What are infant feeding items?

Infant feeding items include bottles and the nipples, rings, and caps that go with them. Certain bottles also may include valves or membranes. Some infants may be fed with a syringe, medicine cup, spoon, or supplemental nursing system.

Can I use a blender, whisk, or spoon to mix formula?

The safest method of mixing formula is by shaking or swirling the formula and water inside the feeding bottle. Blenders can be difficult to clean, and blenders used to prepare infant formula have been linked to illnesses among babies. Whisks and spoons are easier to clean, but they still may increase the risk of getting germs into your baby’s milk.

How often should baby bottles be cleaned?

Bottles should be cleaned after every feeding. If your baby does not finish drinking a bottle within 2 hours, throw away the unfinished formula. Germs can grow quickly if breast milk or formula is added to a partially used bottle, or if a used bottle is only rinsed, rather than cleaned.

How do I clean infant feeding items in the dishwasher (if dishwasher-safe)?

1. Take apart. Separate all bottle parts (for example, bottles, nipples, caps, rings, valves).
2. Rinse. Rinse bottle parts and any other feeding items by holding them under running water. The water can be warm or cold.
3. Wash. Place bottle parts and other feeding items in the dishwasher. (Be sure to place small items inside a closed-top basket or mesh laundry bag so they don’t end up in the dishwasher filter.) If possible, run the dishwasher using hot water and a heated drying cycle (or sanitizing setting); this can help kill more germs.
4. Remove from dishwasher. Wash your hands with soap and water before removing and storing cleaned items.
   • If items are not completely dry, place them on a clean, unused dish towel or paper towel to air-dry thoroughly before storing in an area free of dust or dirt. Do not use a dish towel to rub or pat items dry because doing so may transfer germs to the items.

How do I clean infant feeding items by hand?

• Wash hands. Wash your hands well with soap and water for 20 seconds.
• Take apart. Separate all bottle parts (for example, bottles, nipples, caps, rings, valves).
• Rinse. Rinse bottle parts and any other feeding items by holding them under running water. Do not set them in the sink. The water can be warm or cold.
• Wash feeding items.
  • Place all items in a clean basin or container used only to clean infant feeding items. Do not wash directly in the sink because it may contain germs that could contaminate these items.
  • Fill wash basin with hot water and add soap.
  • Scrub items using a clean brush that is used only to clean infant feeding items.
  • Squeeze water through nipple holes to be sure they get clean.
• Rinse again. Rinse by holding items under running water, or by holding completely under fresh water in a separate basin that is used only for cleaning infant feeding items.
• Allow to air-dry. Place bottle parts, wash basin, and bottle brush on a clean, unused dish towel or paper towel in an area protected from dirt and dust. Allow to air dry thoroughly.
  • Do not use a dish towel to rub or pat items dry because doing so may transfer germs to the items.
• Clean wash basin and bottle brush. Rinse the wash basin and brush well and allow them to air-dry after each use. Wash them every few days, either in a dishwasher with hot water and a heated drying cycle (if they are dishwasher-safe) or by hand with soap and warm water. If your baby is less than 2 months old, was born prematurely, or has a weakened immune system due to illness (such as HIV) or medical treatment (such as chemotherapy for cancer), wash basin and bottle brush after every use.

How do I clean brushes and basins used to wash bottles?

You can clean brushes and basins in a dishwasher if they are dishwasher-safe, or wash them by hand with soap and hot water. They can be sanitized with one of the following methods: boil, steam, or soak in bleach solution if recommended by the item’s manufacturer. If you steam an item, be sure the entire item fits in the steamer.

Do I need to clean infant formula containers?

No studies have shown that babies have become sick from contamination on the outside of an infant formula container. Also, powdered infant formula is less likely to become contaminated if it stays dry. Avoid using liquid cleaners on infant formula containers to help prevent contaminating powdered formula inside the container.

If you want to clean the formula container, use a disinfectant wipe or paper towel sprayed with disinfectant to clean the outside of the container and lid before it is opened for the first time. Do not submerge the container or place it under running water. Wait until the surfaces are completely dry before opening the container. Do not clean the inside of the infant formula container.

