Formula feeding overview

Formula feeding is generally viewed as the delivery of artificial formula milk via a feeding bottle and teat to the baby.

In helping parents to safely feed their baby using formula milk, the following factors are important:

• information regarding the type of formula milk to use that is appropriate for their baby’s age/stage of development and any medical issues known;
  
• how to sterilize all feeding equipment;
  
• information on how to prepare formula feeds if using a powder or liquid concentrate preparation;
  
• techniques to physically feed the baby in a safe manner that also promotes parent–baby relationship;
  
• how much to feed their baby.

Types of formula milk

There are numerous brands of artificial formula milk available to parents in the United Kingdom. The milks can be classified in a number of ways. Whey protein-dominant milks are thought to be closer to the make-up of breast milk and thus are easier to digest. Thus they are advised for newborns. First milks are able to be used from birth to the first birthday when cow’s milk can be introduced. Casein protein-dominant milks are marketed for hungry babies as it is claimed that the higher proportion of casein takes longer to digest and the baby stays fuller longer and sleeps longer. There is no evidence that it is superior to first milks. Follow-on milks are marketed for use from six months of age.

Generally parents will use a powdered form that needs reconstituting before it can be fed to the baby. Such tins/packets of formula powder will come with manufacturer’s instructions for reconstitution and a plastic scoop for measuring the powder.

Sterilizing equipment

Sterilizing all feeding equipment is important as the baby’s immune system is still immature. The major threat to a baby is from gastroenteritis. Fungal infections may also possibly be transmitted via feeding equipment. The steps in achieving a satisfactory level of sterilization are as follows:

• Discard leftover feed.
  
• Rinse bottle and teat thoroughly.
  
• Wash in hot soapy water using a bottle brush to clean inside the bottle, around the neck of the bottle and use a teat brush (often on the other end of the bottle brush) to clean both the outside and the inside of the teat.
  
• Rinse all the cleaned equipment to remove soap.
  
• Use the chosen method of sterilization.

Sterilization may be achieved by one of the following methods:

• chemical sterilization using cold tap water and a sterilizing liquid or tablet;
  
• steam sterilizing using a microwave or an electric steam sterilizer;
  
• boiling in a saucepan for at least 10 minutes.

Preparation of feeds

Current advice is to make up each feed as the baby needs it. Key points to remember are:

• Boil the kettle with the required amount of water and leave it to cool for up to 30 minutes before pouring the required amount into bottle.
  
• Wash your hands and clean the surface to be used to prepare the feed.
  
• Measure out the required number of scoops of powder, levelling each scoop with the leveller and avoiding compression in the scoop. Generally use one scoop of powder for each fluid ounce of water.
  
• Ensure that when placing the teat and screw ring on the top of the bottle that the teat does not touch anything.
  
• Shake well to mix the powder and water thoroughly.

Feeding the baby

There are key safety issues involved in feeding the baby. After preparation of the feed, the temperature of the milk should be checked. Using the inside of your wrist is ideal because the skin in that area is sensitive to temperature. The milk should feel warm rather than hot on your inside wrist. If the milk is too hot, cool the bottle under cold running water and recheck it before feeding starts. The milk should never be made up hours in advance and stored in the fridge due to the risks of bacterial contamination of the powder by organisms such as Enterobacter sakazakii and Salmonella. Equally there is danger from warming chilled feeds using a microwave due to the risks of hotspots that may not be identified when the temperature of the milk is checked on the inside of the wrist.

Babies being fed artificial formula milk should be fed using a demand feeding approach. In this way the baby is able to vary the frequency of feeds and the amount taken at each feed. Observing for early feeding cues is important in order to have time to prepare a fresh feed.

The baby should be clean, dry, and warm and calm prior to the feed. It is an important time of communication between parent and baby and both mother and baby should enjoy the relaxed time. Prop feeding should never be undertaken as there is a risk of choking.

The bottle teat should be placed at the baby’s lips and when the mouth opens, slide the teat into the mouth so that it sits on the upper side of the tongue. It is important to avoid pushing the teat too far back into the baby’s mouth or the gag reflex will be stimulated. The bottle can then be tipped upwards until the flanged area of the teat fills with milk – this avoids excessive ingestion of air. The flow of the teat should be sufficient to provide well-formed drops of milk rather than an overwhelming rush of milk. The baby should be allowed to pace the feed with pauses between sucking bursts and will indicate when they have had sufficient. Burping, or winding, can be undertaken at the end of the feed or periodically during a feed.

How much to feed the baby

This will depend on age, appetite, feeding frequency and the individual preference of the baby. From 1 week to 6 months, a baby will need 150–200 mls/kg/day to meet nutritional needs.