whole milk (with the blue top) and not fully skimmed (red top) or semi-skimmed milk (green top).

NB. Although, you cannot give your baby whole cow’s milk as a drink until they are one year of age and older; from six months onwards, it is perfectly safe to use small volumes of pasteurised whole cow’s milk in the foods that you prepare and cook for your baby. You can also offer your baby fromage frais and yoghurt when you are weaning them.


Other milks

Milks for ‘hungry’ babies – These are also referred to as ‘second milks’; the formula milk contains more casein (a protein), which is designed to make your baby’s tummy feel fuller for longer. However, there isn’t any research evidence that actually supports manufacturer’s claims that babies who are fed ‘hungry baby’ milks settle better and sleep for longer. If you have any concerns, you should always discuss these with your health care professional first. Remember: You can feed your baby ‘first milk’ for their first year; you do not need to put them onto to ‘second milk.’

Follow-on formulas – These formula milks are widely advertised for use once your baby is six months of age and beyond.  They are also marketed as ‘toddler’, ‘growing-up’ and ‘follow-on’ milks. Powdered follow-on formula milk is also not sterile. As previously mentioned, you do not need to use these follow-on milks either. You can safely give your baby ‘first infant’ formula milks for their first year and then switch them to whole cow’s milk. NB. The packaging on these formula milks is very similar to ‘First milks’, so it’s important that you check the labelling very carefully to ensure you have picked up the correct formula milk for your baby’s age.

Other types of formula milk ‘Night-time’ milks are advertised as helping babies to settle quicker and sleep for longer periods during the night. These milks are ‘follow-on’ formula milks that have had cereal added to them; however, the research evidence does not support manufacturers’ claims and, in fact, night-time milks are not necessary either. If you do decide to switch to them though, you should wait until your baby is over six months’ of age before doing so.

Parents’ sometimes worry that their baby has a cow’s milk allergy and formula milks that are based on cow’s milk upset their baby’s tummy. Some formula milks are marketed as being ‘hypoallergenic’; however, these milks are not suitable for those babies who have been medically diagnosed as having cows’ milk allergy. Should you have any concerns that your baby might be allergic to cow’s milk, it is important that you seek advice from your midwife, health visitor or GP. Your GP can prescribe specialist formula feeds for babies with known cow’s milk allergy. Similarly, you should not give your baby Soya-based infant formula milk unless this has been prescribed for your baby by your GP.


Is there any milk that isn’t suitable for my baby?

There are some types of milk that are not suitable for babies and these should never be given to a baby under one year of age:

  • Soya milk (unless recommended by your midwife, health visitor or GP)
  • Goat’s milk
  • Sheep’s milk
  • Dried milk
  • Condensed milk
  • Evaporated milk
  • Milks that are also known as, almond, rice and oat drinks




Formula milk concerns

In recent years there has been growing concern about the contamination of powdered infant formula milks. Contrary to what many parents used to believe, powdered formula milk is not sterile and there have been cases where babies have become seriously ill and, in very rare cases, have even died. The two micro-organisms that have been found in powdered infant formula milk that are of the greatest concern are Enterobacter sakazakii (also called E sakazakii) and Salmonella. Their significantly harmful effects on babies health has resulted in the Department of Health (DH) revising its guidance on the safe preparation, storage and handling of powdered infant formula milks. The main change is that formula milk feeds should be prepared freshly for each feed; this replaces the long-established practice of making several bottle feeds up at the same time and storing them in the fridge for future use. By following the DH guidance you can protect your baby from harmful micro-organisms and can feel confident that you are bottle feeding your baby safely.

For additional information on bottle feeding your baby, see our related articles on Essential bottle feeding equipment, Sterilising your feeding equipment, and Making up a bottle feed.

Atchan M, Foureur M, Davis D (2011). The decision not to initiate breastfeeding – women’s reasons, attitudes and influencing factors – a review of the literature. Breastfeeding Review 19(2):9-17.

Baby Friendly Initiative (2010). A guide to infant formula for parents who are bottle feeding. London: UNICEF UK Baby Friendly Initiative. 8 pages.

Baby Friendly Initiative (2010). The health professional’s guide to: “A guide to infant formula for parents who are bottle feeding”. London: UNICEF UK Baby Friendly Initiative. 21 pages.