Do I need to clean infant formula scoops?

When powdered formula stays dry, it’s less likely to get contaminated. To keep liquids away from the powdered formula, don’t clean the formula scoop unless it gets dirty. If the scoop was dropped on the floor or otherwise soiled, clean it as carefully as you would your baby’s bottles and allow it to air-dry completely before placing it in the formula container.

How do I sanitize infant feeding items for extra protection?

• Note: If you use a dishwasher with hot water and a heated drying cycle (or sanitizing setting) to clean infant feeding items, a separate sanitizing step is not necessary.
• For extra germ removal, sanitize feeding items at least once daily. Sanitizing is particularly important when your baby is younger than 2 months, was born prematurely, or has a weakened immune system. Daily sanitizing of feeding items may not be necessary for older, healthy babies, if those items are cleaned carefully after each use.
• Before sanitizing, make sure you have cleaned feeding items, bottle brushes, and wash basins using one of the methods above. Sanitize all items (even the bottle brush and wash basin) by using one of the following options. Check with the item’s manufacturer about which method to use.
  • Boil:
    • Place disassembled feeding items into a pot and cover with water.
    • Put the pot over heat and bring to a boil.
    • Boil for 5 minutes.
    • Remove items with clean tongs.
  • Steam:
    • Place disassembled items in microwave or plug-in steam system and follow the manufacturer’s instructions for sanitizing, cooling, and drying the items.
  • Bleach: (if you can’t boil, steam, or use a dishwasher)
    • Prepare a bleach solution of 2 teaspoons of unscented bleach per gallon (16 cups) of water in a clean wash basin.
    • Put all items completely underwater. Make sure the solution touches all parts and there are no air bubbles in the bottles.
    • Squeeze solution through nipple holes.
    • Soak items in solution for at least 2 minutes.
    • Remove with clean hands or tongs. Do not rinse because germs could get back onto the sanitized items. Any remaining bleach will break down quickly as it dries and will not hurt your baby. This process is similar to what is done to sanitize dishes in restaurants.
  • After sanitizing, place items on a clean, unused dish towel or paper towel in an area protected from dirt and dust. Allow to air-dry thoroughly before storing. Do not use a dish towel to rub or pat items dry because doing so may transfer germs to the items.

How often should baby bottles be sanitized?

If your baby is less than 2 months old, was born prematurely, or has a weakened immune system due to illness (such as HIV) or medical treatment (such as chemotherapy for cancer), sanitizing feeding items daily (or more often) is particularly important. Daily sanitizing of feeding items may not be necessary for older, healthy babies, if those items are cleaned carefully after each use.

How should I store infant feeding items safely?

Allow the clean feeding items, bottle brushes, and wash basins to air-dry thoroughly before storing to help prevent germs and mold from growing. Once the items are completely dry, put them back together and store them in a clean, protected area to prevent contamination.

1. Wash hands. Wash hands well with soap and water.
2. Put back together. Put together the clean, dry bottle parts.
3. Store safely. Place reassembled bottles and other feeding items, wash basin, and dry bottle brush in a clean, protected area such as inside a closed kitchen cabinet that is used only to store clean dishes.

Why should I air-dry infant feeding items on a clean towel instead of using a drying rack?

Air-drying infant feeding items on a clean dish towel or paper towel is probably more hygienic than using a drying rack. Drying racks may trap moisture, allow mold and germs to grow, and be difficult to clean. If you prefer to use a drying rack, use it to dry only your infant’s feeding items. Every few days (or at least daily if your baby is less than 2 months old, was born prematurely, or has a weakened immune system), be sure to wash it, sanitize it, and allow it to dry thoroughly to reduce contamination.

The Food and Drug Administration (FDA) oversees manufacturers of infant formulas and helps ensure that these products are safe and support healthy growth in infants who consume them.

Don’t Make Homemade Formula

The FDA advises parents and caregivers to not make or feed homemade infant formula to infants. Homemade infant formula recipes have not been evaluated by the FDA and may lack nutrients vital to an infant’s growth. It is important for parents and caregivers to remember that infant formula can be the sole source of nutrition for infants and is strictly regulated by the FDA.

