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Bottle Feeding


What is infant formula?

Most infant formulas are made from cow’s milk which has been processed to make it suitable for babies. It is the only suitable alternative to breastmilk as the sole source of nutrition for babies in the first six months of life.

It is available in two forms

  • Ready-to-feed liquid formula which is sold in cartons or bottles and is sterile.
  • Powdered Infant Formula which is NOT A STERILE PRODUCT

What about the different brands and types of formula?

There are several brands of infant formula with different company names. Although they each make claims about benefits to using their product such as supporting your baby’s immune or digestive system , there is no evidence that one company’s milk is better for your baby than any other. All brands of formula are regulated and have to meet legal requirements. The cost of the product and availability are good criteria to make a choice.

There are also different types of milk e.g first milk, second milk, follow –on milk, etc. This can be very confusing. Most brands in the UK come in ‘whey’ dominant and ‘casein’ dominant formulations. These refer to the proteins in the formula.

A ‘whey’ dominant milk is recommended as most suitable because whey proteins are easier for babies to digest

The current recommendation is that babies remain on a whey dominant milk (usually a stage 1 milk) until they can be weaned onto full fat cow’s milk at a year old.

Follow-on - milks are described as suitable for babies from six months of age. However, there is no evidence that changing to these milks offers any nutritional or health advantages to remaining on the stage 1 milks.

Around six months babies start to wean onto solid foods and this is a better source for extra nutrients they require e.g. iron.

The only supplement babies require is Vitamin D and this is because you can not get sufficient amounts of Vitamin D through dietary sources alone. The main way Vitamin D is made is through skin exposure to sunlight.

Vitamin D is added to all formulas. However when babies are consuming less than 500 ml of formula they require a vitamin supplement containing Vitamin D.

To find out more about the different types of formula available please see attached table entitled INFANT MILKS COMMONLY AVAILABLE IN THE UK

Further detailed information about UK formula milks is available on the First Steps Nutrition website -

www.firststepsnutrition.org

 

What are the rules about safe preparation?

Powdered infant formula is NOT A STERILE PRODUCT and there is a small risk of bacterial contamination which can cause serious illness.

Safer preparation of formula can reduce this risk. It is really important that the temperature of the water is at least 70 degrees C.

 
Infant Formula Preparation Machines - there is insufficient evidence that these machines are safe in the preparation of powdered infant formula.
 
A number of manufacturers are suggesting milks are made up at lower temperatures either because they contain probiotics or because they ‘clump’ if made up with hotter water.It is not recommended that parents or carers follow these instructions and milks made up at less than 70c are not considered suitable for infants in the UK.

CLICK ON GUIDELINES TO MAKING UP A FORMULA FEEDS

What about feeding away from home?

Option 1

  • You can use ready-to- feed infant formula as this is sterile and requires no preparation

Option 2

  • Make up the feed as described in guidelines, cool quickly and store in the back of the fridge for at least one hour.
  • Remove milk just before you leave and transport feeds in a cool bag with frozen ice bricks. Feeds transported in a cool bag should be used within 4 hours.
  • If you reach your destination within 4 hours, feeds transported in a cool bag can be placed in a fridge.
  • If made up formula is stored in a fridge it should be used within 24 hours – this is not ideal as the risk of bacterial growth increases the longer it is stored.
  • If made up formula is stored at room temperature it needs to be used within 2 hours.

If you have started giving your baby a feed discard any left over milk

Option 3

  • You can take the powdered infant formula in a small, clean and dry container.
  • A FULL vacuum flask of hot water that has just been boiled
  • An empty sterilised feeding bottle
  • Make up feed fresh as you need it.

If you need to warm feeds you can use bottle warmer or place in a container of warm water. Don’t leave a feed warming for more than 15 minutes. NEVER USE A MICROWAVE TO HEAT MILK AND ALWAYS CHECK THE TEMPERATURE OF THE MILK BEFORE GIVING IT TO YOUR BABY.

How do I help my baby feed from a bottle?

