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Feeding hygiene: the genie is out of the bottle

Feeding hygiene: the genie is out of the bottle

Every component of the feeding bottle has to be sterilised to prevent infections. Paladai and nifty cups could also be used in place of the bottle

feeding hygiene- the need to sterilize the bottle feeder

When a child displays sudden bouts of vomiting, diarrhoea, ear pain, throat pain or stomach pain, these could be the early signs of bacterial infection. The culprit may be the feeding hygiene of the baby’s feeding bottle.

Feeding hygiene- Sterilisation from bacteria an illusion? 

Dr Asmita Mahajan, a neonatologist at Raheja Fortis Hospital, Mahim West, Mumbai, explains, “The nipple of the bottle feeder, which encompasses a tiny hole at its tip can harbour bacteria despite lengthy periods of sterilisation. A fall or a human touch can contaminate the bottle.”

Often, microorganisms (bacteria, fungi or viruses) could attack the infant’s throat, stomach, tooth, ears or skin through bottle feeding. “As much as one square inch area of our hand can carries crores of bacteria,” reveals Dr Sandhya Soneja, Pediatrician, Elantis Healthcare, New Delhi.

Cause of ear infection: Inadequate feeding hygiene?

Ear infections due to bottle feeding are common in a neonate, says Dr Srinivas S, chairman of the National IMA standing committee for child health. Studies indicate ear infections (in the form of otitis media or OM) are very common among infants and this can in turn affect their speech, hearing and language development.

A 2009 article published in the journal Paediatrics and Child Health points out that children who are bottle-fed and who swallow milk while lying down are at higher risk of developing ear infections.

“In bottle feeding, the tip of the nipple continues to enlarge as the child suckles and the milk gushes into the child’s mouth leading to ear infections. When the baby lies down while bottle feeding, the bottle feed can create negative pressure and milk enters the eustachian tube, located in the middle ear, causing irritation, swelling and eventually contamination,” Dr Srinivas S tells Happiest Health.

Feeding bottles could cause stomach infection

Dr Mahajan says that bottle feeding can also affect the respiratory or gastrointestinal tract.

Diarrhoea is another risk with bottle feeding. Dr Soneja recalls a recent case.

“A highly dehydrated five-month-old infant was rushed in after five episodes of vomiting and loose stools in a day. After ruling out the chances of viral diarrhoea, we identified the bacterial infection through a blood test and immediately administered antibiotics. This was a case of diarrhoea due to bottle feeding,” says Dr Soneja.

“The hazard of plastic is not unknown. Hot milk in plastic bottles or environmental contamination can cause diarrhoea. In extreme cases, it could also lead to child mortality,” warns Dr Soneja. Other than bacterial infections, fungal infections such as candidiasis are common among infants. “Immunosuppressive babies [such as those with leukaemia or cancer or those with malnutrition] are more prone to fungal infection,” says Dr Srinivas S.

Bottle feeding and tooth decay

Dr Yathish Kamath, a practising specialist dentist from the Sharjah, UAE tells Happiest Health, that feeding bottle caries or baby bottle tooth decay is a common case among infants who use feeding bottles extensively. He points out, “Baby bottle tooth decay leads to teeth alignment issues and the upper teeth are most affected.”

Hygienic bottle feeding practices

For many parents, bottle feeding is an occasional choice and breastfeeding is the oft-resorted option. However, for children with sucking issues (such as those with a weak heart, weak lungs, cleft palate, tongue, lips, vocal cords and other areas that affect the sucking process) or mothers who are unable to nurse, bottle feeding is the most suitable option.

Dr Suhaim Afsar, neonatologist and paediatrician from Motherhood Women and Children’s hospital recommends the following precautions while using feeding bottles:

  • Choose vented-feeding bottles: Vented bottles prevent air ingestion in the baby’s stomach. Thus, they are anti-colic and reduce the chances of vomiting or any form of intolerance. A 2000 study published in the International Journal of Pediatric Otorhinolaryngology indicated that fully-ventilated bottles can prevent ear infections and are similar to breastfeeding.
  • Choose BPA-free plastic feeding bottles: BPA (Bisphenol A) is a chemical that has proven to be harmful to the infant’s health. It can adversely impact behaviour, cardiovascular health and blood pressure too. Baby bottles should be BPA-free if they are plastic. One can also choose steel or glass.
  • Sterilise for 20 minutes: Sterilise every component of the feeding bottle (bottle, nipple, caps and other ancillaries) either using good quality sterilisers or in rolling boiled water for at least 20 minutes. Once sterilised, dry your feeding bottles at regular room temperature by placing them upside down in a clean and cool space.
  • Change your feeding bottles often: Considering your child consumes food at least eight to 12 times a day, keep at least six to eight feeding bottles sterilised and ready each day. Replace the feeding bottles with new bottles once in two to three months and the nipple in two to four weeks.
  • Opt for paced bottle feeding for non-vented feeding bottles: In this form of feeding, parents should carefully watch the baby to prevent any air ingestion. The baby should be seated in an upright position and ensure the nipple is constantly covered with milk. Also, the parents should be watchful of the tilting angle of the bottle.

Paladai: a sound alternative to bottle feeding?

Ms Sneha Baliga who delivered a premature baby could not breastfeed her child for a long time. However, she says, she resorted to the traditional Indian feeding technique. Southern parts of India use paladai instead of bottle feeders.

Paladai is a cup-like bowl with a beak-shaped tip used to feed a child when breastfeeding is challenging. It is most often a steel or silver cup. “Today a reusable, silicone cup known as a nifty feeding cup is used as an alternative to paladai. One can feed semi-solid and liquid food and this cup is softer with no sharp edges,” says Dr Mahajan.


  • Choose BPA-free and vented bottles.
  • For feeding hygiene, sterilise the feeding bottles (bottle, nipple, caps and the ancillaries) either using sterilisers or in rolling boiled water for at least 20 minutes.
  • Dry the sterilised feeding bottles at regular room temperature by putting them upside down in a clean and cool space.
  • Replace the feeding bottles with new bottles once in two to three months.
  • Replace the nipple every two to four weeks.
  • Choose healthier alternatives for feeding with paladai or nifty cups.

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2 Responses

  1. Very well written and in detail explanation understandable in simple terms. Valuable information with apt references.

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