The agency has requirements for certain nutrients in infant formulas sold in interstate commerce, and if the formula does not contain these nutrients at or above the minimum level or within its specified range, the infant formula is adulterated. The agency can take action to remove adulterated formula from the marketplace.

The agency has received reports of hospitalized babies who had been fed homemade infant formula and then suffered from hypocalcemia (low calcium). Other potential problems with homemade formulas include contamination and absence of, or inadequate amounts of, critical nutrients. These problems are serious, and the consequences may range from severe nutritional imbalances to foodborne illnesses, both of which can be life-threatening. Because of these severe health concerns, the FDA strongly advises parents and caregivers not to make and feed their infants homemade formulas.

Other Safety Issues to Keep in Mind

Formula Preparation: Use water from a safe source to mix with powdered infant formula. If you are not sure if your tap water is safe to use for preparing infant formula, contact your local health department or use bottled water. If your baby is very young (younger than 3 months old), was born prematurely, or has a weakened immune system, contact your infant’s pediatrician to find out if you need to take extra precautions in preparing your infant’s formula. Use the amount of water and number of powder scoops listed on the instructions of the infant formula label. Be sure to use the scoop provided by the manufacturer. Always measure the water first and then add the powder. If the formula is not being fed immediately, refrigerate it right away, keep refrigerated until feeding, and use within 24 hours. Discard any formula left in the bottle after your infant has finished a feeding.

Bottles & Nipples: Bottles, rings, caps, and nipples need to be clean and sanitized. To learn more about how to properly clean your baby’s bottles and other feeding supplies, visit the Centers for Disease Control (CDC) webpage “How to Clean, Sanitize, and Store Infant Feeding Items.”

Formula Warming: This isn’t necessary. If you prefer to feed your infant warmed formula, place the bottle under running warm water, taking care to keep the water from getting into the bottle or on the nipple. Put a couple drops of the infant formula on the back of your hand to make sure it is lukewarm and not too hot. Never use a microwave oven for heating infant formulas. Microwaving may cause the bottle to remain cool while hot spots develop in the formula. Overheated formula can cause serious burns to your baby.

“Use By” Date: This is the date up to which the manufacturer guarantees the nutrient content and the quality of the formula. After this date, a package or container of infant formula should not be fed to infants. FDA regulations require this date to be specified on each container of infant formula.

Storage: Manufacturers must include instructions on infant formula packaging for its handling before and after the container is opened. They must also include information on the storage and disposal of prepared formula.

Freezing Formula: This is not recommended, as it may cause the product’s components to separate.

Products on the Market

The American Academy of Pediatrics recommends exclusive breastfeeding for about 6 months, followed by continued breastfeeding as other foods and drinks are introduced with continuation of breastfeeding for one year or longer as mutually desired by mother and infant. While breastfeeding is strongly recommended and many mothers hope to breastfeed their infants, many infants in the U.S. rely on infant formula for some portion of their nutrition.

Infant formula comes in three forms:

• Powder — Must be mixed with water before feeding.
• Liquid concentrate — Must be mixed with an equal amount of water before feeding.
• Ready-to-feed — Requires no mixing.

The FDA’s nutrient specifications for infant formulas are set at levels to meet the nutritional needs of infants, and formula manufacturers generally set nutrient levels that are above the FDA minimum requirements. Thus, babies fed infant formulas do not need additional nutrients unless they are fed a low-iron formula.

The infant formulas currently available in the U.S. are labeled as either “Infant Formula with Iron” or “Additional Iron May Be Necessary.” The American Academy of Pediatrics recommends that formula-fed infants receive an “Infant Formula with Iron” as a way of preventing iron-deficiency anemia.

If you have concerns about infant formula, contact your health care provider and FDA at 1-888-INFO-FDA (1-888-463-6332), or you can file a report online at MedWatch.

Getting sick from Cronobacter does not happen often, but infections in infants can be deadly. Cronobacter infections in infants less than 12 months old are often linked to powdered infant formula. If your baby is fed with powdered infant formula, you can take steps to protect your baby from sickness.

Cronobacter sakazakii is a germ found naturally in the environment.

