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Baby's

First Year

Revised: Monday August 10 2015

Safety

Safe Formula Preparation

It’s important to make an informed decision about feeding your baby. Speak with a Public Health Nurse if you have questions.

Exclusive breastfeeding is recommended for the first six months of life. Breastfeeding should continue for up to two years or longer with appropriate complementary feeding starting around six months.

If you made an informed decision to formula feed your baby, choose an iron-fortified cow’s milk-based commercial infant formula, unless otherwise advised by your health care provider.

You must be careful to prepare formula safely or your baby can get sick. It’s best to make each bottle of formula fresh and use it right away.

Warning: We do not recommend using automatic formula preparation machines to prepare formula, as they do not use water hot enough to kill bacteria in powdered formula. Bacteria can cause serious illness in infants.

Sterilization of Feeding Equipment (bottles, nipples, rims, etc.) is recommended as long as your baby is drinking Formula:

Bottles and feeding equipment must always be sterilized for babies who are drinking formula, no matter what their age. Sterilizing kills germs that could make your baby sick.

Before starting always wash your hands with soap and warm water.

Step one:
Wash bottles, nipples, caps, tongs, can opener, measuring cup, stirring forks or wire whisk, in hot soapy water.

Step two:
Rinse all equipment well with hot water.

Step three:
Place all cleaned items in a deep pot of water with the lid off and boil for two minutes to sterilize.

Once cool, use the boiled tongs to remove items and allow to air dry on a clean towel.
Cover with a clean cloth until needed.

Commercially-produced Infant Formula comes in Three Forms:

Home-made formula is not a substitute for commercially produced infant formula and may be harmful to your baby.
Ready-to-feed – no water needed
Liquid concentrate – mix with safe sterilized water
Powder – mix with safe sterilized water

*Reminder to check Health Canada’s website for any infant formula advisories and recalls. You can find this information by searching ‘infant formula’ under the recalls and alerts tab.

Choosing Safe Water:

Municipal tap water is the best choice for your baby because it’s tested regularly to make sure that it’s safe. Use water from the cold water tap and let it run until it’s cold before using it for formula preparation.

If you have a well, test your well water regularly for mineral levels and contaminants.

Bottled water that is not fortified (has no added minerals or vitamins) and is not carbonated is also safe to use.

Certain types of water that should not be used are:

  • Softened tap water
  • Mineral water
  • Distilled water
  • Carbonated water
  • Soda water
  • Fortified water

Water for Mixing Formula must always be Sterilized (including bottled water):

In a large pot, boil water needed to make formula.
Sterilize water by bringing it to a rolling boil for two minutes.
Do not use a kettle that shuts off before the water has boiled for two minutes.

Preparing Ready-to-feed Infant Formula:

Comes in two forms:  

  • Cans
  • Pre-filled bottles

Step one:
Wash your hands with soap and warm water.

Check the can/pre-filled bottle of formula for dents/damage and check the ‘expiry’ date. Do not use if the can/pre-filled bottle is dented/damaged or is past the expiry date.
Check that the word “Ready-to-feed” is on the label and read the directions.
Wash top of can/pre-filled bottle with hot water.

Step two:

Can

Shake can well and open with a sterilized can opener.
Pour all formula into sterilized bottles. Use smaller glass bottles if possible.

Pre-filled bottles
Shake bottle gently before opening, twist off the cap

Step three:
Pick up sterilized nipple, rim and cap with sterilized tongs and put on bottles. Then tighten the rims with your hands.

Before feeding your baby check the temperature of the formula by dripping a few drops on the inside of your wrist. It should feel lukewarm, room temperature (25°C).
Do not store any open formula in a can.

Place bottles of extra formula on the top shelf of your refrigerator (4°C or lower) and use within 24 hours. Never freeze formula.

Preparing Liquid Concentrate Infant Formula:

Step one:
Wash your hands with soap and warm water.

Check the can of formula for dents and check the ‘expiry’ date. Do not use if the can is dented or is past the expiry date.

Check that the word “Concentrate” is on the label and read the directions.
Wash top of can with hot water.

Step two:
Shake can well and open with a sterilized can opener.
Measure the formula in a sterilized measuring cup and add equal amount of sterilized water which has been cooled to room temperature.

Mix well with a sterilized fork.

Step three:
Pour all formula into sterilized bottles. Use smaller glass bottles if possible.

Pick up nipple, rim and cap with sterile tongs and put on bottles. Then tighten the rims with your hands.

Before feeding your baby check the temperature of the formula by dripping a few drops on the inside of your wrist. It should feel lukewarm, room temperature (25°C).
Do not store any open formula in a can.

Place bottles of extra formula on the top shelf of your refrigerator (4°C or lower) and use within 24 hours. Never freeze formula.

Preparing Powdered Infant Formula:

Powdered infant formula is not sterile and may contain bacteria that are harmful to your baby.

For safety, children at high risk of health complications and those under 2 months of age should be fed commercially produced liquid infant formula and not powdered formula. At-risk children include those born prematurely, at a low birth weight, or with a vulnerable immune system. If you absolutely have to feed a child less than 2 months of age or at-risk child powdered formula, always use sterilized hot water no less than 70°C before adding the powder.

Step one:
Wash your hands with soap and warm water.
Check the can of formula for dents and check the ‘expiry’ date. Do not use if the can is dented or is past the expiry date.
Check and read the directions.
Wash top of can and plastic lid with hot water.

Step two:
Boil safe water for two minutes in an open pot.
Make the formula within 30 minutes of boiling the water.

  • After 30 minutes the water is not hot enough to kill harmful bacteria, no less than 70°C (158°F).

