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If you have chosen to formula-feed your baby, you can find information here on how to make up feeds safely.

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When should you worry?

Newborn

NEWBORN

Contact your health visitor or GP if your baby is newborn and they…

  • Feel very stiff, for example:
    • Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs 
    • Find it difficult to change their position on their own 
    • You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
  • Feel very floppy, or have floppy arms or legs when awake
  • Move their arms and legs in repetitive jerky movements, or writhing movements
  • Don’t have a Grasp Reflex (doesn’t grab your finger or small object when you put it in their hand)
  • Are often startling and you cannot understand why
  • Move one side of their body more than the other, for example:
    • Rarely moves one of their arms compared to the other arm
    • Rarely moves one leg compared to the other leg
    • When your baby startles, one side moves or looks different from the other

6-8 weeks 

6-8 WEEKS

Contact your health visitor or GP if your baby is 6-8 weeks and they…

  • Feel very stiff, for example:
    • Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs 
    • Find it difficult to change their position on their own
    • You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
  • Feel very floppy, or have floppy arms or legs when awake
  • Move their arms and legs in repetitive jerky movements, or writhing movements
  • Have not started to bring both their hands to their face, or do not move their arms much
  • Keep their hands fisted, and you find it difficult to open their hands
  • Can’t lift their head when lying on their tummy
  • Move one side of their body more than the other, for example:
    • Mostly moves one arm or mostly brings one hand to their face
    • Rarely kicks or moves one leg compared to the other leg

2-3 months

2-3 MONTHS

Contact your health visitor or GP if your baby is 2-3 months and they…

  • Feel very stiff, for example:
    • Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
    • Find it difficult to change their position on their own
    • You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
  • Feel very floppy, or have floppy arms or legs when awake
  • Move their arms and legs in repetitive jerky movements, or writhing movements
  • Have not started to bring both their hands to their face, or do not move their arms much
  • Keep their hands fisted, and you find it difficult to open their hands
  • Can’t lift their head when lying on their tummy
  • Move one side of their body more than the other, for example:
    • Mostly moves one arm or mostly brings one hand to their face
    • Rarely kicks or moves one leg compared to the other leg

3-4 months

3-4 MONTHS

Contact your health visitor or GP if your baby is 3-4 months and they…

  • Have lost skills which they could do before
  • Feel very stiff, for example:
    • Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
    • Find it difficult to change their position on their own
    • You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
  • Feel very floppy when awake
  • Prefer to keep their arms by their sides. For example, they do not reach for things, or do not bring their hands together over their face or tummy
  • Move their arms or legs in repetitive, jerky, or strange ways
  • Still need you to support their head, or can’t lift their head when lying on their tummy 
  • Have very tight fists and it’s hard to open their hand
  • Move one side of their body more than the other, for example:
    • Rarely use one of their arms to pick up toys 
    • Rarely kick one leg compared to the other

4-6 months

4-6 MONTHS

Contact your health visitor or GP if your baby is 4-6 months and they…

  • Have lost skills which they could do before
  • Feel very stiff, for example:
    • Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
    • Find it difficult to change their position on their own
    • You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
  • Feel very floppy when they are awake
  • Move their arms or legs in repetitive, jerky, or strange ways
  • Move one side of their body more than the other, for example:
    • Rarely use one of their arms to pick up toys 
    • Rarely kick one leg compared to the other
  • Are unable to roll, or can roll in one direction but not the other
  • Find it difficult to reach their arms out. For example, they do not reach for toys
  • Still have their early reflexes, like the startle reflex and grasp reflex
  • Keep their legs flat when lying on their back. For example, they do not bring their feet to their chest
  • Still need you to support their head

6-9 months

6-9 MONTHS

Contact your health visitor or GP if your baby is 6-9 months and they…

  • Have lost skills which they could do before
  • Feel very stiff, for example:
    • Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
    • Find it difficult to change their position on their own
    • You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
  • Feel very floppy when they are awake
  • Move their arms or legs in repetitive, jerky or strange ways
  • Move one side of their body more than the other, for example:
    • Rarely use one of their arms to pick up toys, or eat and drink
    • Rarely kick one leg compared to the other
  • Can’t sit without support. For example, they lean on their hand, or, when they sit, their back is very curved
  • Still have their early reflexes, like the startle reflex and grasp reflex
  • Keep their legs flat when lying on their back, for example, do not bring their feet to their chest
  • Still need you to support their head
  • Still need you to help turn their head when lying on their back
  • Can’t crawl, or find it hard, for example, drags one of their legs behind them
  • Find it difficult to stand, for example:
    • Can’t stand with support 
    • Doesn’t try to pull themselves up to stand
  • Can’t move a toy from one hand to the other
  • Doesn’t use both hands to hold larger things