These germs can live in dry foods, such as:

• Powdered infant formula
• Powdered milk
• Herbal teas
• Starches

Rare but Serious Illness in Infants

Cronobacter infections are rare, but they can be deadly in newborns. Infections in infants usually occur in the first days or weeks of life. About two to four cases are reported to CDC every year, but this figure may not reflect the true number of illnesses. That’s because most hospitals and laboratories are not required to report Cronobacter infections to health departments.

Cronobacter germs can cause a dangerous blood infection (sepsis). They can also make the linings surrounding the brain and spinal cord swell (meningitis).

Infants who are more likely to get sick include:

• Infants 2 months and younger. These infants are most likely to develop meningitis if they get sick from Cronobacter.
• Infants born prematurely.
• Infants with weakened immune systems. Babies with this condition can’t fight germs as well because of illness or medical treatment, such as chemotherapy for cancer.

Cronobacter illness in infants will usually start with a fever and poor feeding, excessive crying, or very low energy. Some infants may also have seizures. You should take an infant with these symptoms to a medical provider as soon as possible.

Cronobacter infection can also be serious for:

• People 65 years and older.
• People who have immune systems weakened due to illnesses or conditions, such as HIV, organ transplants, or cancer.

Powdered formula is not sterile and might have germs in it.

Powdered infant formula can be contaminated in homes or in processing facilities that make it.

In the home:

You can accidentally get Cronobacter in powdered formula after you open the container. Cronobacter can live on surfaces in your home, such as a kitchen counter or sinks, and in water. Cronobacter could get into powdered formula if you place formula lids or scoops on contaminated surfaces and later touch the formula. It can also get into formula if you mix the formula with contaminated water or in a contaminated bottle.

In a processing facility:

Cronobacter can also get into powdered infant formula in a processing facility in these ways:

• If the manufacturer uses contaminated ingredients to make the formula.
• If the formula powder touches a contaminated surface.

Your baby is learning how to chew and swallow foods. This means your child may choke. By 12 months old, your child is getting better at eating and may even be feeding themselves. Even though your child can now eat most foods, some are still choking hazards. The way food is prepared may increase the risk for choking. For example, some foods that are served uncooked, whole, or in certain shapes or sizes can be choking hazards. Cutting up food into smaller pieces and mashing foods can help prevent choking.

Here are ways to help prevent your child from choking.

Foods and preparation

• Cook and prepare food to the right shape, size, and texture for your child’s development.
• Avoid small, sticky, or hard foods that are hard to chew and swallow.

Meals and snacktime

• Have your child sit up while eating (no lying down, crawling, or walking).
• Have your child sit in a high chair or other safe place.
• Avoid letting your child eat in the car or stroller.
• Keep mealtimes calm. Avoid distractions, disruptions, and rushing when eating.

Always

• Pay close attention to what your child puts in his or her mouth.
• Watch your child at all times while he or she is eating.

Be ready

• Talk to your child’s doctor or nurse to learn what to do if your child chokes.

Potential Choking Hazards for Young Children

Fruits/Vegetables

• Cooked or raw whole corn kernels
• Uncut cherry or grape tomatoes
• Pieces of hard raw vegetables or fruit, such as raw carrots or apples
• Whole pieces of canned fruit
• Uncut grapes, berries, cherries, or melon balls
• Uncooked dried vegetables or fruit, such as raisins

Proteins

• Whole or chopped nuts and seeds
• Chunks or spoonfuls of nut and seed butters, such as peanut butter
• Tough or large chunks of meat
• Hot dogs, meat sticks, or sausages
• Large chunks of cheese, especially string cheese
• Bones in meat or fish
• Whole beans

Grain Products

• Cookies or granola bars
• Potato or corn chips, pretzels, popcorn, or similar snack foods
• Crackers or breads with seeds, nut pieces, or whole grain kernels
• Whole grain kernels of cooked barley, wheat, or other grains
• Plain wheat germ

Sweetened Foods

• Round or hard candy, jelly beans, caramels, gum drops, or gummy candies
• Chewy fruit snacks
• Chewing gum
• Marshmallows