Feeding your baby with formula

Formula is an alternative to breast milk. It's a manufactured product made from processed milk and added nutrients designed to provide nutrition for babies. Infant formula is a safe option if you can't breastfeed, or if you choose not to.

Most infant formula products are made from cow's milk, with extra vitamins and minerals added. Formula also includes fat from vegetable oils. All approved infant formulas in Australia contain the nutrients that your baby needs.

Formula powder is mixed with cooled boiled water and offered to your baby in a bottle. You can also buy liquid formula, known as ready-to-drink formula.

Infant formula feeding supports your baby's growth during their first 6 months. Once they reach around 6 months (but not before 4 months), they can start eating solid foods as well.

The protein in most infant formula comes from cow's milk. Some formula products use protein from other sources like soybeans or rice. These formulas are suitable for babies who cannot tolerate cow's milk protein or lactose, and should only be used under the guidance of a healthcare professional. You should not give your baby soy-based formula unless your doctor has recommended it.

How is formula different from cow's milk?

Babies under 12 months should not have cow's milk as their main drink because they can't digest the protein and salt very well. Formula made from cow's milk is processed so babies can digest the protein. Feeding your baby regular cow's milk will lower their blood iron (Opens in new tab) levels.

How is formula different from breast milk?

Both breast milk and formula provide complete nutrition for babies during their first 6 months.

One of the main differences is that breast milk contains antibodies that help protect your baby from illness while their immune system is still developing.

The nutrients in breast milk naturally change to meet your baby's needs as they grow. Formula stays the same, but you can buy different types to suit their age and stage.

Breast milk contains the right amount of protein and nutrients for your baby. Some formulas are advertised as having more protein than breast milk. Too much protein is not healthy for your baby and can lead to a range of diseases later in life.

The amount of breast milk naturally adjusts to a baby's needs, but when feeding with formula you'll need to follow the instructions on the pack. These are based on your baby's age and weight.

There are many reasons why formula might be the best option for you and your baby.

Deciding to feed your baby formula is your choice. Speak to your doctor or maternal health provider if you have any concerns about this decision.

If you want to breastfeed but have difficulties or aren't making enough breastmilk, you might consider mixed feeding. Mixed feeding is when your baby drinks some breast milk and some formula. Mixed feeding with formula can make breastfeeding more challenging, as it can reduce your milk supply. Once you introduce a bottle, feeding at the breast can sometimes become harder. Babies may prefer the faster flow of a bottle and may also find latching at the breast more difficult.

There are several ways that formula is manufactured:

• milk-based formulas — based on cow's milk
• soy-based formulas — based on soybeans
• other formulas — made from cow's milk where the protein is removed, broken down or reduced. Hypoallergenic formulas are also available.
• added compounds — may include prebiotics, probiotics and antioxidants or long chain polyunsaturated (LCP) acids.

Manufacturers sometimes claim to make some formulas more like breast milk. This doesn't mean your baby can digest them in the same way as if they were breastfed.

What are the different formula products available in Australia?

In Australia, there are 3 main types of infant formula:

1. Stage 1 or starter formulas: these are suitable for babies aged up to 6 months.
2. Stage 2 or follow-on formulas: these are for babies aged 6 to 12 months and they often have a higher iron content. You don't have to change to a follow-on formula. You can continue using your current infant formula.
3. Other formulas: these are designed to suit babies with a food protein or milk allergy or another form of digestive, malabsorption or gut problem. Anti-reflux (AR) formulas have a thickener added that helps to keep the milk in the baby's stomach and reduce the chance of reflux. Use these formulas under the guidance of a health professional.

You might also choose a particular formula for cultural or religious reasons.

Non-standard baby formula can be expensive. Speak with your doctor or baby's paediatrician about getting a prescription to help reduce costs.

Toddler formulas

Toddler formula is made for children over 12 months old. After this age, healthy children don't need formula. They should be eating a variety of solid foods that follow the Australian Dietary Guidelines.

Speak to your child's doctor if you are concerned about their health and development.

Some babies are sensitive or allergic to cow's milk-based formula. The protein in cow's milk might cause your baby to have a reaction. Symptoms of a cow's milk allergy can include:

• slow weight gain
• gastrointestinal symptoms such as diarrhoea or blood in stool
• skin rash
• discomfort or fussiness after feeding

Speak to your doctor if you notice these symptoms in your baby.

Preventing allergy

Your health professional might suggest a hydrolysed formula instead. Hydrolysed formula contains cow's milk protein that has been broken down into smaller particles.