9-12 months

9-12 MONTHS

Contact your health visitor or GP if your baby is 9-12 months and they…

  • Have lost skills which they could do before
  • Feel very stiff, for example:
    • Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
    • Find it difficult to change their position on their own 
    • You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
  • Feel very floppy when they are awake
  • Move their arms and legs in repetitive, jerky, or strange ways
  • Use one side of their body more than the other, for example:
    • Lean to the side when they sit
    • Use one arm to pull to stand more than the other
    • Rarely use one of their arms to pick up toys, or eat and drink. 
    • Rarely kick one leg compared to the other 
  • Find it difficult to sit, for example:
    • Only sit with support
    • Lean on their hand when sitting
    • When they sit their back is very curved
  • Can’t move a toy from one hand to the other
  • Don’t use both hands to hold larger things
  • Don’t point to objects
  • Can’t crawl, or find it hard, for example, drags one leg behind them
  • Find it difficult to stand, for example:
    • Can’t pull themselves up to stand
    • Find it hard to pull themselves up. For example, they only use their arms and don’t push with their legs
    • Can’t stand with support

2 months

Your Baby By Two Months

Social/Emotional Milestones

  • Calms down when spoken to or picked up
  • Looks at your face
  • Seems happy to see you when you walk up to her
  • Smiles when you talk to or smile at her

Language/Communication Milestones

  • Makes sounds other than crying
  • Reacts to loud sounds

Cognitive Milestones (learning, thinking, problem-solving)

  • Watches you as you move
  • Looks at a toy for several seconds

Movement/Physical Development Milestones

  • Holds head up when on tummy
  • Moves both arms and both legs
  • Opens hands briefly

4 months

Your Baby By Four Months

Social/Emotional Milestones

  • Smiles on his own to get your attention
  • Chuckles (not yet a full laugh) when you try to make him laugh
  • Looks at you, moves, or makes sounds to get or keep your attention

Language/Communication Milestones

  • Makes sounds like “oooo”, “aahh” (cooing)
  • Makes sounds back when you talk to him
  • Turns head towards the sound of your voice

Cognitive Milestones (learning, thinking, problem-solving

  • If hungry, opens mouth when he sees breast or bottle
  • Looks at her hands with interest

Movement/Physical Development Milestones

  • Holds head steady without support when you are holding him
  • Holds a toy when you put it in his hand
  • Uses his arm to swing at toys
  • Brings hands to mouth
  • Pushes up onto elbows/forearms when on tummy

6 months

Your Baby By Six Months

Social/Emotional Milestones

  • Knows familiar people
  • Likes to look at self in a mirror
  • Laughs

Language/Communication Milestones

  • Takes turns making sounds with you
  • Blows “raspberries” (sticks tongue out and blows)
  • Makes squealing noises

Cognitive Milestones (learning, thinking, problem-solving)

  • Puts things in her mouth to explore them
  • Reaches to grab a toy she wants
  • Closes lips to show she doesn’t want more food

Movement/Physical Development Milestones

  • Rolls from tummy to back
  • Pushes up with straight arms when on tummy
  • Leans on hands to support herself when sitting

9 months

Your Baby By Nine Months

Social/Emotional Milestones

  • Is shy, clingy, or fearful around strangers
  • Shows several facial expressions, like happy, sad, angry, and surprised
  • Looks when you call her name
  • Reacts when you leave (looks, reaches for you, or cries)
  • Smiles or laughs when you play peek-a-boo

Language/Communication Milestones

  • Makes a lot of different sounds like “mamamama” and “bababababa”
  • Lifts arms up to be picked up

Cognitive Milestones (learning, thinking, problem-solving)

  • Looks for objects when dropped out of sight (like his spoon or toy)
  • Bangs two things together

Movement/Physical Development Milestones

  • Gets to a sitting position by herself
  • Moves things from one hand to her other hand
  • Uses fingers to “rake” food towards himself
  • Sits without support

1 year

Your Baby By One Year

Social/Emotional Milestones

  • Plays games with you, like pat-a-cake

Language/Communication Milestones

  • Waves “bye-bye”
  • Calls a parent “mama” or “dada” or another special name
  • Understands “no” (pauses briefly or stops when you say it)

Cognitive Milestones (learning, thinking, problem-solving)

  • Puts something in a container, like a block in a cup
  • Looks for things he sees you hide, like a toy under a blanket

Movement/Physical Development Milestones

  • Pulls up to stand
  • Walks, holding on to furniture
  • Drinks from a cup without a lid, as you hold it
  • Picks things up between thumb and pointer finger, like small bits of food
RED
RED
AMBER
AMBER
AMBER
AMBER
Green
Green

Advice and Guidance

Powdered infant formula

Powdered infant formula is not sterile and needs to be made up at a temperature which will kill any potential bacteria present. Even when tins and packets of powdered infant formula are sealed, they can sometimes contain bacteria. It is therefore important to know how to make and store infant formula milk safely and reduce the risk of your baby becoming unwell with an infection.

To reduce your baby’s risk of infection:

  • all equipment needs to be sterilised
  • each bottle of formula milk should be freshly made when it is needed
  • leftover formula milk should be discarded at the end of a feed
  • unused bottles of formula milk should be discarded if they have been kept at room temperature for over 2 hours (bacteria multiply very fast at room temperature and can also survive and multiply when in the fridge)

It is also important to follow the manufacturer’s instructions very carefully and use the scoop provided. The amount of water and powder may vary according to the brand.

