Information on feeding your baby with infant formula

By Cordelia Uys, NCT Breastfeeding Counsellor

Breastmilk substitutes

The World Health Organisation and the NHS recommend exclusive breastfeeding for the first six months of a baby’s life, and continued breastfeeding, alongside the gradual introduction of solids foods, for as long as the mother wishes. Where parents cannot, or choose not to breastfeed, breastmilk substitutes, in the form of infant formula milk, are available.

First Steps Nutrition

The public health charity First Steps Nutrition is the best source of independent, evidence-based information on infant formula milks.

First Stage Infant Formula from 0 to 12 months

The majority of infant formula milks are made from cow’s milk that has been modified to make it suitable for babies. Although there are many types of formula available, the WHO and the NHS recommend First Stage formula (also called First Milk or Stage 1 Milk) for the first 12 months of a baby’s life.

From 12 months onwards, infants can drink full-fat cow’s milk. There is no need for a child over one to be given formula milk.

‘Hungry Baby’ milks, ‘Goodnight’ milks and Follow-on milks are not recommended

There are two cow’s milk proteins in formula: whey and casein. First Stage formula is based on whey protein, which is believed to be easier for babies to digest. ‘Hungry baby’ milks and ‘Goodnight’ milks are harder to digest and not recommended by the NHS or UNICEF. There is no evidence that babies settle better or sleep longer when fed these milks.

Follow-on milks, marketed as being for babies over 6 months, are also not recommended by the NHS. Follow-on milk was invented for advertising purposes, because advertising of First Stage milks is not permitted in the UK. Follow-on milks don’t exist in the U.S. where there are no restrictions on advertising formula.

There is no difference in quality between different brands of formula milk

All First Stage infant formula milks are required by law to provide sufficient macro and micro nutrients to support adequate growth, and they must all meet the same compositional standards. Any additional ingredients claimed by an individual brand are just a marketing ploy: if one particular formula milk contained an ingredient proven to be beneficial to babies, then all formula milks would have to contain it. It’s therefore pointless spending lots of money on an expensive brand.

Dispatches documentary on Channel 4

In 2019, the Channel 4 documentary programme Dispatches highlighted the enormous discrepancy in price between various brands of formula.

Sainsbury’s Little Ones formula - £175.99 buys six months of formula
SMA Pro First Formula - £175.99 buys three and a half months of formula
Aptamil Profutura Stage 1 - £175.99 bus two and a half months of formula
Pre-mixed bottles of Aptamil Profutura – would cost £789.31 for six months.

Powdered infant formula is not sterile

Many parents are not aware that powdered infant formula is not sterile and may contain pathogens. The biggest risks are from Cronobacter sakazakii and Salmonella, both of which can make babies very ill. It is therefore essential for bottles made using powdered formula to be prepared carefully, with freshly boiled tap water that then needs to be allowed to cool to no less than 70C before formula powder is added. If the water is cooler than 70C when the formula powder is added, any pathogens in the milk might not be killed.

Please follow NHS guidelines for making up bottles of powdered formula very carefully:

https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2022/10/Bottle-feeding-leaflet.pdf

Any formula left-over after a feed should be discarded within an hour. Formula that has not been used and has been kept at room temperature must be thrown away within two hours.

Bottled water is not recommended for making up bottle feeds

Bottled water is not recommended for making up feeds as it is not sterile and might contain too much salt or sulphate. Below is a photo of page 46 from ‘Why Formula Feeding Matters’ by Shel Banks.

Batch preparation of formula bottles

When using powdered formula, the NHS strongly recommends preparing bottles on an individual basis, as required, because this reduces the risk of bacteria multiplying.

However, this is time-consuming, and can be stressful if a baby is crying for a feed. If parents decide to prepare several bottles in advance, it’s essential they cool and refrigerate the bottles immediately, place them at the back of the fridge, and use them within 24 hours.

Ready-to-drink liquid formula milk

Liquid, ready-to-drink formula, which is available in cartons, is sterile and convenient, but expensive. The U.S. government’s Centers for Disease Control and Prevention (CDC) says: “If your baby gets formula, consider using formula sold as a liquid rather than a powder. This is especially important when your baby is less than 3 months old or if your baby was born prematurely or has a weakened immune system. Liquid infant formula is made to be sterile (without germs) and should not transmit Cronobacter infection when handled carefully. Powdered formula is not sterile.”

Preparing formula feeds when away from home

Some parents use ready-to-drink liquid formula when they’re out and about due to the convenience.

If you need to prepare a bottle of powdered formula when away from home, please see the recommendations from pages 47-51 of‘Why Formula Feeding Matters’ by Shel Banks attached below.

Potential risks of machines designed to speed up formula feed preparation

As you will have seen from the pages above from ‘Why Formula Feeding Matters’, there are several machines available on the market that speed up the process of preparing bottles of powdered formula. But there are concerns that these machines might not be safe because they do not heat all the water in the feed, meaning that some pathogens in the formula powder might not be killed. There is also information about this in the link below from First Steps Nutrition.

BBC article on baby formula machines not killing bacteria: https://apple.news/AAmS4xfE5ThSoLQP3_ZrRVw

Links

Books:

Why Formula Feeding Matters by Shel Banks https://www.pinterandmartin.com/why-formula-feeding-matters

Successful Infant Feeding by Heather Welford: https://www.goodreads.com/book/show/14570476-successful-infant-feeding

First Steps Nutrition website for independent information on infant formula:

First Steps Nutrition Trust

https://www.firststepsnutrition.org/parents-carers

https://static1.squarespace.com/static/59f75004f09ca48694070f3b/t/5d131007a4f6110001954318/1561530383222/Infant_formula_an_overview_June2019.pdf

Making infant milk safely — First Steps Nutrition Trust

https://static1.squarespace.com/static/59f75004f09ca48694070f3b/t/5a5f913c0d92977380f39cbd/1516212541405/Statement_on_formula_preparation_machines_Nov+2016.pdf

Which? magazine on formula prep machines: