Bottle Feeding Basics: Formula Prep for Newborns

All bottles should be sterilised before use until your baby is one year old. This prevents any nasty bacteria that may make your child sick.

Before sterilising, clean your bottles by washing in detergent and hot water, then rinsing thoroughly. Make sure to pull the entire bottle apart – separating the ring and teat – before moving on to sterilisation. Once your baby’s bottles are sterilised, you’re ready to prepare formula.

The National Health Medical Research Council of Australia’s Infant Feeding Guidelines advocate the following three methods.

The Boiling Method

Place all bottle parts, teats, and dummies in a large saucepan
Cover with water
Ensure all air bubbles are eliminated
Bring water to boil
Boil for 5 minutes
Allow equipment to cool in saucepan until safe to remove
Store equipment in a clean, lidded container
Place container in fridge
Repeat after each use
Boil every 24 hours, whether used or unused

Safety Alert: Care should be taken to avoid scalds. Keep children away from hot and boiling water.

The Steam Sterilisation Method

Automatic electric steam sterilisers quickly raise temperatures to the range that kills bacteria. When selecting a unit, choose one that meets Australian standards.

Place clean bottles into unit
Add water, as per manufacturer instructions
Turn on
Wait until sterilisation is complete
Store equipment in a clean, lidded container
Place container in fridge
Repeat after each use
Steam sterilise every 24 hours, whether used or unused

The Chemical Sterilisation Method

Antibacterial chemical sterilising solutions come in both liquid and tablet forms. To prepare your solution, you’ll need a lidded container big enough to fit all parts of your baby’s bottles. Only use plastic or glass, as metal will corrode in contact with the solution.

Prepare solution according to manufacturer instructions
Fully submerge clean bottles into solution
Ensure all air bubbles are eliminated
Leave equipment in solution for recommended time
Discard solution after 24 hours
Scrub container thoroughly in warm, soapy water before preparing new solution

Karitane tip: Do not rinse bottles after they have been sterilised with the solution.

Safety Alert: Ensure the chemical solution and concentrate are stored well out of children’s reach.

To view correct sterilisation and formula preparation, see the following video from Raising Children.

Make sure you choose a formula appropriate to your baby’s age. Don’t hesitate to ask a healthcare professional if you’re still uncertain.

If you’re using infant formula, you’ll need the powered concentrate and fresh, boiled water.

Wash your hands – they must be germ free.
Boil water.
Allow to cool until lukewarm.
Read the tin instructions carefully.
Add correct amount of water to the bottle.
Fill tin scoop with formula, levelling with a flat blade (tap to remove air gaps). Do not pack formula in tightly.
Add correct ratio of scoops to water (do not use half scoops).
Store the scoop in the tin (do not wash the scoop, as moisture affects the formula).
Assemble the bottle.
Shake until dissolved.
Check temperature by sprinkling a few drops on the wrist (milk should be warm when fed to the baby, but always remember that it’s better for a baby’s bottle to be cool rather than hot).
To rewarm milk, stand the bottle in warm water briefly. Do not use a microwave to heat milk, as this can cause hot spots that burn your baby’s mouth.

Karitane Tip: We recommend cow’s milk based infant formulas until one year of age. All infant formulas available in Australia are iron-fortified. Special formulas can be used under medical supervision if your child can’t take cow’s milk, or if you have specific medical, cultural or religious reasons.

Karitane Tip: Remember, the volume is the total reconstituted amount. That’s the amount of milk in the bottle once the formula powder is added – not the amount of water beforehand.

Safety Alert: We recommend preparing only one bottle at a time, and always just before feeding. If you need formula in advance, place the prepared bottle in the fridge immediately. Discard any formula that has been at room temperature for one hour, and any formula left after a feed. Throw out opened formula tins after one month, or if past the use by date.

To view correct sterilisation and formula preparation, see the following video from Raising Children.

Feeding your baby is an excellent opportunity to bond – so it’s important for both of you to be comfortable. If your baby has given you hunger cues, you can begin to prepare their next bottle.

Check formula temperature
Shake a little onto your wrist. It should be warm, not hot.
Hold your baby close, unwrapped and well supported
Ensure your baby faces you
Hold, cuddle and talk to your baby
Doing so while making lots of eye contact is a great way to build your relationship, provided it isn’t too distracting.
Stay with your baby
Do not leave your baby to feed alone (e.g. with the bottle propped) as the milk may flow too fast, causing spluttering or choking.
Do not put your baby to sleep while feeding
- This increases risk of choking, ear infection and dental caries.

In the early weeks your baby will try to communicate their needs. As you get to know each other better, you’ll begin to understand these cues.

Babies are ‘wired’ to look for food when hungry, and feeding times can vary greatly. On average, newborns feed every 2-3 hours – so if your baby starts to fuss and hasn’t been fed in the last few hours, checking their appetite is a good start. It’s normal to feed a newborn baby 6-12 times per day.

Karitane Tip: Your baby’s hunger cues are the best indicator for when to feed. Going by a set time period doesn’t take your baby’s individual needs into consideration.

Hunger cues include:

Sucking noises
Opening mouth
Turning towards breast or bottle
Sucking fingers and/or fist
Crying
Being unsettled

The following video demonstrates some baby hunger signs (Sourced from Raising Children).

Sometimes your baby just wants to feed for comfort. This reassurance is fine when your baby is very distressed as it can be calming in these situations.

As your baby grows, you’ll notice they are able to latch more independently with increased sucking efficiency – which means that they can feed for a shorter time, but with the same satisfaction. At around three to four months, you may also notice your baby becomes easily distracted, and detaches and attaches several times during the feed. This is more prone to happen in new and/or stimulating environments, like a shopping centre. Around this time babies also generally reduce breastfeeds over 24 hours. At this point, it is common for babies to feed every 3-4 hours – including overnight feeds. Remember to keep looking for hunger cues as an appropriate indicator of when to offer the breast.

Karitane Tip: We recommend giving your baby only breast milk or formula for the first six months, as these contain all the nutrients your child needs. To cater to your baby’s growing development, you can begin to introduce solids around this six-month period. Read more on solids here.

When assessing whether your baby is actually hungry or not, it’s important to consider other things your baby might be trying to express. Look at your baby’s growth, development, sleep routine, activity, health and environment, to determine whether your baby is really hungry, tired or needs changing.

Every baby is unique and will therefore grow a little differently. However, you may find it helpful to have your baby’s head length and weight checked and recorded at regular intervals. Your child and family health nurse can do this for you, during regular child health checks. You’ll find a copy of their growth percentile chart in the Blue Book.

Your baby’s weight will vary significantly as your breastfeeding routine is established over time. All babies experience greater periods of hunger at certain times, so your baby may increase feeds to change your milk supply at these times of growth. Look for these additional hunger cues and feed to your baby’s demand.

Babies tend to grow according to their percentile. This expected weight gain table offers a general guide to growth rates.

Aged 0 - 3 months gain 150 - 200g / week
Aged 3 - 6 months gain 100 - 150g / week
Aged 6 - 12 months gain 70 - 90g / week
Birth - 1 year should be 2 - 3 x birth weight
1 - 2 years gain 2 - 3kg / year (40 - 50g / week)
2 - 5 years gain 2kg / year

Your baby’s development influences when and how often a feed is offered. As your child grows, you’ll find they begin to attach and breastfeed with more ease. Breast milk should remain the primary source of nutrition before solid foods are introduced at six months. At this stage water may be introduced in small amounts, for thirst only.

At Karitane, we’ve found promoting a feed, then play, and then sleep helps you determine your baby’s hunger and sleep cues more easily. Not feeding when they’re due to be sleeping also helps your child learn to sleep more independently over time.

Additionally, you’ll find daily activity helps reduce snack feeding – promoting better, healthier feed and sleep patterns. Activity for infants up to one year is typically floor play, including tummy time and time smiling and talking with mum and dad.

Feeding and sleeping work closely together. Too little sleep can make it hard to feed well, just as too little food affects sleeping patterns. Over the first few weeks, you’ll experience some trial and error when it comes to these. Don’t be discouraged. It takes time to get know your baby.

