Infant Formula

Use a commercial infant formula that you can buy from a store in Canada

• Check the expiry date on the can and make sure there are no dents or bulges.
• Infant formulas bought from stores outside of Canada may not be safe or have the right nutrition for your baby.
• Homemade infant formulas, such as evaporated milk formula, do not have the nutrients your baby needs to grow and develop.

Use a cow milk-based infant formula

• Only use soy-based or other special infant formulas if your health-care provider tells you to.
• Some families may use soy-based infant formulas for personal, cultural, or religious reasons.

Types of infant formulas

There are three types of infant formula:

• Ready-to-feed
  • do not need to mix with water
• Liquid concentrate
  • mixed with sterilized water
• Powder
  • mixed with sterilized water

Powdered infant formula is not sterile but is safe for most babies if it is prepared and handled properly. Powdered infant formula is not recommended for:

• Babies who are premature or had a low birth weight and are under two months of age unless recommended by your physician or dietitian
• Babies with a weakened immune system.

Check out Infant Formula: What You Need to Know for other important information.

Bottles and equipment

• Wash and sterilize all bottles and feeding equipment.
• Use home sterilizers you can buy in the store or a pot on the stove. Dishwashers don’t normally sterilize infant formula equipment.

If no instructions or sterilizer are available, use the following instructions:

• Clean all equipment with warm soapy water and rinse with clean water.
• Place equipment in a pot of water. The water should cover everything in the pot.
• Cover the pot and bring to a boil. Boil rapidly for 2 to 5 minutes.
• Let cool and remove equipment with sterilized tongs.
• Let all items air dry.
• Store equipment in a clean covered container.

There is NO age at which it is safe to stop sterilizing bottles and feeding equipment.

Water

• Sterilize water used to prepare infant formula.
• To sterilize water:
  • Boil water in a pot, or a kettle (that does not shut off before 2 minutes of boiling). Once the water is boiling let it continue to boil for 2 minutes.
• The following types of water are safe to use to prepare infant formula, once they have been sterilized:
  • Cold tap (not hot tap) water from your community, town, or city
    • If there is a boil water advisory or a drinking water non-consumption advisory in your community, buy water and sterilize it.
  • Private well water tested regularly to make sure it is safe to drink.
  • Bottled water that has no added minerals or vitamins.

There is NO age at which it is safe to stop sterilizing water for preparing infant formula.

Preparing infant formula

• Wash your hands with soap and warm water and sanitize the counter area.
• Always read the label and follow the directions when preparing infant formula, including how much formula and water to use.
• When preparing powdered infant formula, use sterilized hot water. The temperature must be over 70^oC to kill harmful bacteria that may be in the powder (this takes about 30 minutes). Cool the bottle of formula before feeding it to your baby. If storing the prepared formula, cool the bottle of formula under running cold water before placing it in refrigerator.

Automatic formula preparation machines for use at home are not recommended for preparing infant formula because:

• Bacteria can grow if the water sits too long in the machine.
• Water may not be hot enough to kill the bacteria that may be in powdered infant formula.
• The infant formula prepared by the machine may have too much or too little formula or water added.

Warming infant formula

• Heat the bottle of infant formula in a container of warm water for no longer than 15 minutes. If using a bottle warmer, then follow the manufacturing instructions. You can also use a bottle warmer.

• Heating bottles in the microwave can create “hot spots” that could burn your baby’s mouth.
• Check to make sure the infant formula is not too hot before feeding your baby. Check the temperature by placing a drop of the prepared mixture on the inside of your forearm. It should feel like room temperature.

• Once you open the can of infant formula, mark the date and time when you opened it on the container.
• It is best to use infant formula right after making it. If you haven’t refrigerated the prepared formula, use it within 2 hours.
• Refer to the table below for storage instructions for opened cans of infant formula and prepared bottles.

Check out Infant Formula: What You Need to Know for detailed instructions on preparing bottles, equipment, water and formula.

• Check to make sure the infant formula is not too hot before feeding your baby.
• Use your baby’s appetite to guide you on how much formula to feed. Follow your baby’s cues for hunger and fullness.
• Once your baby drinks from the bottle, throw out any leftover formula after 1 hour because the leftover formula can grow bacteria that can make your baby sick.
• Always hold your baby in an upright position when feeding. Cuddle, talk to and look at your baby while feeding.

Check out Infant Formula: What You Need to Know for other important information.

Most babies will do fine with different brands of infant formula, as long as they are the same type of formula.

If you have to switch your baby to a new formula, be patient. It may take time for your baby to adjust to the taste. They may also become gassy or fussy, but this should improve in a few days.

To help your baby adjust, if possible:

• Start by replacing a small amount of your baby’s bottle with the new formula
• Gradually increase the amount of the new formula, as your baby tolerates it.

If your baby is 9-12 months old, and eating a variety of iron-rich foods, you can start to transition to homogenized cow’s milk.

If you are having trouble finding formula for your baby, talk to your public health nurse. The following feeding practices are not recommended:

• Preparing homemade infant formula
• Diluting or watering down infant formula
• Introducing cow milk before your baby is 9-12 months old
• Using other beverages in place of formula, such as plant-based beverages
• Using breastmilk obtained online or directly from someone

• If your baby is breastfed, giving them formula can decrease your breastmilk supply and may lead to stopping breastfeeding before you had planned to.
• If you are thinking about using formula, or need to give formula, talk to your health care provider to get help to maintain your breastmilk supply and improve breastfeeding.

Check out Infant Formula: What You Need to Know for information about supplementing your breastfed baby.

Some babies grow attached to the bottle and don’t want to give it up. Be patient. Weaning usually works best when done gradually over several weeks or months.

Here are tips to help make weaning your baby from a bottle easier:

• As you introduce solids, start offering breastmilk and/or formula in an open cup at mealtimes. First, your baby will need help with the cup. Over time, you can stop their bottle-feedings.
• As you introduce fluids other than breastmilk and/or formula, offer them in an open cup.
• Bedtime and naptime bottles are often the hardest to give up. It is best if you don’t start this habit. If a bedtime or naptime bottle is part of your baby’s regular routine, gradually replace the bedtime or naptime bottle with a new routine such as cuddles, bedtime stories or songs. This will help your baby to learn to self-soothe without a bottle.
• Transfer your baby’s attachment from the bottle to another comfort object such as a blanket or a stuffed toy or replace the bottle with hugs and attention.
• Make sure other caregivers such as day care providers, grandparents and friends follow the same routine.