Do not:

  • add extra formula powder (this can make your baby constipated or dehydrated)
  • add extra water (too little powder may not give your baby enough nourishment)
  • add sugar or cereals to your baby's formula
  • warm up formula milk in a microwave (it may heat the milk unevenly and burn your baby's mouth)
How to make a formula feed
Formula feeding to go with point 1.png

1.  Empty your kettle and refill it with at least one litre of fresh tap water from the cold tap. Do not use water that has been previously boiled or water that has been softened. Bottled water is not recommended to make up a feed as it is not sterile and may contain too much salt (sodium) or sulphate.

Formula milk point 2.png

2. Boil the water. Leave the water to cool in the kettle for no more than 30 minutes, so that it remains at a temperature of at least 70°C. If less water is used, the cooling time will be significantly shorter.

Formula milk point 3.png

3. Clean and disinfect the work surface you are going to use. It is also really important that you wash your hands with soap and water to stop bacteria spreading.

4. If you are using a cold-water steriliser, shake off any excess sterilising solution from the bottle and the teat, or rinse the bottle with cooled boiled water from the kettle (not the tap). 

Formula feeding to go with point 5.jpg

5. Keep the teat and cap on the upturned lid of the steriliser. Avoid putting them on the work surface.

6.   Follow the manufacturer’s instructions and pour the correct amount of water into the bottle first. Double check the water level is correct.

Formula milk to go with point 7.jpg

7. Loosely fill the supplied scoop with the formula powder and level it off using either the flat edge of a clean, dry knife or the leveller provided. Follow the manufacturer’s instructions and only put the suggested number of scoops in the bottle.

Formula milk point 8.png

8. Holding the retaining ring, put it on the bottle and screw it on. Cover the teat with the cap and shake the bottle until the powder is dissolved.

Formula milk point 9.png

9. It is really important to cool the formula, so it is not too hot to drink. Cool the formula by holding the bottom half of the bottle under cold running water. Move the bottle about under the tap to ensure even cooling.

Formula feeding to gp with point 10.jpg

10. Test the temperature of the formula on the inside of your wrist before giving it to your baby. It should be body temperature, which means it should feel warm or cool, but not hot.

11.  If there is any formula left in the bottle after a feed, throw it away.

12. To reduce the risk of infection, make up formula feeds as your baby needs them. One at a time.

Formula preparation machines

At present, there is no published research and insufficient evidence that these machines are safe to use when preparing infant formula. Powdered infant formula is not sterile and needs to be made up at a temperature which will kill any potential bacteria present. The Department of Health recommends that powdered infant formula is made up with a litre of freshly boiled water and left for no more than 30 minutes so that it remains at a temperature of at least 70°C. This will reduce the risk of your baby becoming unwell with bacterial infections, which can lead to sickness and diarrhoea.

For more information about the bacterial contamination of powdered infant formula, please visit:

www.firststepsnutrition.org/making-infant-milk-safely

Domestic hot taps

Powdered infant formula is not sterile and needs to be made up at a temperature which will kill any potential bacteria present. The water added to the bottle should be fresh (not re-boiled) and at least 70°C when the powdered infant formula is added. Although different brands of hot taps provide water at different temperatures and the time taken to fill a bottle varies, the limited research available suggests that powdered infant formula should be added:

  • immediately if volumes of 2 to 3oz (60 to 90ml) are being made up
  • after no more than 5 minutes for volumes of 4oz to 5oz (120ml to 180ml)
  • after no more than 10 minutes for volumes 6oz to 8oz (210ml to 240ml)

For more information about making up bottles of infant formula from hot taps and baby kettles, please visit: www.firststepsnutrition.org/making-infant-milk-safely

Baby kettles

Evidence examining the safety of baby kettles is limited. If you plan to use one, please visit www.firststepsnutrition.org/making-infant-milk-safely for further information

Bottled water

Cold tap water (boiled only once and cooled for no longer than 30 minutes) is best for preparing infant formula. However, in certain circumstances, you may need to use bottled water.

If you are using bottled water, you should:

  • use still water only, never use fizzy or sparkling water
  • always boil the bottled water before using it to make formula milk (bottled water is not sterile)

It is better not to use bottled water that is labelled as ‘natural mineral water’, as it can have higher levels of sodium and other minerals. However, it can be used temporarily to keep your baby hydrated if no other water is available.

Ready-to-feed liquid infant formula
  • Ready-to-feed liquid formula can be more convenient than powdered infant formula, but it is usually more expensive.
  • All feeding equipment will still need to be sterilised.
  • Ready-to-feed liquid infant formula is sterile until opened. However, once opened, it needs to be used more quickly than powdered infant formula.
  • Once opened, any unused ready-to-feed liquid infant formula that remains in the carton needs to be stored at the back of the fridge on the top shelf with the cut corner turned down. This should be used within 24 hours or discarded.

For more information about ready-to-feed liquid infant formula, please visit:

www.unicef.org.uk/babyfriendly/baby-friendly-resources/bottle-feeding-resources/guide-to-bottle-feeding

www.firststepsnutrition.org/making-infant-milk-safely

Self care and Prevention

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