Bottle feeding

How do I know if my baby is hungry?

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.

Tips for feeding formula
  • Give your baby only iron-fortified formula
  • Speak with your baby's health care provider before changing infant formula
  • Do not put your baby to bed with a bottle
  • Watch for feeding cues and signs that your baby is full
  • Read the labels carefully and check the expiry date on all formula packages. Make sure cans are clean and have no dents.
  • 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.
  • Never replace formula with 1%, 2%, skim milk, coffee whitener, condensed evaporated milk, or soy or rice beverages.
Types of formula

There are three types of formula that offer proper nutrition for your baby and meet Health Canada standards.

Infant formula type

Cost

Mixing directions/How To prepare

Storage

Liquid Concentrate

More expensive than powdered

Follow exact instructions for mixing as listed on the product. For infants up to 4 months of age it is important to mix formula with water that has been boiled.

*Sterile product when unopened. After opening, cover the can tightly with a lid and refrigerate. Read the labels for specific storage instructions.

Ready to feed

Most costly and convenient

Does not require any mixing or water

*Sterile product when unopened. After opening, twist the cap back on and refrigerate. Read the label for specific storage instructions.

Powdered

Important information for babies with specific health conditions. Please see below. **

Least expensive

Follow exact instructions for mixing as listed on the product.  Always mix formula with water that has been boiled. Prepared formula should be given or stored right after it has cooled.

Not a *sterile product. After opening, cover the can with the lid. Store in a cool, dark place for no more than 30 days.

 *Sterile: A product that does not contain harmful bacteria and does not pose a risk of infection.
 **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. If you are using powdered infant formula water should be boiled for 2 minutes and cooled to no less than 70 C (takes about 30 minutes) before mixing as per the packaging instructions. The prepared formula should be given immediately after it has cooled to the right temperature.

How to sterilize equipment

Follow these steps to keep your baby safe. Sterilize equipment until your baby is at least 4 months old.

Electric kettles and dishwashers do not sterilize equipment.

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
Making and storing formula

Each type of formula is made differently. Follow exact instructions listed on the product.

Mixing your baby's formula

  • Unsoftened tap water, bottled water and well water can be used to mix your baby's formula. However, none of these types of water are sterile.
  • Well water should be tested at least twice a year for bacteria and nitrates. For more information about well water testing or contact Ottawa Public Health at 613-580-6744 ext. 23806.
  • Do not use mineral water, distilled water, carbonated water or softened tap water for formula preparation.
  • Boil any kind of water for 2 minutes for babies until they are 4 months old. Use a pot on the stove or an electric kettle to sterilize water.
  • 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. If you are unsure about the safety of the water where you will be visiting ask your health care provider

How to prepare infant formula

For healthy-term infants

  1. Wash hands and counter with soap and water
  2. Run cold water for at least 2 minutes (use approved filter if you have lead pipes), boil water for 2 minutes and let it cool and use within 30 minutes
  3. Have sterilized equipment ready on a clean paper towel
  4. Read the label carefully, it will tell you how much formula and water to use. It could harm your baby if you add too little or too much water
  5. Wash top of can with warm water
  6. Pour boiled water into empty glass measuring cup
  7. Prepare formula - powdered, liquid or ready-to-feed
  8. Pour amount of infant formula for one feeding into each bottle (use glass if possible)
  9. Pick up nipples, rims and caps with sterile tongs and put on bottles and then tighten with your hands
  10. Shake bottle well
  11. Cool bottle under cold running water
  12. Put bottles in refrigerator and use within 24 hours

Powdered infant formula

Fill scoop from can with powder and level with knife. Add the required number of scoops of powder to the boiled water and mix until no lumps of powder are left. Cover can with plastic lid and store in cool, dry place. Use within 1 month.

Liquid formula

Add an equal amount of liquid concentrate formula to the boiled water. Be sure to measure carefully. Stir well with a sterile fork. Tightly cover open can and put in refrigerator. Use within 48 hours.

Ready-to-feed infant 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. Tightly cover open can and put in refrigerator. Use within 48 hours.

Storing 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
Guide to amount of infant formula to prepare daily

The amount of formula to feed is different for every baby. Follow the signs that tell you when your baby is full or hungry.

Age

Approximate amount of formula in each bottle in ounces and millilitres

Approximate number of feedings per day

Approximate amount of formula per day in ounces and millilitres

Birth

½ to 2 oz or 15 to 59 ml

6 to 10

14 to 22 oz or 410 to 650 ml

2 weeks

2 to 4 oz or 59 to 118 ml

6 to 10

16 to 26 oz or 470 to 770 ml

1 month

2 to 4 oz or 59 to 118 ml

6 to 8

17 to 29 oz or 500 to 860 ml

2 months

2 to 4 oz or 59 to 118 ml

5 to 7

22 to 35 oz or 650 to 1030 ml

3 months

5 to 6 oz or 148 to 177 ml

5 to 7

24 to 39 oz or 710 to 1150 ml

4 months

5 to 6 oz or 148 to 177 ml

5 to 7

20 to 37 oz or 590 to 1090 ml

5 months

5 to 6 oz or 148 to 177 ml

5 to 7

22 to 39 oz or 650 to 1150 ml

6 months

6 to 8 oz or 177 to 237 ml

4 to 5

17 to 35 oz or 500 to 1030 ml

7 months

6 to 8 oz or 177 to 237 ml

4 to 5

16 to 35 oz or 470 to 1030 ml

8 months

6 to 8 oz or 177 to 237 ml

4 to 5

17 to 37 oz or 500 to 1090 ml

9 months

6 to 8 oz or 177 to 237 ml

3 to 4

10 to 30 oz or 300 to 890 ml

10 months

6 to 8 oz or 177 to 237 ml

3 to 4

10 to 31 oz or 300 to 920 ml

11 months

6 to 8 oz or 177 to 237 ml

3 to 4

11 to 33 oz or 330 to 980 ml

12 months

6 to 8 oz or 177 to 237 ml

0 to 3

0 to 21 oz or 0 to 620 ml

Note: This table is a guide for the approximate amount of infant formula to prepare. The infant's appetite should be the guide for how much infant formula to offer. Adapted from Manual of Clinical Dietetics 2000, Institute of Medicine 2005, and World Health Organization 2004/2006.
For information on infant formula recalls please visit the Canadian Food Inspection Agency website.

How to bottle feed baby

 

  1. Watch your baby for early feeding cues
  2. Wait for baby to open their mouth
  3. Tip bottle slightly so there is no air in the nipple
  4. Always hold your baby close in an upright position, hold baby skin-to-skin as often as possible
  5. Watch your baby swallow and allow baby to rest (babies often need a break and you should allow them)
  6. Burp your baby as needed
  7. Stop feeding when your baby shows signs of being full
  8. Keep your baby upright for at least 30 minutes after feeding
  9. 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.

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 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 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 – 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

Want to speak with a Registered Dietitian

Call Health Connect Ontario and ask to speak with a Registered Dietitian. Available Monday-Friday 9am-5pm by calling 811 (TTY: 1-866-797-0007) or starting a chat

Do you have more questions about parenting?

  • Speak with a Public Health Nurse. Call the Ottawa Public Health Info Centre at 613-PARENTS [613-727-3687]  (TTY: 613-580-9656), reach out via our live chat , or email Ottawa Public Health at ParentinginOttawa@ottawa.ca
  • Connect with a Public Health Nurse and other parents on the Parenting in Ottawa Facebook page
  • There are a variety of services to make it easier for your child to grow up healthy in Ottawa

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