Bottle Feeding

Feeding Cues

Babies need to feed a lot in the early days. Your baby has many ways to tell you they are hungry. These signs are called feeding cues.

Your baby is hungry when you see these feeding cues:

Rapid eye movements
Stretching, moving arms and legs
Bringing hands to mouth
Sticking out tongue and licking lips
Sucking motions or sounds
Rooting (opening the mouth, searching to suck, and sucking on contact)
Turning head back and forth
Soft cooing or sighing sounds

Your baby is full when:

Your baby closes their mouth
Your baby turns away from the bottle
Your baby looks relaxed and calm

Following your baby's feeding cues will:

Help feeding go well
Help you get to know your baby
Allow your baby to build trust, and allow parents to gain confidence
Build a positive feeding relationship which supports child growth

Remember...

Your baby should feed at least 8 times or more in a 24 hour day, until about 6 weeks of life.
It is normal for some babies to have many feedings in a short period. They may sleep longer between feeds at other times. This is called cluster feeding. This is more common in the later afternoon or evening.
Skin-to-skin contact lets parents learn baby's feeding cues.
Crying is a late sign of hunger. A baby crying from hunger may be too upset to settle down to feed. Get to know your baby's early feeding cues.
Your baby will have growth spurts. These happen at around 2 to 3 weeks, 6 weeks, 3 months and 6 months. Growth spurts typically last 2 to 3 days. Your baby may feed more often at these times.

Baby Formula

If you have made the informed decision to give your baby formula, please see the information below on how to safely prepare, store and provide formula.

For information on infant formula recalls please visit the Find recalls, advisories and safety alerts - Canada.ca.

Tips for feeding formula

If your baby is not breastfed, iron-fortified infant formula is the only food that should be given for the first 6 months. It should be used until your baby is 9 to 12 months old and able to eat a variety of food.
Every baby needs a different amount of infant formula. Your baby may drink a little more or less than other babies. You can refer to the Guide to amount of infant formula to prepare daily below to know approximately what you can expect.
Do not put your baby to bed with a bottle.
Watch for feeding cues and signs that your baby is full. (see accordion above)
Read the labels carefully and check the expiry date on all formula packages. Make sure cans are clean and have no dents.
Speak with your baby's health care provider before changing infant formula.
Never replace formula with 1%, 2%, skim milk, coffee whitener, condensed evaporated milk, or soy or rice beverages.

Types of formula

Type of Formula	Cost	Considerations
Ready-to-feed	Most costly and convenient	Does not require any mixing or water
Liquid Concentrate	More expensive than powdered	Needs to be mixed with clean, sterile water.**
Powdered	Least expensive*	Needs to be mixed with clean, sterile water.**

* Powdered infant formula may contain bacteria. It is safer to use a sterile liquid infant formula to feed premature and low birth weight infants under two months of age and babies with weakened immune systems.

**Always use clean and sterile water that has been boiled for infants less than 2 months of age. If the infant is born healthy and at term, you can stop boiling water after 2 months but remember to continue choosing water from a safe source. If the infant is born premature, low birth weight, or has a weakened immune system, consult their health care provider to know when you can stop boiling water.

You can sterilize water by boiling it for two minutes on the stove top, or by using an electric kettle that can bring water to a rolling boil. See the “How to prepare water for formula feeding” and the “How to sterilize equipment for bottle feeding” sections of this webpage below to learn more.

How to sterilize equipment for bottle feeding

Follow these steps to keep your baby safe. Sterilize equipment for a minimum of two months and up to six months. If your baby is premature, underweight, or has a weak immune system, ask their healthcare provider when it's safe to stop boiling water.

Dishwasher-safe equipment can be sanitized in the dishwasher with hot water and a heated drying cycle. You can also use a home electric or microwave steam sanitizer.

What you need:

A large pot with lid, bottle brush and nipple brush, tongs, knife, fork, can opener, glass measuring cup, glass bottles (if possible), nipples, caps, rims, mixing jugs and any other equipment.

If using a disposable system:

Bottle holders, rims, caps, nipples and a roll of disposable liners. Throw out liners after one use. Throw out nipples when they become soft and sticky. *Note: If using disposable bottles sterilize only the nipples.

Steps:

Wash hands and counter with soap and water
Wash all items in warm, soapy water
Make sure holes in nipples are not clogged
Rinse well
Put clean items in a pot and fill pot with water
Boil for 2 minutes and keep pot covered until items are needed
Remove items with tongs and set on a clean paper towel

How to prepare water for formula feeding

Select water from a safe source

Choose unsoftened tap water, bottled water or well water to mix your baby's formula. However, none of these types of water are sterile.
Do not use mineral water, distilled water, carbonated water or softened tap water for formula preparation.
Well water should be tested at least twice a year for bacteria and nitrates. For more information about well water testing, contact Ottawa Public Health at 613-580-6744 ext. 23806.
Minimize lead exposure from tap water. Run your tap for approximately 2 minutes prior to drinking or cooking to flush stagnant water sitting in your plumbing.
In the morning, it is helpful to use water for flushing toilets, bathing, showering, etc. before using for drinking and cooking.