Babies find it difficult to regulate their own body temperature, so your baby can easily overheat with overdressing, multiple blankets, room heating and/or hot weather. This increases their need for extra fluids. If your baby is under six months, this may mean additional feeding.

If your baby is too hot, they may wake for more feeds or fluid overnight. If your baby is too cold, they may expend more energy to stay warm, and demand more feeds to sustain this energy. As a general rule for hot weather, dress your child in one item less than you’re wearing. In the cold, add one layer extra.

Karitane Tip: There is also no evidence to support maintaining a specific room temperature, or any specific bedding configuration (number of blankets required) as this depends on a number of factors, such as what your baby is wearing, whether it is summer or winter, and whether there is heating or cooling within the room where your baby is sleeping.

Sourced from Red Nose: Room Temperature.

When deciding whether your baby is getting enough out of their feed, it’s useful to remember every child is different. No two babies have the same appetite. Instead of focusing on each individual feed, try to consider the feeds over the whole day. There will be times of the day where you will feel your baby has had a good feed and other times of the day where your baby might have had a short feed or been fussy.

Contentment:

If your child seems generally content after a feed, this is a cue of satisfaction. You may notice your baby also appears more alert and active when awake. Remember, in the early months it’s normal for your baby to experience one or two unsettled periods a day, and they may want to feed more often – so don’t be worried if this occurs.

Output:

Urine: Your baby will have six or more wet nappies over the course of 24 hours. Healthy urine is a clear, pale yellow. Should the urine darken, seek medical advice.

Stools: Your baby’s bowel movements are soft, and occur many times in the first 6-8 weeks. If your baby is also taking formula, stool (poo) frequency and consistency can be firmer and less regular (every 1-2 days on average). Once solid foods are introduced, colour, texture and frequency often change as your baby adjusts to the new diet.

Karitane Tip: If you notice firm, pebble-like stools, difficulty passing stools, crying when passing stools, or bleeding when passing stools, seek medical advice.

For more information on breastfeeding, download a copy of Breastfeeding your Baby by the NSW Ministry of Health.

Feeding can be a challenging time for many parents and babies. Fortunately, there are many support avenues available to you. For support, look to:

Karitane Careline (1300 CARING | 1300 227 464)

Karitane provides feeding support through our free careline. Should you reach us out of hours, an experienced child and family health nurse will phone back within 24 hours, between 12.30pm – 9pm / 11pm – 6am Monday to Thursday, or 9am – 3.30pm Friday to Saturday.

Note: The Karitane Careline is not a crisis line. If your child is unwell, or your question is urgent, please call Health Direct on 1800 022 222 for medical advice, or 000 for emergency.

Karitane emails

Don’t hesitate to email KRTNE-OnlineEnquiries@health.nsw.gov.au if you have any feeding questions.

Friends and family

If you’re lucky to have generous friends and family offering to help, request assistance in practical ways. They can help by making meals, doing laundry, hosting play dates, preparing snack boxes and offering emotional support.

Child and family health nurses

Registered child and family health nurses are qualified in child and family health and are trained to support parents with feeding issues.

Your local community health centre

Local family health centres are a great place to seek help with feeding. Many centres offer drop-in feeding clinics and/or appointments for difficulties.

www.healthdirect.gov.au l 1800 022 222

Australian Breastfeeding Association

The ABA is a non-profit organisation run by other breastfeeding mums. Their breastfeeding helpline is staffed by trained volunteers and is available seven days a week.

1800 MUM 2 MUM | 1800 686 268

Lactation consultant

This trained breastfeeding specialist will provide support and advice, often in a clinical or home setting. Free lactation consultations are available from a child and family health centre. Private consultations will incur a fee. To find a consultant, ask your family doctor or search online.

Your local feeding clinic

Many large hospitals house specialist feeding clinics. These are often required after oral surgery, feeding tubes, oral trauma, medical conditions or interfering feeding behaviours. Ask your family doctor for a referral.

Karitane Tip: Karitane’s call back service is free of charge, however some mobile providers may charge a fee for dialling Karitane’s number. Please check with your provider if you’re unsure, or dial 9794 2350 for the cost of a local call.