Synopsis
Support formula and mixed feeding without judgement, select an age-appropriate product, prepare powdered formula with water at least 70°C, prevent dilution and contamination errors, use responsive bottle technique, and recognise feeding or illness red flags.
- First infant formula is nutritionally suitable as the main milk from birth to 12 months; follow-on formula is not required and should not be given before 6 months.
- Powdered formula is not sterile. Wash hands, disinfect the surface and wash and sterilise bottles, teats and preparation equipment before each feed until at least 12 months.
- First-line safe method: make one feed at a time with fresh cold tap water that has been boiled once and cooled for no more than 30 minutes, so it remains at least 70°C.
- Measure water into the sterilised bottle first, then add the exact number of level scoops supplied with that product. Different brands can use different scoop sizes.
- Cool the closed bottle under cold running tap water, keeping water away from the teat, and test on the inside of the wrist before feeding.
- Do not use previously boiled, artificially softened or routinely bottled water. Bottled water is not sterile and may contain excessive sodium or sulphate.
- A preparation machine must deliver water at least 70°C when it contacts powder. Stop using it if measured output does not meet this temperature.
- Never add extra powder, extra water, cereal or sugar. Concentration errors cause dehydration, electrolyte disturbance, inadequate energy intake or excessive renal solute load.
- Make feeds as needed and discard any formula left after a feed. Ready-to-feed liquid formula is sterile until opened and is the safer option when hot-water preparation is not possible.
- Never microwave a bottle because hot spots can burn. Do not leave a bottle warming or at room temperature for prolonged periods.
- Use responsive paced bottle feeding: hold the baby semi-upright and close, keep the bottle near horizontal, allow pauses and stop for satiety cues. Never prop a bottle.
- Specialist anti-reflux, hydrolysed, amino-acid, preterm or metabolic formulas are treatments for defined indications and should not be switched repeatedly without clinical and dietetic review.
Key red flags
A baby who is difficult to wake, persistently refuses feeds, has fever or hypothermia, respiratory distress or poor perfusion needs urgent assessment.
Fewer wet nappies, dry mouth, sunken fontanelle, marked weight loss or concentrated feeds raises dehydration and potentially dangerous hypernatraemia.
Bilious or projectile vomiting, abdominal distension, blood in stool or severe persistent pain is not routine feed intolerance.
Coughing, choking, cyanosis, wet breathing or recurrent chest infection during or after bottles raises oropharyngeal dysphagia and aspiration.
Powder prepared below 70°C, stored too long, used after a safety recall or mixed with an incorrect powder-to-water ratio creates infection or electrolyte risk.
Repeated carer reports of unavailable formula, unsafe dilution, missed feeds or unexplained growth change should prompt practical support, food-security assessment and proportionate safeguarding review.
Investigation priorities
Identify temperature, ratio, hygiene and storage errors that history alone may miss.
Management branches
Powdered first infant formula is being prepared at home.
- Wash hands, disinfect the surface and assemble washed sterilised equipment.
- Boil at least 1 litre of fresh cold tap water, cool no more than 30 minutes, measure water first and add exact level scoops.
- Shake carefully, cool the closed bottle under running water, test temperature and feed promptly, discarding leftovers.