A Nurse’s Guide To Feeding Your Baby Formula

If formula feeding is going to play a role in your baby’s schedule, regardless of reason, you will need fact-based information on how to feed your baby formula in a safe and effective manner.

I am absolutely positive that I do not need to go on about how it is now recommended to breastfeed your baby exclusively for six months and beyond two years of age.

While it is important to find out whether your baby is getting enough breast milk, to learn about breastfeeding complications and solutions, as well as breastfeeding tips and tricks, it is also important to know as a parent that when it comes to feeding your baby, you will need to do whatever works for your family. This article will provide you with the information you need to bottle feed your baby with formula.

Formula Feeding Basics (2)

Choosing The Best Formula For Your Baby

(Photo from www.freedigitalphotos.net)
(Photo from www.freedigitalphotos.net)

Unless directed otherwise, always choose a cow’s milk based infant formula that contains supplemental iron.

Formula comes in several options including ready-to-feed, concentrated, and powdered formulations. What you decide to feed your baby depends on the health of your baby, along with many other factors.

  • Ready-to-feed: Do not add water, just pour and go. Most convenient and sterile. Highest price tag.
  • Concentrated: Water must be added according to package directions, normally a 50/50 ratio of concentrated formula to water. Sterile.
  • Powdered: Water must be added according to package directions, but normally is one scoop of powdered formula per two ounces of water. Not sterile.

Health Canada suggests that babies who are premature, are born at a low birth-weight, or that have a weakened immune system, should drink sterile liquid infant formula if they’re not being breastfed². This can include both ready-to-feed and concentrated formulas.

Formula Feeding Safety Practices

Your hands should always be washed thoroughly with soap and warm water before preparing formula. Clean counter tops that you will be working on regularly.

Read the directions on the formula container before use and check the expiration date. Feeding your baby formula in the wrong concentration can make her very sick.

Powdered formula is NOT sterile and can have bacteria packaged within including Enterobacter Sakazakii and Salmonella Enterica¹. Because of this, extra care must be taken when mixing powdered formula to prevent your baby from getting sick.

When mixing powdered formula, the World Health Organization now recommends:

  1. Boiling clean, cold tap or bottled water in either a pot or kettle to a rolling boil.
  2. Reading instructions carefully on how much powder and water is needed.
  3. Pouring the right amount of boiled water into the sterile bottle when it’s temperature is higher than 70°C (mixed within 30 minutes of boiling), in order to kill any harmful bacteria.
  4. Pouring the right amount of powdered formula into the sterile bottle with the included spoon.
  5. Mixing bottle together by gently shaking or swirling.
  6. Placing bottle under cold water right away to cool formula.
  7.  Drying bottle off.
  8. Checking temperature of mixed formula by dripping a small amount on your wrist.
  9. Feeding your baby.
  10. Throwing the extra formula away that is not used within a two hour window³.


Although boiled water is the best option for baby, you can use “fresh, safe water at room temperature” if boiled water is not readily available. In such cases, bottles should be used right away and extras should not be made in advance³.

Best Practices For Washing Baby Bottles

(Photo from www.freedigitalphotos.net)
(Photo from www.freedigitalphotos.net)

Bottles and accessories should be washed with hot, soapy water, rinsed well and air dried on a clean paper towel or cloth after each use. You can also use the hottest and longest setting on your dishwasher.

Always sterilize new equipment before it’s first use, by boiling in water for five minutes, using a microwave steam bag or a stand-alone sterilizer.

According to the World Health Organization and the Government of Canada, you should continue sterilizing equipment (nipples, bottles, tongs) and boiling water for the entire time you feed your baby formula¹,².

Other guidelines suggest that after your baby is four months of age you can discontinue sterilizing your equipment and boiling water ,. The Mayo Clinic even suggests that sterilization of equipment is not required after first use . You may want to ask your paediatrician what they suggest for feeding your baby, as recommendations seem to vary when it comes to sterilizing equipment after baby has begun interacting with the world (and of course the germs) around us.

Warming Your Baby’s Formula

Babies do not need their formula warmed up, but some may prefer it. Formula should NOT be warmed up in a microwave as doing so may create hot spots in the bottle which is dangerous to baby. You can warm formula up by placing bottle in a bowl of hot water for 15 minutes or less or using a bottle warmer.

Always check the temperature of the formula before feeding to your baby by dripping a small amount onto the inside of your wrist or the top of your hand.

Formula Storage Guidelines

(Photo from www.freedigitalphotos.net)
(Photo from www.freedigitalphotos.net)

Although it is recommended that formula be made for each feed it can be refrigerated for future use in a sterile container for up to 24 hours, provided it hasn’t been used before.

If travelling, make sure to pack pre-made formula or opened ready-to-use formula in an ice pack so that it stays cold enough so that it doesn’t breed bacteria. Another great option is to pack boiled water in a Thermos and the powdered formula in a sterile container, which gives the option of mixing them together as needed.

During a feed, bacteria transfers from a baby’s mouth to the bottle that is being used. Therefore, used formula should be discarded within two hours of when the feeding began, and should never be refrigerated for reuse.

