Formula is a part or all of infants’ diets for many families. Here are tips and considerations to make formula use easier and healthier for babies.

Infant formulas are available as ready-to-use liquid, liquid concentrate and powdered concentrate. Liquid formulas are sterile. Always check the expiry date on the formula package. All formulas are in cow milk or soy milk. Avoid soy if possible. You can find lots of info about formula and considerations for choosing one, nutritional value etc. at https://www.askdrsears.com/?s=formula .

Special high calorie formula may be recommended for premies, whether the baby receives breastmilk or not. Hypoallergenic formulas should only be used, under medical supervision and only after all other remedies for infant discomfort have been explored. They’re much more processed than regular formulae.

Equipment

Glass bottles are best from a sanitation, environmental and health point of view. If plastic is used, then choose BPA-free plastic bottles.
Ensure the nipple hole is the right size. If it’s too large, the baby may gag or be forced to gulp. If it’s too small, then the baby has to suck hard and gets frustrated.
Some babies prefer different shapes than others.
The nipple can become distorted over time with repeat washing and sanitation.
Baby’s needs change with growth and development.

Breastfeeding contributes to healthy formation of facial muscles and oral/jaw coordination as babies grow. A friend of mine, a dentist who is an expert in infant orofacial muscle development and tongue-tie, recommends these bottles: Eve Flo balance + wide neck. (Come in plastic or glass. She recommends glass to avoid microplastic leakage, which has been reported recently.)

https://lactationhub.com/evenflo-balance-wide-neck-bottles-5oz-slow-flow-nipple/

https://www.evenflofeeding.com/en-ca/products/balance-bottles-glass-wide-neck

Sanitation

Always wash hands thoroughly before handling equipment.
Wash, rinse and dry the top of the formula can before opening.
Use only clean equipment – can opener, mixing containers, jars, spoons.
Sterilize all new supplies that will be used for formula feeding.
Immediately after use, wash all equipment in hot soapy water, use a bottle brush to remove milk residue, and rinse thoroughly.
Sterilization may or may not be required.

Sterilization is a contentious issue. Routine sterilization of all bottles, nipples and equipment used to be recommended and still is in areas with poor sanitation and/or untreated water. Otherwise, the recommendations are mixed, from boiling water sterilization, to counter-top appliances for sterilizing bottles, to simply washing all supplies in a dishwasher.

Whether sterilizing equipment or simply washing it well, ensure hands, surfaces and storage containers are clean when handling freshly sanitized supplies. Everything should be air or heat dried. No matter how you choose to sanitize your equipment, do not use a tea-towel to dry it.

Preparing Formula

Follow instructions on the label as they vary with brand and type of formula.
Make only enough for 1 feeding at a time.
Mix powdered formula with sterile water (heat water to a rolling boil for 2+ minutes, then cool to room temp)
Liquid formula does not require mixing.
It’s safe to use cold or room temperature formula, but many babies prefer it warmed up. Warm the bottle in a hot water bath, shaking often for even warming.
Test the formula temperature by putting a couple of drops on inner wrist. It should feel same temperature.
NEVER microwave formula – may lead to burns and toxic plastic from bottles.
Do not overheat as the composition of the milk can change with high temperatures.

Storage

Powder should be used within 1 month of opening the seal.
Ready-to-use (but unused) liquid formula can be refrigerated and used within 48 hours.
Prepared, unused formula can be stored at room temp for max 1 hour, or up to 24 hours in fridge.
Formula left over in baby’s bottle must be disposed of within 1 hour; never reuse!
When travelling with powdered formulas, it’s safest and easiest to carry a thermos of sterilized water and mix the formula as needed.

Feeding Your Baby

Wash hands thoroughly before feeding.
Watch for hunger cues rather than using a schedule for feeding
Hold baby to feed – it’s bonding time. (Never prop the bottle or leave baby unattended.)
Baby’s ear, shoulder, hips should be in line; straight (not twisted)
Switch sides with every feeding (encourages even development).
Burp baby part way through feeding and again after.
Do not over-feed or force baby to finish entire bottle. Small frequent meals are preferable.
Never let baby go to bed with bottle – leads to tooth decay.
Use paced feeding, which allows for normal eating behaviours. Many people end up force-feeding or over feeding their formula-fed babies, which can lead to indigestion and obesity.

See this excellent video on Paced Feeding: https://youtu.be/iKSSi5pi57I?si=tF-U7PQvwB85VZoc

How Much to Feed?

See label as it varies with brand, age and size of baby. Feed the baby in small, frequent meals. Like breastfed babies, formula-fed babies should soak 6-10 diapers daily after the first week.

Nutrition

Formula is created to provide basic nutrients such as vitamins, minerals, and protein/macronutrients that babies need to grow. It is simply not nearly as healthy as breastmilk but it is much better for babies than some of the other alternatives that some people are forced to use, especially in light of barriers such as finances and availability of formula. Everyone has their own reasons for using formula for some or all of their baby’s meals.

Two nutrients missing from formula that can be easily added are probiotics and essential fatty acids, especially the omega-3 family of oils. If that interests you, here are suggestions:

Add a high-quality infant probiotic by putting some of the powder on a clean, damp finger and allowing baby to suck it. Or put some of the probiotic powder on the end of the bottle.
The probiotic can be added to the formula if it’s not being heated. Heat kills probiotics.
Add a children’s fish oil formula from a company that produces high-quality oil free of toxins (e.g. Nordic Naturals). For vegans, an algae-based omega-3 oil is the most digestible. Nut and seed based omega-3 aren’t well assimilated by babies’ digestive systems.
Cod-liver oil is also a good source of vit-D. If your formula contains adequate vit-D3 then consider using a fish oil from smaller fish such as mackerel/sardines.
Fish oil that smells fishy is likely rancid. The high quality oils don’t taste or smell fishy.

Also see my Drying Up Breastmilk article.