Giving your baby hydrolysed formula if they are not allergic to cow's milk-based formula is not recommended. There is no evidence that it reduces their chance of developing allergies later in life.

To reduce the risk of your baby developing an allergy, you should stop smoking during pregnancy and make sure your child is in a smoke-free environment.

It can be hard to know when your baby is hungry or if there is something else making them fussy. Babies cry for many reasons. Sometimes you won't know for sure that your baby is hungry until you offer a feed.

Babies usually cry when they are hungry. You should watch for hunger cues from your baby.

Then you can feed them on demand when they are hungry, rather than on a feeding schedule.

To know if your baby is showing hunger cues, you might:

• place the teat of the bottle in their mouth to see if they start sucking
• hold your baby in your arms as you would if you were breastfeeding
• cuddle them and look into their eyes for their cues or signals

Read more on hunger cues.

When feeding your baby, they will suck and swallow steadily. They may look as if they're concentrating on feeding.

Breastfed babies regulate their own milk intake. They suck when they're hungry and stop sucking when they're full. If you are using formula in a bottle, you have more control of how much milk they drink because you are holding the bottle.

Try to offer as much milk as your baby needs. You should feed them as much as they need according to their hunger cues and signals. This will change as they grow. Use the information on the formula container about how much a baby needs for their age or weight as a guide. Your baby may need more or less than it says on the label.

When your baby has had enough, they will usually pull away from the teat to let you know they are full. You may notice that their sucking slows down and they have longer pauses between sucks.

How much formula your baby needs each day will vary. Every baby is different and it's important to follow your baby's cues for when they are hungry and when they're full.

The Australian Infant Feeding Guidelines make recommendations on how much formula to feed your baby each day. Remember that it is a guide only and may not be exactly what your baby needs — some babies need more, some less.

The best signs that your baby is getting enough milk include that they:

• have plenty of wet nappies each day (6 or more)
• steadily gain weight
• are happy and active

Before you start to prepare formula:

• Read the information on the container.
• Check how much water and how many scoops of powder you will need to mix.
• Wash and dry your hands well.
• Make sure you have a clean sterilised bottle.
• Make sure you have a clean surface and space to work.

It is important to prepare and store formula properly. Things to take note of include:

• Only use bottles and feeding equipment that have been washed and sterilised.
• Make up each bottle as your baby needs to be fed. If you do need to store formula, place it towards the back of the fridge where the temperature is coldest.
• If your baby has not finished the formula in the bottle after an hour, throw away what is left. Formula and bottles become contaminated once the baby has fed from them. Do not store partly used bottles of formula.
• If you're going out, transport the cooled, boiled water and formula powder separately. Mix the 2 just before feeding. Otherwise, keep the prepared formula cold in an'esky' (cold storage container), baby bottle pack or cold bag.
• Never warm formula in a microwave. This can cause the milk to heat unevenly and lead to burns. Instead, warm up each bottle in a jug of hot water. Bottle warmers are another safe option. Follow the instructions provided.
• Always make up formula according to the instructions on the tin. If the formula is made too weak, it can cause poor growth and your baby will be hungry. If it is too strong, it can lead to constipation and your baby could become overweight.

All formula sold in Australia needs to meet strict nutritional and hygiene standards.

If you are bottle feeding your baby with formula, you should always hold them when feeding. This supports their emotional development. It also prevents the risk of them choking.

Do not leave your baby unattended with a bottle or prop the bottle against them.

To help your baby pace their feed, aim to stop rapid flow of milk from the bottle. This is important during the first weeks of your baby's life, as they develop their feeding skills. To slow the rate of milk flow from the bottle you can buy teats that have a slow flow. You can test the flow rate of your bottle by holding it upside down. Milk should come out drop by drop, rather than in a stream.

Check with your child health nurse if you're unsure about how much formula to offer your baby. They will guide you on the correct amount for your baby's age and weight.

The Sydney Children's Hospital has more information about different types of infant formula (Opens in new tab).

Learn more about food and nutrition in your baby's first year (Opens in new tab) from the Royal Children's Hospital.

Good for Kids by the NSW Government has a summary of the infant feeding guidelines (Opens in new tab).

The Australian Breastfeeding Association has information on choosing and preparing formula for your baby (Opens in new tab).

Food Standards Australia New Zealand (FSANZ) has a fact sheet on regulation of infant formula products (Opens in new tab).

Get Up and Grow has resources for Aboriginal and/or Torres Strait Islander peoples on infant formula (Opens in new tab).