The promotion and support of breastfeeding is a vital part of my role as a maternity support worker. However, it is also important that women who choose to use formula milk are supported in their choice of infant-feeding (Scowen, 2009).
The NICE guidelines for postnatal care state that parents should be offered ‘appropriate and tailored advice on formula feeding’ including being taught how to prepare feeds, sterilise equipment and store formula milk (NICE, 2006).
It is therefore essential that healthcare providers are skilled in the correct preparation of powdered infant formula and are aware of the health implications, which are associated with poor hygiene and the incorrect preparation of feeds (Hormann, 2010).
Before you start✲ Wherever possible, powdered infant formula should be made up at the time of the feed to avoid storing prepared formula, as this encourages bacteria growth. If the prepared formula must be stored for later use, it must be refrigerated at no higher than 5˚C for no more than 24 hours (WHO, 2007)
✲ The water used to prepare infant formula should be normal tap water – avoid bottled water, softened water or water that has been repeatedly boiled as they will have a higher sodium content (Department of Health, 2011)
✲ The powdered formula is not sterile (Crawley et al, 2011) and may contain bacteria such as salmonella and enterobacter sakazakii. It is important to use boiled water at the correct temperature in order to kill the bacteria and protect against illness and infection (Hormann, 2010).
✲ The water should be heated to at least 70˚C – the easiest way to achieve this is to boil a kettle and leave it to cool for no more than 30 minutes
(Department of Health, 2011)
✲ Never use a microwave to heat infant formula, as this can cause dangerous hot spots to form within the milk (WHO, 2007)
✲ Clean the preparation area thoroughly and wash your hands
✲ Ensure the bottle, teat and lid have been sterilised before use.
Feeding amounts✲ Check the manufacturer's instructions regarding the correct water to formula ratio and the recommended intake of formula per feed depending upon the baby’s weight
✲ Over concentrating the feed by adding too much powdered formula and not enough water can lead to constipation, dehydration and in the long term can contribute to childhood obesity (Scowen, 2009)
✲ Using too little powdered formula means the feed will not fulfil the baby’s nutritional requirements and can lead to malnutrition and failure to thrive.
Making up the feed✲ Place the bottle on a level surface, add water to the bottle first to ensure the correct measure of liquid
✲ When measuring the powder always use the scoop provided by the manufacturer to prevent against errors
✲ Scoop the powder and level it off without compressing the powder
✲ Add the powder to the water in the bottle, attach the teat and lid, then shake for at least 10 seconds to mix the powder with the liquid
✲ Once the formula is well mixed and no powder remains, the feed should be used as soon as possible
✲ The temperature of the feed should be tested to prevent scolding. Do this by pouring a few drops onto the inside of your wrist. The optimum temperature is body temperature, so the milk should feel comfortable on your skin
✲ If the formula is too hot, cool it by holding the body of the bottle under cold running water and then re-test
✲ Any formula remaining in the bottle at the end of the feed must be discarded
✲ The bottle, teat and lid should then be rinsed thoroughly to remove traces of formula and re-sterilised ready for the next feed.
The author would like to acknowledge the support of Gina Short – senior lecturer at London South Bank University.
References
Department of Health. (2011)
Guide to bottle-feeding. See:
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_124525 (accessed 22 September 2011).
Hormann E. (2010) Reducing the risk for formula-fed infants: examining the guidelines.
Birth:
Issues in Perinatal Care 37(1): 72-6.
NICE. (2006) Postnatal care:
Routine postnatal care of women and their babies. Clinical Guideline 37. See:
www.nice.org.uk/CG037 (accessed 22 September 2011).
Scowen P. (2009) Bottle-feeding mothers and babies matter too.
Journal of Family Health Care 19(4): 112.
World Health Organization. (2007)
Guidelines for the safe preparation, storage and handling of powdered infant formula. See:
www.who.int/foodsafety/publications/micro/pif2007/en/ (accessed 22 September 2011).