Boil water if needed:

Bring water to a rolling boil, which means that entire amount of water should be forming large bubbles and churning vigorously.
If using an electric kettle that is shutting off automatically too soon to achieve a full rolling boil, use a stove-top kettle or a suitable pan or pot instead.
After the water has reached a rolling boil, it should be removed from the heat, allowed to cool naturally, without the addition of ice, and protected from recontamination during storage.
Water should cool to a safe temperature for formula preparation (between room and body temperature) about 30 minutes after the boil.
Prepared formula should be given or stored right after it has cooled.
Boiled water can be stored in a covered sterile container for up to 3 days in the fridge or for 24 hours at room temperature.
If travelling, boil water at home and measure the correct amount of cooled boiled water into a sterilized container.
Boiling kills bacteria and other pathogens even if the water has suspended particles in it. If, however, settling or filtration is used on turbid (cloudy) water to improve how it looks, this should be done before boiling.
Hot water readily causes burn injuries to skin. Always take great care when boiling water to avoid burn injuries from spillage or splashing.

How to prepare infant formula

Baby's age	Boiling water	Sterilizing equipment
Infants less than 2 months	Always use water that has been boiled.	Always sterilize equipment
Healthy term infants 2 months and older	It is optional to continue boiling water if formula will be consumed immediately. If preparing formula for later use, use boiled water and sterilized equipment.	Always wash equipment in warm soapy water, rinse thoroughly and air dry of a clean surface. If bottle is being prepared for later use, it is recommended to use sterilized equipment.
Premature, low birth weight or weakened immune system infants	Consult your health care provider to know when you can stop boiling water.	Consult health care provider to know when you can stop sterilizing equipment.

See the “How to prepare water for formula feeding” and the “How to sterilize equipment for bottle feeding” sections if you need to boil or sterilize equipment.

Powdered infant formula

Fill scoop from can with powder and level with clean knife.
Add the required number of scoops of powder to the boiled and cooled water.
Pick up nipples, rims and caps with sterile tongs and put on bottles and then tighten with your hands.
Shake bottle well.
Cool bottle under cold running water.
Drink immediately or put bottles in refrigerator and use within 24 hours
Cover can with plastic lid and store in cool, dry place. Use within 1 month.

Liquid concentrate formula

Add an equal amount of liquid concentrate formula to the boiled water. Be sure to measure carefully.
Pick up nipples, rims and caps with sterile tongs and put on bottles and then tighten with your hands.
Shake bottle well.
Cool bottle under cold running water.
Drink immediately or put bottles in refrigerator and use within 24 hours
Tightly cover open can and put in refrigerator. Use within 48 hours.

Ready-to-feed formula

Shake can.
Open with a sterile can opener.
Pour amount of infant formula for one feeding into each bottle (use glass if possible).
DO NOT ADD WATER.
Pick up nipples, rims and caps with sterile tongs and put on bottles and then tighten with your hands.
Tightly cover open can and put in refrigerator. Use within 48 hours.

Automatic formula dispensing machines are not recommended

Automatic formula preparation machines for use at home are NOT recommended for the following reasons:

The water that is used may sit formant for a long time. More bacteria may grow in this water.
When the water is heated, it is not hot enough to kill bacteria that may be in powdered formula. This is important if your baby is premature, of low-birthweight or has a specific health condition and requires water to be boiled prior to preparing formula.
These machines do not consistently mix powdered formula well. Too much water may not meet the nutritional needs of your baby, and too little water may cause your baby’s kidneys and digestive system to work too hard and may cause your baby to become dehydrated.

Storing prepared formula

Do not freeze any type of formula. Freezing changes the fat content in infant formula.
Throw away any leftover formula at the end of each feeding.
If travelling for more than 30 minutes store bottles with an ice pack in a cooler or thermal lunch bag. Store formula in a refrigerator when you reach your destination.
Do not use prepared formula if it is unrefrigerated for more than a total of 2 hours.
Formula should be used within 24 hours from the time it was made, as long as it is kept in the refrigerator.

How to bottle feed baby

Watch your baby for early feeding cues. 
Wait for baby to open their mouth
Tip bottle slightly so there is no air in the nipple
Always hold your baby close in an upright position, hold baby skin-to-skin as often as possible
Watch your baby swallow and allow baby to rest (babies often need a break and you should allow them)
Burp your baby as needed
Stop feeding when your baby shows signs of being full
Keep your baby upright for at least 30 minutes after feeding
Throw away what your baby does not want to drink within 2 hours

How to warm your baby's bottle

Place the bottle of formula in warm water for 15 minutes. Shake the bottle to heat evenly. Check the temperature by putting a few drops on your wrist. Never microwave your baby's bottle. This creates "hotspots" that may burn your baby's mouth.