  • Hold you baby in your arms, across you body and close to you with their head well supported. 
  • Babies shouldn’t be flat on their backs to feed. Support them so that they are slightly raised and able to look at you 
  • Gently place the bottle teat against lower lip, pointing upwards. Wait until they open their mouth  and then place the teat inside, following the signs that they are ready 
  • Tip up the bottle at an angle so the teat fills with milk. They should be able to suck and swallow without spluttering. The teat needs to be filled with milk during the feed so that they don’t draw in air. 
  • When your baby slows her sucking and swallowing you can help ‘pace’ the feed by partially moving the teat out and then letting them draw it in again 
  • Interrupting the feed from time to time also gives your baby a chance to register how ‘full’  s/ he is, and thus control intake 

Your baby needs to be able to relate to those who are caring for him/her. Aim to keep the number of people who feed him/her as small as possible

How often should I feed my baby and how much?

You can usually trust your baby to feed according to appetite and the amount suggested on the tin or packet is only a guide.

Newborn babies have very small stomachs and will take small amounts to start with, but by the end of the first week of life most babies will ask for approximately 150-200 ml per kg of weight per day until they are six months.

For example a baby weighing 3kgs will require between 450 – 600ml a day.

This is then divided by the number of feeds so if the baby feeds 6 times a day then they will need between 75-100ml per feed.

Giving lots of milk in one feed will not necessarily enable the baby to go longer between feeds. It is just as likely to make him sick or to put on too much weight.

It is better to feed a baby before s/he becomes distressed as it is easier to feed a baby when they are calm.  Babies can often signal they need milk by:

  • Moving their arms and becoming restless
  • Rooting and moving their head
  • Finding something to suck usually their fingers

How do I know my baby is getting enough milk?

Your baby’s weight gain and the number of wet and dirty nappies will help inform you whether they are getting enough formula.

After the first few days there should be around 6 wet nappies a day .For the first few days after birth, the baby will produce dark sticky poos known as meconium. Towards the end of the first week, the poo should become pale yellow or yellowish brown and should have the consistency of mashed potato.

Often as the weeks pass babies poo less frequently. As long as the poo is soft the baby is not constipated. If the poo becomes hard and difficult to pass the baby could be constipated. Often this can be resolved by paying closer attention to the way the milk is made up or by changing the type of formula used. Parents often find that using a formula which is marketed for ‘hungrier’ babies and is ‘casein’ dominant can cause constipation. Changing back to stage 1 milk which is ‘whey’ dominant can help. Ask a member of your health visiting team for help.

What about teats and bottles?

Teats can be made from rubber or silicone and vary in shape. There is no evidence that one teat is better than another and it is fine to try different teats.

  • Size of teat hole accounts for observed variability in milk flow.
  • Starting guide: milk should drop out of upturned bottle at 1 drop/second.
  • If milk flow  is too fast, baby will most likely drool

What about mixed feeding- combining breast and formula milk?

Parents often do this for a variety of reasons but it is important to think through why you are doing this as it can make breastfeeding work less well.

  • Milk production will decrease if you replace breastfeeds with formula. LESS MILK OUT= LESS MILK MADE
  • Breastfeeding and formula feeding require different techniques on the part of the baby and sometimes babies find it difficult to breastfeed after they have had a bottle.

If you want to give formula because you feel you baby is not getting enough breastmilk then it might help to talk it over with a professional or access breastfeeding support. There are ways to increase your breastmilk supply but starting giving formula straight away will not help.

Some parents are told that giving a bottle of formula makes the baby sleep better at night. There is no evidence that this is true and those night feeds are important to keep milk production going-especially in the early weeks. Think about getting practical help from friends and family so that you can rest during the day and get through those early weeks. The baby will naturally start to go a little longer at night between feeds

Sometimes mums decide to use a bottle of formula so that their partner or someone else can be involved with feeding. Partners can be involved in many other aspects of care. If partners really want to feed the baby then mums can express breastmilk.

It is usually a good idea to get breastfeeding working well over a few weeks before a bottle is introduced, so that the milk supply is well-established and the baby know how to breastfed well.

If the decision is made to give the baby some formula, then the impact on your supply can be minimised by keeping the total amount as small as possible.

A few mothers and babies hit a breastfeeding crisis for example more formula is needed to prevent the baby becoming dehydrated and/or to ensure the baby has enough energy to feed effectively on the breast.

With support you can return to full breastfeeding

Please click on following to find out more about formula feeding.

Further information about UK formula milks is available on the First Steps Nutrition website

This link is to Infant Milks : A simple guide

http://www.firststepsnutrition.org/pdfs/Infant_milks_a_simple_guide_England_July2016.pdf

This second link is to a more detailed document:

 http://www.firststepsnutrition.org/pdfs/Infant_Milks_September_2016.pdf

 

 

 

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