Step three:
According to directions on the can, pour the required amount of hot sterilized water into sterilized measuring cup (taking care to avoid burns).
Measure the temperature of the hot sterilized water with a sterilized digital thermometer to make sure it’s no less than 70°C (158°F).

Step four:
Open can.
Using the scoop that comes in the formula can, measure out the exact amount of powdered formula according to directions on the can.
Level the scoop with a sterilized knife.
Add powder to the hot sterilized water.

Mix well with a sterilized fork. There should be no lumps.

Step five:
Pour the mixed formula into sterilized bottles (taking care to avoid burns). Use smaller glass bottles if possible.
Pick up sterilized nipple, rim and cap with sterilized tongs and put on bottles. Then tighten the rims with your hands (use an oven mitt to hold the bottle and be careful not to burn yourself).

Step six:
Using an oven mitt, pick up the bottle.

Quickly cool the bottle of infant formula under cold, running water or in a container of cold water. Keep the rim and nipple area out of the water.

Cover opened can of powdered formula with the plastic lid and store it in a cool dry place in a cupboard.
Once opened use within one month of opening and before expiry date.

Before feeding your baby check the temperature of the formula by dripping a few drops on the inside of your wrist. It should feel lukewarm, room temperature (25°C).

Place cooled bottles of extra formula on the top shelf of your refrigerator (4°C or lower) and use within 24 hours. Never freeze formula.

Storing and Transporting Formula:
All properly prepared bottles of formula must be used within 24 hours.

Store formula on the top shelf of the refrigerator, never in the door of a refrigerator.

Stored formula should only be removed from the refrigerator just before

  • it’s going to be used and reheated or
  • transported in a cooler bag with icepacks
    • make sure formula is cooled before transporting it
    • if transported cold within two hours and then placed in a refrigerator, it can be used within 24 hours of the time it was prepared

Warming Previously Prepared Formula:

Step one:
Remove cold formula from the refrigerator just before it’s going to be used.
Warm formula to room or body temperature (25°C - 37°C) in a container of hot water or in a bottle warmer for no longer than 15 minutes.
Keep the rim and nipple area out of the water.

Do not heat bottles in the microwave.

  • It heats the formula unevenly, creating ‘hot spots’ that can cause serious burns to your baby’s mouth and throat.

Step two:
Swirl or gently shake the bottle to distribute heat evenly.
Dry the outside of the bottle with a clean cloth.

Do not refrigerate and do not reuse or reheat formula.

Before feeding your baby check the temperature of the formula by dripping a few drops on the inside of your wrist. It should feel lukewarm, room temperature (25°C).

Feeding Your Baby:

Always test formula temperature by letting a drop fall on your wrist before each feeding. It should feel warm or at least room temperature and not hot to touch.
Once you start feeding your baby, the formula should be used within two hours or discarded.

Feed your baby when she is hungry and ready to feed.

  • Watch and listen for baby’s hunger cues:
    • Licking lips and opening mouth
    • Trying to suck at whatever is close to her face
    • Rubbing her face with hands
    • Sucking on her hands
  • Crying is a late sign of hunger

Hold, smile and talk to your baby during feeding times and make it a special time for both parent and baby.

  • Always hold your baby during feeding
  • Skin-to-skin is important for babies because it:
    • helps stabilize baby’s heart rate, breathing, blood sugar and adjust to life outside the womb
    • keeps baby warm
    • helps you and your baby get to know each other
    • helps to soothe your baby
    • provides quality bonding time and can be practiced by mothers, fathers and other care givers in the family

Hold your baby in an upright position, supporting her head and neck with your hand and pace the bottle feed.

  • It allows your baby to drink at a comfortable rate and helps prevent overfeeding.
    • Use a wide-based, slow-flow nipple
      • Do not enlarge the nipple hole as it:
        • may cause choking
        • may cause overfeeding
    • Keep the bottle horizontal so that the nipple is partially full.
      • This will slow the flow of milk
      • It is not necessary to keep the nipple full of milk as all babies swallow air while feeding.
    • Baby will suck and swallow and breathe
      • If your baby does not take a breath by the third to fifth suck, remove the bottle and take a 3-5 second pause to let her breathe.
      • Your baby may suck harder when you try to take the nipple from her mouth, even though she needs a breath.
    • Often baby will swallow, then breathe, and then open her mouth.
      • This shows she is ready to begin feeding again.
  • Never prop a bottle because it can:
      • cause choking
      • lead to tooth decay
      • cause your baby to drink too much or too little
  • Do not add cereal or thickeners to the formulas:
      • baby will not get the right amount of nutrients for proper growth and development.
      • It may cause choking

Burping your baby helps to release air that is swallowed during a feeding.

  • Burp your baby when she is about halfway through a feeding or when she shows signs of needing to burp, such as:
    • arching her back
    • pulling/bending her legs
    • getting cranky or fussy
    • pulling away from the bottle

Watch for these cues that suggest your baby is full:

  • Falling asleep
  • Turning head aside
  • No longer sucking
  • Letting go of the nipple
  • Pursing lips

Remove the bottle if your baby shows any of these dangerous signs:

  • Swallowing quickly without taking a breath after each swallow
  • Milk spilling from her mouth
  • Opening eyes widely
  • Stiffening of arms and legs
  • Flaring nostrils
  • Grimacing
  • Lips turning blue

It could mean that the formula is flowing too quickly, or that your baby needs to take a breath or a break, or that your baby is full.

For more information:

Region of Peel – Public Health
905-799-7700
Monday to Friday 8:30 a.m. to 4:30 p.m.
Caledon residents call free of charge at 905-584-2216
To speak with a Public Health Nurse


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Revised: Monday August 10 2015

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