Guide to amount of infant formula to prepare

The amount of formula a baby needs is different for every baby. Follow your baby's hunger and fullness cues, outlined in the Feeding Cues section, to help guide feeding.

Newborns have very small stomachs. Use the table below as a general guide for how much infant formula to prepare at each feeding. In the first 6 weeks of life, most babies drink infant formula at least 6 - 8 times in 24 hours.

Remember: Your baby's appetite is the best guide for how much infant formula to offer. Let your baby decide when they are hungry and how much to drink.

Baby's age	Amount the stomach can hold
1 day old	5 to 7 ml (1 teaspoon) per feeding (size of a cherry)
3 days old	22 to 27 ml (4 to 5 teaspoons) per feeding (size of a walnut)
7 days old	45 to 60 ml (1 ½ to 2 oz) per feeding (size of an apricot)
2 to 3 weeks old	60 to 90 ml (2 to 3 oz) per feeding
1 month	80 to 150 ml (3 to 5 oz) per feeding (size of a large chicken egg)

Reference: La Leche League Canada (2022)

Introducing a bottle when breastfeeding (paced bottle feeding)

The way a baby sucks on a bottle nipple or pacifier is very different from how a baby sucks at the breast. For this reason it is best to not introduce any bottles until after breastfeeding is going well. This is usually about 4 to 6 weeks after your baby is born. Giving your baby a bottle before breastfeeding is going well can affect breastfeeding/nursing including building up your milk supply.

Paced bottle feeding

Paced bottle feeding is when you control or pace the flow of milk to be like breastfeeding/nursing. It also helps your baby keep breastfeeding/nursing behaviours while they feed from the bottle. Here is how to pace feeds:

Hold your baby in an upright position, supporting their head and neck with your hand.
Feed your baby skin-to-skin if possible.
Use a wide-based, slow-flow nipple.
Touch your baby's upper lip with the bottle nipple until your baby opens their mouth wide.
Tip bottle horizontally. Let your baby pull the nipple into their mouth so their lips close on the wide base of the bottle nipple.
Keep nipple partially full as it will help your baby control flow better. Your baby will naturally swallow air during feeds.
If your baby gets tense or gulps, stop feed. Stop the feed by tilting bottle down to stop flow but keeping bottle nipple in contact with your baby's lower lip. This way your baby can pull the nipple back into their mouth.
Your baby will learn to take breaks and 3 to 5 second pauses on their own usually after the fourth or fifth suck and as needed.
When you think your baby is nearly full, twist and remove bottle keeping the nipple lying on your baby's lip as described above. If your baby takes bottle again, let your baby feed for a short period (for example, 5-10 swallows) and repeat process. When your baby has had enough to drink they will not open their mouth when you try to give them the bottle. This is sign a baby uses to let you know they are full.
Throw away any milk left in the bottle after the feeding.

Transitioning to an open cup, weaning from the bottle, and introducing cow’s milk

How to do it:

Starting at 6 months, you can start to help baby drink from an open cup by offering water at meals and snacks. You can also offer breastmilk or formula in an open cup at meals and snacks, but this “practice time” should not replace regular nursing/bottle feeding sessions.
Continue offering breastmilk/formula on demand to ensure that baby get all the energy and hydration they need for their day as they learn how to eat solid foods and use an open cup.
Around 9 to 12 months, you can begin offering homogenized (3.25% M.F.) cow milk in an open cup at meals and snacks.
If bottle feeding, you can begin to transition baby from a bottle to an open cup for all fluids at around 12 months. At this age, homogenized cow milk, along with nutritious family foods, can provide all the energy and nutrients that your child needs to grow and develop.
By the age of 18 months baby should not be using a bottle.

What type of cups to use:

Introduce open cups first and once baby is able to drink from an open cup, you can introduce a straw cup. Drinking from an open cup or a straw cup, as opposed to a sippy cup, helps baby learn to drink like a big kid.
Sippy cups and 360 cups are not recommended. The infant get water out of these cups by sucking. These movements don’t help them develop the skill of drinking from a regular cup.
You can help your baby learn how to use an open cup by holding it against their mouth. Baby will use a familiar suckling pattern to “sip” the water. With time and practice they will be able to drink at their own pace.

Tips to wean from bottle:

Wean gradually
Use the bottle of least interest
Offer breastmilk or formula in a cup before every bottle feeding
Give an open cup instead of a bottle, one feeding at a time
Establish a routine for mealtimes
Tell your baby he or she is doing a great job
Use only water in the bottle, for all other liquids use a cup
Store bottles where your child cannot see them
If you choose to use a sippy cup, fill it with water only

For more information on weaning baby from the bottle, Download our factsheet: Time for a Cup - Weaning baby from the bottle