The purpose of this guideline is to provide guidance about infant feeding with formula at Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH).
Breastfeeding is the most appropriate method of feeding most newborn infants (Rationale 1). The following resource can support staff in assisting mothers with breastfeeding:
- 'Off to the best start' leaflet produced by UNICEF should be given to all breastfeeding mothers. It contains pictures and advice about positioning and attachment.
- Whilst actively supporting mothers to breastfeed where possible, it is acknowledged that this method of feeding may not be feasible for some mothers. This guideline highlights the alternative products that are available and proffers advice as to the best alternative way to feed babies.
Feeding the newborn baby
Formula feeding for babies
Feed volumes required
Preparing the feed
- Make sure the tamper proof seal is in place.
- Check the patient’s name and number on the bottle, and that it has not passed its use by date (Rationale 21).
- Term babies should have the standard teats. These teats are single use only and must be disposed of at the end feed; they must not be sterilised on the ward (Rationale 22).
- Pre-term babies should have a premature teat. Please note: the fast flow delivered by these teats may not be suitable for every pre-term baby. These teats are single use only and must be disposed of at the end of the feed; they must not be sterilised on the ward (Rationale 23).
- If the baby has their own teat system then use this e.g. Haberman teat. Please note: re-usable teats must be decontaminated in microwave sterilising bags available from the ward in accordance with the manufacturer’s instructions (Rationale 23).
Feeding the baby
Rationale 1: The benefits of human milk for normal growth and development and associated long-term benefits are well documented (American Academy of Paediatrics 2012; Angelsen et al 2001; Arenz et al 2004; Bartok et al. 2009; Cesar et al 1999; Fewtrell 2004; Horta et al. 2013; Jones et al 2000; Kramer et al 2001; Ladomenou et al 2010; Marild et al 2004; Quigley et al 2009; Sadauskaite-Kuehne et al 2004; Wilson et al 1998). To promote successful breastfeeding (Broadfoot et al 2005). Sick and premature infants may benefit from the immunological advantages of receiving breast milk (Kelleher & Lonnerdal 2001; Groer and Walker 1996; Mathur et al 1990). The suck-swallow-breathe reflex is not fully developed before 34 weeks gestation and may be delayed in infants with certain clinical disorders and premature babies (Arvedson and Brodsky 2002).
Rationale 2: To ensure successful and confident breastfeeding
Rationale 3: To ensure nutritional adequacy.
Rationale 4: To prevent potential contamination if feeds were to be prepared in the ward environment. To comply with infection control guidance.
Rationale 5: Whey-based infant formulas have a profile closer to that of breast milk.
Rationale 6: Term formulas do not meet the increased nutritional requirements of premature babies. The levels of some nutrients in preterm formulas are too high for term infants.
Rationale 7: To comply with patient choice (Department of Health 2004).
Rationale 8: There is no evidence to suggest that casein-based formulas ‘satisfy the hungry baby’.
Rationale 9: According to manufacturer’s instructions.
Rationale 10: To ensure that the correct feed is supplied and nutritional adequacy is guaranteed. To ensure feeds are made in a safe environment.
Rationale 11: To comply with infection control and security guidance.
Rationale 12a: Newborn babies gradually increase their intake from about 20ml/kg on the first day of life to 150ml/kg by seven days. To provide nutritional adequacy and meet fluid requirements. To prevent under or over-feeding.
Rationale 12b: As an indicator of nutritional adequacy.
Rationale 13: To maintain fluid balance. To provide extra fluid.
Rationale 14: To satisfy the baby’s natural feeding pattern.
Rationale 15: To ensure adequate nutrition and hydration.
Rationale 16: To prevent cross-infection.
Rationale 17: Warming feeds for term infants is not necessary, but most infants show a preference for warmed feeds, possibly due to the body temperature of breast milk.
Rationale 18: To ensure that non-sterile water on the surface of the bottle does not enter when the cap is removed. To prevent proliferation of any micro-organisms that may be present in non-sterile feeds.
Rationale 19: Hot spots may remain in the milk and burn the baby’s mouth. Heat sensitive vitamins will be destroyed (World Health Organisation 2007).
Rationale 20: Indicates that the feed is sterile, and has not been previously opened, ensures the feed is in date and the feed is therefore safe to use.
Rationale 21: Indicates the feed has not been previously opened and is therefore safe to use. To ensure that the correct feed is being given and that it is in date.
