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Serving Bottles to Infants

This quick reference offers guidance on safely preparing and feeding infants and young children in child care settings. It covers important topics such as handwashing, thawing and warming human milk, bottle preparation, and feeding procedures.

1. Handwashing

Early educators and staff wash hands:

  • Before preparing a bottle
  • Before feeding an infant a bottle

Infants wash hands:

  • Before a feeding

2. Preparing a Bottle

Use bottles that are:

  • Labeled with the child’s name and date
  • Clean and sanitized
  • Stored properly in the refrigerator (temperature at or below 45 degrees) until feeding time*

If using glass bottles, make sure they have silicone sleeves to prevent breakage. If using plastic bottles, consider using safer plastic labeled BPA-free.

*See below for instructions on thawing human milk.

3. Bottle Warming

It is not necessary to warm formula or human milk. Bottles can be served cold from the refrigerator. However, the child or family may prefer that the bottles be warmed. If so, there are safe ways to warm a bottle.*

  • Bottles must be warmed in the kitchen or in a designated food preparation area in the classroom
  • For centers, this food prep area must contain a counter that is kept clean and in good repair, a dedicated food prep handwash sink, and refrigeration
    • Water used for bottle warming or bottle warming equipment should come from a designated sink not used for handwashing
    • Never hold an infant while warming or preparing a bottle
  • After warming the bottle, gently swirl the bottle to evenly distribute the temperature in the milk and mix the fat, which may have separated
  • Check the temperature of the milk by putting a few drops of milk on the wrist
  • The milk should feel warm, not hot

*See below for instructions on warming bottles with or without equipment.

4. Ready for Feeding

  • Hold infants during bottle feeding until they can hold the bottle themselves
  • Once infants can hold their own bottle, they can be placed in a feeding chair, such as a highchair
  • Do not prop bottles, as it increases the risk of choking
  • Feeding is complete when:
    • The early educator has stopped feeding the child because the child indicated they are done feeding
    • The child has been removed from the feeding area and returned to other activities
    • Before returning the child to other activities, the child should wash their hands if they touched the bottle
    • The early educator must wash their hands since the feeding is complete
  • After the feeding is done:
    • Leftover formula or human milk cannot be returned to the refrigerator
    • Leftover formula or human milk can be emptied in the sink, but bottles cannot be rinsed out
  • Leftover formula or human milk may be sent home at the end of the day in a cooler bag, with written permission from the child’s parent or guardian

Thawing Human Milk

Thaw human milk with water that is:

  • No warmer than 70 degrees Fahrenheit
  • From a dedicated sink that is never used for handwashing

Place the sealed container of milk:

  • In the refrigerator to thaw overnight (temperature at or below 45 degrees)
  • Under warm, running water
  • In a bowl of warm water

Label bottles with the date the milk is taken out of the freezer to thaw. Once thawed, keep human milk in the refrigerator for no more than 24 hours. Thawed milk should not be refrozen.

Warming a Bottle

Water used for bottle warming or bottle warming equipment should come from a designated sink not used for handwashing.

Without Equipment

Bottles can be warmed with water that is:

  • No warmer than 110 degrees
  • From a dedicated sink that is never used for handwashing

Warm the bottle by placing it:

  • Under running water
  • In a container of water that is no warmer than 110 degrees for no more than five minutes

The container used to warm bottles should remain out of reach of children and be washed, rinsed, and sanitized in the kitchen after use.

With Equipment

Bottle warming equipment should be:

  • Used in accordance with the manufacturer’s instructions
  • Checked regularly for malfunctions to be sure that water is not overheating
  • Kept out of reach of children
  • Clean bottle warming equipment when visibly soiled and at least daily.
    • Follow the manufacturer’s instructions to effectively clean and sanitize and avoid damaging bottle warming equipment. If the manufacturer’s instructions are unclear, clean and sanitize with a spray-on or wipe-on sanitizer. After sanitizing, let the equipment air dry.

Important Reminders

Do not warm bottles in a microwave or slow cooker.

Hot water and steam from bottle warming equipment can scald or burn infants. Check the water temperature used to warm the bottle to be sure it is not more than 110 degrees Fahrenheit. Dry the outside of bottles thoroughly before feeding.

References:

Caring for Our Children, Standard 4.3.1.3 Preparing, Feeding, and Storing Human Milk. https://nrckids.org/CFOC/Database/4.3.1.3

Caring for Our Children, Standard 4.3.1.9 Warming Bottles and Infant Foods. https://nrckids.org/CFOC/Database/4.3.1.9

NC Child Care Rules. https://ncchildcare.ncdhhs.gov/Services/ Child-Care-Rules-Law-and-Public-Information

  • 10A NCAC 09 .1719 (a)(28)

NC Child Care Sanitation Rules. https://ncchildcare.ncdhhs.gov/Services/Child-Care-Rules-Law-and-Public-Information

  • 15A NCAC 18A .2803
  • 15A NCAC 18A .2804
  • 15A NCAC 18A .2807(i)
  • 15A NCAC 18A .2810 (f)
  • 15A NCAC 18A .2812
  • 15A NCAC 18A .2815(e)
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