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Infant Formula

Informed Decision Making about Infant Feeding

Deciding how to feed their baby is one of the many very important decisions your patients will make. In order to help your patients make the best choices for them and their baby, they need good, quality information. The Middlesex-London Health Unit (MLHU) can assist with providing this information.  The Middlesex-London Health Unit is a Baby-Friendly Designated organization, which means that our organization supports all families regardless of their infant feeding choices. 

Healthcare providers can support patients and their families by engaging in discussions about breastfeeding and formula feeding early in pregnancy in a non-judgmental manner. The healthcare provider should provide information to allow patients and their families to make an informed decision and then should support that decision. Healthcare providers can remind patients and their families that even if they have decided to formula feed, it is acceptable to change their mind and try breastfeeding. Providing even a small amount of breastmilk is beneficial to infants.

If a family has decided to give their baby infant formula, commercial infant formulas are the most feasible alternative. Homemade infant formulas, cow’s milk, goat’s milk and other plant-based beverages are not recommended as they are not nutritionally sufficient to meet the needs of the infant. Families will need to learn how to safely prepare and feed commercial infant formula to their baby. Healthcare providers should ensure that families have accurate, evidenced based information. The following information can be provided to families who have decided to formula feed.

All formula preparation equipment, bottles and water should be sterilized, as long as formula is being used, regardless of the child’s age. There is no evidence that indicates when it is safe to stop sterilizing.


Steps to Safely Prepare Commercial Infant Formula

Sterilizing Water

  • Tap water and bottled water can be used to make formula. There is no advantage to using bottled water when public water is safe. It is recommended not to use carbonated or mineral water to make formula. Distilled water is not necessary.
  • Water should be brought to a hard boil in a pot on the stovetop for two minutes. Sterilized water can be stored in a clean covered container at room temperature for 24 hours or in the fridge for two to three days.

Sterilizing Equipment

  • All equipment that will touch the formula should be washed with a brush in hot, soapy water and rinsed well. 
  • Nipples that are swollen, cracked or sticky should be thrown out.
  • All feeding equipment should be sterilized before each use.
  • Clean bottles, nipples, tongs, knife and can-opener should be placed in a pot of water and boiled hard for two minutes.
  • Items should be removed from pot with sterile tongs and placed on a clean towel to dry.
  • Dishwashers do not reach a high enough temperature and do not sterilize equipment.
  • Microwave sterilizers are safe to use. Be sure to follow the manufacturer’s instructions.

There are three different forms of commercial infant formula:

Powdered infant formula (PIF) is not sterile. Harmful bacteria (such as Enterobacter sakazakii (Cronobacter spp.) and Salmonella enterica) have been found in powdered formula and can cause food- borne illness. This is rare and is less of a risk for babies that are healthy and born full term. Proper preparation, handling and storage practices for PIF are recommended to reduce the risk of bacteria-related illness.


For healthy babies born full term:

When powdered infant formula is prepared for a healthy baby, it can be mixed with water that has been sterilized and cooled. One bottle can be prepared at a time and then fed right away to baby. It can be offered at room temperature or slightly warm.

For babies at greatest risk of infections from powdered formula:

It is best to offer at risk babies, (born prematurely, low birth weight and under two months of age, or has a weakened immune system), liquid infant formula, such as liquid concentrate or ready-to-feed when possible. If powdered formula must be used, it should be prepared in a specific way to lower the risk of illness. Health Canada provides tips for preparing and handling powdered infant formula to make it as safe as possible for at risk baby.

Health Care Providers should instruct parents to follow the directions on the infant formula packaging and be sure they use the correct measurement of water.


Health Connection

Call Health Connection to speak with a Public Health Nurse from the Middlesex-London Health Unit.

  • 519-663-5317 ext. 2280
  • Monday - Friday
  • 8:30 a.m. - 4:30 p.m.
Date of creation: December 24, 2017
Last modified on: September 5, 2019


1Health Canada, Canadian Paediatric Society, Dietitians of Canada, and Breastfeeding Committee for Canada. (2015, August 18). Nutrition for healthy term infants. Recommendations from birth to six months. Retrieved from
2Health Canada. (2010, February 15). Recommendations for the Preparation and Handling of Powdered Infant Formula. Retrieved from