If you frequently have left over formula after your baby’s feeds, try reducing the amount that you give to your baby at each feed and see if you can find a best amount that doesn’t result in waste. I know how expensive formula is!

Gassiness, Fussiness, and Spitting Up

It is common for babies to spit up and be fussy occasionally, and some babies do so more than others. Sometimes, babies are excessively gassy and fussy due to an issue with their formula feeding. Speak to your baby’s health care provider to see if your baby fits into the normal range or if her symptoms need further intervention.

If you and your health care provider are concerned, you may decide to:

  • baby-215303_1920Give baby smaller, more frequent feeds while giving your baby many chances to burp.
  • Keeping baby’s head elevated after feeds for a designated amount of time.
  • Raising baby’s head of her crib and/or a prescription for baby Zantac if Gastroesophageal Reflux Disease (GERD) is suspected.
  • Switching the brand of formula, or trying a formula designed for babies with a cow’s milk sensitivity or allergy.


Do you have any tips or tricks for formula feeding? Please share your stories in the comment section below! Thanks for reading, Mama’s!


World Health Organization. (2007). Safe Preparation, Storage and Handling of Powdered Infant Formula Guidelines. http://www.who.int/foodsafety/publications/micro/pif_guidelines.pdf

Government of Canada. (2011). Preparing and Handling Powdered Infant Formula. http://healthycanadians.gc.ca/eating-nutrition/healthy-eating-saine-alimentation/safety-salubrite/milk-lait/formula-nourrisson-eng.php

World Health Organization. (2007).How to Prepare Formula for Bottle-Feeding at Home. http://www.who.int/foodsafety/publications/micro/PIF_Bottle_en.pdf

Healthy Parents Healthy Children – Alberta Health Services. (2013). Safe Feeding Equipment. http://www.healthyparentshealthychildren.ca/feeding-your-baby/safe-feeding-equipment/

Healthy Alberta. (2009). Feeding Baby Infant Formula. http://healthyalberta.com/BabyFormula-Jan2009.pdf

Mayo Clinic. (2016). Infant Formula: 7 Steps to Prepare it Safely. http://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/infant-formula/art-20045791?pg=1


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Hi! I am a Registered Nurse on a unit that encompasses labour and delivery, postpartum, medical, surgical and palliative care in a rural hospital in Ontario, Canada. I am a mom of two and am passionate about women's rights, mom and infant care, parenting and nursing. I hope to create an educational, entertaining and highly relatable resource for women around the world. Thanks for stopping by! Xo, The Mama Nurse

15 thoughts on “A Nurse’s Guide To Feeding Your Baby Formula

  • January 27, 2016 at 7:53 pm

    Thank you sharing this. I breastfed my kids but this is good info to know.

    • January 30, 2016 at 8:38 am

      No problem, I thought it may come in handy to someone out there 🙂

  • January 27, 2016 at 10:19 pm

    Awesome well researched post! We always used bottled water to mix the formula, I didn’t even know boiled water was recommended.

    • January 30, 2016 at 8:40 am

      Yes it’s definitely not black and white. There’s a lot of confusion on best practices so I thought I’d better do my research. I was surprised when I read that you are to boil water not for the sake of the water but the formula!!

  • January 27, 2016 at 10:21 pm

    This is incredibly helpful! I nursed my first for 17 months, but when my second was in the NICU he was too weak at first to nurse (breathing issues). I would have done anything to get him home sooner, so bottles (and formula if pumping didn’t work out) were definitely an option! Our situation worked out to where he did nurse (11 months so far!) but I would have been totally lost if I had needed formula. A post like this would have answered all of my questions! Pinning and sharing! Thank you!

    • January 30, 2016 at 8:44 am

      Thanks for sharing Erin. It is a topic rarely discussed in hospitals now because everyone wants to support breastfeeding. Its unfortunate because a large percentage of women switch to formula when they’re home and may not have the facts

  • January 28, 2016 at 7:32 am

    Great post! We’ve been using a bottle warmer for our little guy mostly just because we got it as a gift! It conked out on us recently and we discovered he’ll pretty much just drink his bottle no matter the temperature! I assumed he’d want it warmed up because when he nursed, he was getting room temperature (body temperature!) food!

    • January 30, 2016 at 8:48 am

      A bottle warmer would definitely make life easier in the early days if you are bottle feeding. But yes, most babies will take a cold bottle just fine, once they get used to it! A friend of mine actually had the brilliant idea of putting a mini fridge in their room to house premade bottles for use at night. What a life saver!

  • July 21, 2016 at 4:40 am

    Thank you, very useful information!
    I always use boiled and filtered water with holle organic formula. It is also suggested on myorganicformula.com.

    All the best,

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  • August 25, 2016 at 6:36 pm

    wow ! Awesome post!
    Thank you very much for your amazing and useful post !
    Have a nice day !

  • February 9, 2017 at 12:34 pm

    My wife and I are looking for Feeding milk Thank for share

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