Baby Milk Action (2011). Infant formula explained DVD. Bristol Mark-it Television.

Foster A (2011). A topic in 10 questions. How to support bottle feeding mothers. Journal of Family Health Care 21(3):20-21.

Greer FR, Sicherer SH, Burks AW et al (2008). Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods and hydrolyzed formulas. Pediatrics 121(1):183-191.

Heurou-LuronIL, Blat S, Boudry G (2010). Breast- v, formula-feeding: impacts on the digestive tract and immediate and long term health effects. Nutrition Research Reviews 23(1):23-36.

Jones S, Stoppard M (2011). Baby Friendly Hospitals: are we failing mothers who formula feed their babies? Journal of Family Health Care 21(1):12-14.

Lakshman R, Ogilvie D, Ong KK (2009). Mothers’ experiences of bottle-feeding: a systematic review of qualitative and quantitative studies. Archives of Disease in Childhood 94(8):596-601.

Lee E (2007). Health, morality and infant feeding: British mothers’ experiences of formula milk use in the early weeks. Sociology of Health and Illness 29(7):1075-1090.

Li R, Fein SBG, Grummer-Strawn LM (2010). Do infants fed from bottles lack self-regulation of milk intake compared with directly breastfed infants? Pediatrics 125(6):e1386-1393.

Li R, Magadia J, Fein SB et al (2012). Risk of Bottle-feeding for Rapid Weight Gain During the First Year of life. Archives of Pediatrics and Adolescent Medicine 166(5):431-436.

Ludlow V, Newhook LA, Newhook JT et al (2012). How formula feeding mothers balance risks and define themselves as ‘good mothers’. Health, Risk and Society 14(3):291-306.

Marshall J (2013). Midwifery Basics. Infant feeding. 6. Formula feeding. The Practising Midwife 16(3):35-38.

McNiel ME, Labbok MH, Abrahams SW (2010). What are the risks associated with formula feeding? a re-analysis and review. Birth 37(1):50-58.

MIDIRS (2008). Breastfeeding or bottle feeding: for professionals. Bristol: MIDIRS.10 pages.

Mizuno K, Ueda A (2006). Changes in sucking performance from nonnutritive sucking to nutritive sucking during breast- and bottle-feeding. Pediatric Research 59(5):728-731.

Moral A, Bolibar I, Seguranyes G et al (2010).  Mechanics of sucking: comparison between bottle feeding and breastfeeding. BMC Pediatrics 10(6)11 February. 8 pages.

Nainar SMH, Mohummed S (2004). Role of infant feeding practices on the dental health of children. Clinical Pediatrics 43(2):129-133.

Osborn DA, Sinn J (2006). Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants (Cochrane Review). (Date of most recent substantive amendment: 27 July 2006). The Cochrane Database of Systematic Reviews. Issue 4.

Patelarou E, Girvalaki C, Brokalaki H et al (2012). Current evidence on the associations of breastfeeding, infant formula, and cow’s milk introduction with type 1 diabetes mellitus: a systematic review.     Nutrition Reviews 70(9):509-519.

Pozo-Rubio T, Capilla A, Mujico JR et al (2013). Influence of breastfeeding versus formula feeding on lymphocyte subsets in infants at risk of celiac disease: the PROFICEL study. European Journal of Nutrition 52(2):637-646.

Scowen P (2009). Bottle-feeding mothers and babies matter too. Journal of Family Health Care 19(4):112.

Start4Life (2010). Guide to bottle feeding: how to prepare infant formula and sterilise feeding equipment to minimise the risks to your baby. London: Department of Health. 22 pages.

Sterken E (2006). Risks of formula feeding: a brief annotated bibliography. Toronto: INFACT Canada. 8 pages.

Stevens EE, Patrick TE, Pickler R (2009). A history of infant feeding. Journal of Perinatal Education 18(2):32-39.

Vincent Sarah (2010). Getting bottle feeding mothers the information they need. MIDIRS Essence issue 37.

Wall A (2006). What choice in infant feeding methods? Journal of Family Health Care 16(1):13-15.

Waterston AJR (2009). Your Babycare Bible. London: Carroll and Brown. 392 pages.

World Health Organization, UNICEF (2003). Global strategy for infant and young child feeding. Geneva: WHO.