Infant feeding is the means of meeting the nutritional needs of the infant so that they may be healthy and happy. The World Health Organization (2003) recommends exclusive breastfeeding for the first six months of life with the introduction of complementary food after this point, while continuing to breastfeed up till the second birthday or beyond. Other food or drink can be used in the first six months if medically indicated or if there is evidence that the infant is not growing adequately.

In the first six months parents choose either breast (human) milk or artificial formula milk. After six months of age these milks can be used alongside weaning foods. Thus infant feeding incorporates:

• breastfeeding (breastmilk directly from the breast);
  
• bottle-feeding using artificial formula milk or less commonly breastmilk;
  
• mixed feeding – breast and artificial formula milk/breastmilk and solids/artificial formula milk and solids.

Parental choice is influenced by a number of physical, emotional and social factors. These include:

• prevailing societal/cultural/family attitudes/practices;
  
• attitude of partner;
  
• previous personal experience or having watched close friend or family member feed their baby;
  
• personal beliefs about their body function and image;
  
• knowledge of the different methods and their health and social benefits;
  
• perceived ease or difficulty with breastfeeding/formula feeding;
  
• media portrayal of infant feeding.

Parents in Britain gain information from a wide variety of sources, such as family and friends, parenting books/magazines, the internet, and health professionals. All of these sources of information can be both accurate and inaccurate. It is recognized that parents face a potential minefield of conflicting information about infant feeding choices and practices.

At the heart of the choice, parents need to be assured that their choice will achieve the following:

• normal pattern of weight gain and growth to achieve regaining birth weight by 2 weeks of age, doubling of birth weight by 6 months and tripling of birth weight by the first birthday;
  
• normal psychomotor development;
  
• normal cognitive development;
  
• happy parent(s) and baby.

While the ‘breast is best’ message dominates, many parents and professionals perceive artificial formula feeding to be an acceptable, though not best, alternative to breastfeeding.

Commercially manufactured artificial formula milks are the only recommended alternatives to breastmilk. Most formula milk is essentially modified cow’s milk. Modification is essential because cow’s milk is unsuitable for a baby under one year of age due to higher levels of elements such as sodium. Manufacturers are required to include the type and amount of specific ingredients. For example, the kcal value of the milk must be 60–70 kcal/100 mls – this ensures that any baby will receive sufficient nutrients to maintain their metabolism and grow.

The Infant Feeding surveys undertaken in the United Kingdom every five years have generally indicated that breastfeeding is more likely to be undertaken by women who are older, better educated, married or in a supportive relationship and who are in a higher socio-economic group.

There has been a sustained campaign from the Department of Health to improve the breastfeeding rates. At the last survey in 2010 there was some evidence of this continuing, though when the UK is measured against other countries or the World Health Organization strategy, the picture is not as encouraging. See the Figures for the rates of any breastfeeding from birth to six months with mothers moving from exclusive breastfeeding to the introduction of artificial formula milk on its own or in tandem with some breastfeeding, versus exclusive breastfeeding rates.

While it is accepted that both breastmilk and formula milk will provide nutritional adequacy in relation to protein, fat and carbohydrate composition, there is compelling evidence of the advantages in the ‘live’ species-specific nature of breastmilk. Breastmilk has immune-enhancing capabilities that extend beyond the colostrum phase. It is nutritionally complete and able to adapt to the changing needs of the baby over time.

All professionals need to ensure that they are up-to-date with information relating to infant feeding in order to provide parents with evidence-based information and care. They need to respect parental choice and offer support through general information, specific problem-solving in relation to parental care or medical management of conditions as well as providing an environment where parents feel comfortable meeting the nutritional needs of the baby.

Many parents worry about the quantities of milk to feed their baby. Determination of an overall feed can be influenced by the age of the baby/infant, the frequency of feeds, the response to feeding cues, and the baby’s satisfaction during and after feeds.

Early recognition of the baby’s feeding cues will help parents avoid stressful situations when the baby is upset and crying. This potentially can make feeding a distressing time for all involved and can erode parenting belief.