Infant Feeding Part 2: Formula Feeding

Question 1

What is the only other option for feeding infants up to 6 months old?

Answer 1

Infant forumla - but it is inferior to breastmilk

Question 2

Does infant formula provide against immunity to disease?

Answer 2

No

Question 3

What are some of the reasons why infant formula is inferior to breastmilk?

Answer 3

1. Infant formulas are synthetic foods that carry contamination risks, such as bacteria and toxins
2. Formula-fed babies do not receive the immunological benefits of breast milk and are more likely to become ill and require hospitalisation
3. The growth pattern of formula-fed infants is different to that of breast-fed babies. Formula-fed infants lose less weight in the first few days following birth but they gain weight more quickly from around 4-6 months, which may increase their risk of cardiovascular disease in the future
4. Infant formulas are made to standard recipes and the composition does not vary with the differing needs of infants over time as breast milk does

Question 4

What are the Do’s and don’t of formula feeding ?

Answer 4

• Feeds should be prepared one bottle at a time
• Eye contact and cuddling the infant - skin to skin when possible – helps to release oxytocin in both baby and carer
• Do not force a baby to finish his feed or push a bottle in his mouth as this can lead to over-feeding.
• Keep the bottle tilted and sit the baby upright so that the milk does not pool at the back of his mouth.
• Any leftover milk after a feed should be discarded within two hours.

Question 5

How much/how often should formula fed babies be fed?

Answer 5

• They feed in small amounts but often follow the baby’s cues such as mouthing, rooting and fussing which are signs they are hungry to feed (this includes not making the baby finish milk, finish when they want to)
• The average formula intake from around day four to about 5-6 months of age is 150 ml/kg body weight in a 24 hour period.

Question 6

What is recommended for extra-fluids for formula fed babies in hot weather?

Answer 6

Formula-fed infants can be offered drinks of plain, cooled, boiled water.

Question 7

Why do breast fed babies not require extra fluids in hot weather ?

Answer 7

Breast milk composition changes in response to the baby’s needs for fluid, even in very hot weather.

Question 8

What 3 things can infant formula only be based on ?

Answer 8

Cows’ milk, goats’ milk or soya protein

Question 9

What are the different types of infant formula?

Answer 9

Cows’ milk infant formulas:

1. Whey-dominant formulas
2. Casein-dominant formulas
3. Modified formulas for minor digestive problems

Goats’ milk infant formulas

Soya based infant formulas - these arent recommended for infants under 6 months though

A range of specialised prescribable infant formulas for specific medical conditions such as food allergies, malabsorption syndromes and metabolic disorders. These should only be used under the supervision of a doctor or dietician. Only a doctor can prescribe them.

Question 10

What is the main difference between whey dominant and caesin dominant cows milk infant formula ?

Answer 10

Simply the ratio of whey:caesin

In one whey is higher in the other caesin is higher

Question 11

What do modified formulas designed for infants with minor digestive problems, such as colic consist of ?

Answer 11

Partially-hydrolysed protein, modified fat and thickeners.

Question 12

Are follow on formulas suitable for infants under 6 months ?

Answer 12

No! remember only infant formula can be used for infants under 6 months

Question 13

What are the 2 formats which infant formulas come in ?

Answer 13

• Dried powder which is not sterile
• Sterile UHT-treated ready to feed liquid that is more expensive

Question 14

What is the problem with dry powered formula and what can happen because of this ?

Answer 14

• It is not sterile
• Therefore it may contain a range of organisms Salmonella and Enterobacter Sakazakii (now referred to as Cronobacter spp) are the most dangerous.

Question 15

How can you reduce the risk of infection for bottle-fed babies?

Answer 15

• Use a liquid ready-to-feed formula for infants. (more expensive)
• Powdered formula should be added to water that has been freshly boiled and is above 70^°C.
• Freshly boiled water should be left to cool in a lidded kettle for no more than 30 minutes
• The batch of formula used should be cultured if an infant presents with botulism

Question 16

When parents do not follow the manufacture guidelines on making formula milk what are the potential problems which can arise ?

Answer 16

A risk of over- or under-nutrition.

• Over-concentration of feeds can result in constipation, hypernatraemia, vomiting and excess weight gain.
• Under-concentrating feeds may not provide the infant with sufficient calories or nutrients for growth and development.

Question 17

Storing prepared infant formula is advised against - T or F?

Answer 17

True - it increases the risk of bacterial growth

Question 18

If infant formula needs to be prepared in advance what it recommended for storage ?

Answer 18

• Keep them constantly at 5°C or below
• Use them within 24 hours
• Use a cool box with an ice brick to carry prepared feeds that need to be transported
• Refrigerated feeds should be warmed to room temperature by standing in a jug of hot water for a few minutes immediately before feeding. - do not use a microwave

Question 19

Bottles, teats, milk expression and other equipment are difficult to clean thoroughly and must be sterilised before being used up to 12months old, what are the suitable methods for steralising ?

Answer 19

The recommended methods of sterilisation are:

• Chemical
• Steam
• Microwave - with a special steamer
• Boiling water: equipment should be fully immersed in boiling water for ten minutes

Don’t use Microwave ovens without a special steamer or Dishwashers

Question 20

What are the risks of formula feeding?

Answer 20

• Increased illnesses in infancy and later life due to immune protection that is given in breastmilk
• Risks of contamination of the infant formula or the equipment used to feed baby
• Excessive weight gain in infancy through overfeeding when baby’s feeding cues are not followed
• Childhood obesity and associated diseases as a result of rapid weight gain in infancy

Question 21

How long can infant formula be used for ?

Answer 21

Infant formula is suitable for infants up to 12 months of age and there is no advantage in changing to a follow on formula from 6 months of age.