Rationale 22: To comply with infection control guidance. To ensure that the baby is fed from a teat most suited to their developmental stage.
Rationale 23: To comply with infection control guidance. To ensure that the baby is fed from a teat most suited to their needs.
Rationale 24: To check that the feed isn’t too hot.
Rationale 25: To enhance the feeding experience. To prevent overheating.
Rationale 26: To calm the baby (Murray and Andrews 2000).
Rationale 27: To prevent any potential microbiological contamination.
Rationale 28: So that the baby can suck properly.
Rationale 29: To comfort the baby (Murray and Andrews 2000).
Rationale 30: So the baby can continue to feed in comfort.
Rationale 31: To promote self-feeding in the future.
Rationale 32: The baby will become tired and bored.
Rationale 33: To prevent choking.
Rationale 34: To prevent any potential microbiological overgrowth (Robbins and Becker 2005)
Rationale 35: To comply with recommendations. (Scientific Advisory Committee on Nutrition 2016).
Rationale 36: To ensure that the correct supplements are given.
American Academy of Paediatrics (2012) Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics 129 (3): e827-e841.
Angelsen NK, Vik T, Jacobsen G, Bakketeig LS (2001) Breast feeding and cognitive development at age 1 and 5 years. Arch Dis Child 85 (3): 183-8.
Arenz S, Ruckerl R, Koletzko B, von Kries R (2004) Breast-feeding and childhood obesity -a systematic review. Int J Obes Relat Metab Disord 28 (10): 1247-56.
Arvedson JC, Brodsky L (2002) Pediatric Swallowing and Feeding Assessment and Management, 2nd Ed. San Diego, Singular Publishing Group
Bartok C, Ventura A (2009) Mechanisms underlying the association between breastfeeding and obesity. Inter J Pediatr Obes 4 (4): 196-204.
Broadfoot M, Britten J, Tappin DM, MacKenzie JM (2005) The Baby Friendly Hospital Initiative and breast feeding rates in Scotland. Arch Dis Child Fetal Neonatal Ed 90 (2): F114-6.
Cesar JA, Victora CG, Barros FC, Santos IS, Flores JA (1999) Impact of breast feeding on admission for pneumonia during postneonatal period in Brazil: nested case-control study. BMJ 318 (7194): 1316-20.
Department of Health (2004) National Service Framework for Children, Young People and Maternity Services. London, Department of Health.
Fewtrell, M.S. (2004) The long-term benefits of having been breastfed. Current Paediatrics 14 : .97-103. http://www.the long-term benefits of having been breast-fed.com [last accessed 22/09/17]
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Horta BL, Victoria CG (2013) Long-term effects of breastfeeding: a systematic review. WHO, Geneva.
Jones G, Riley M, Dwyer T (2000) Breastfeeding in early life and bone mass in prepubertal children: a longitudinal study. Osteoporos Int 11 (2): 146-52.
Kelleher SL & Lonnerdal B (2001). Immunological activities associated with milk. Adv Nutr Res. 2001;10(39-65)
Kramer MS, Chalmers B, Hodnett ED, Sevkovskaya Z, Dzikovich I, Shapiro S, Collet JP, Vanilovich I, Mezen I, Ducruet T, Shishko G, Zubovich V, Mknuik D, Gluchanina E, Dombrovskiy V, Ustinovitch A, Kot T, Bogdanovich N, Ovchinikova L, Helsing E, PROBIT Study Group (Promotion of Breastfeeding Intervention Trial) (2001) Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA 285 (4): 413-20.
Ladomenou F, Moschandreas J, Kofatos A, Tselentis Y, Galanakis E (2010) Protective effect of exclusive breastfeeding against infections during infancy: a prospective study. Arch Dis Child 95: 1004-1008.
Marild S, Hansson S, Jodal U, Oden A, Svedberg K (2004) Protective effect of breastfeeding against urinary tract infection. Acta Paediatr 93 (2): 164-8.
Mathur NB, Dwarkadas AM, Sharma VK, Saha K, Jain N (1990) Anti-infective factors in preterm human colostrum. Acta Paediatr Scand 79 (11): 1039-44.
Murray L, Andrews L (2000) The Social Baby. Understanding Babies Communication from Birth . Richmond, CP Publishing.
Quigley M A, Kelly YJ, Sacker A (2009) Infant feeding, solid foods and hospitalisation in the first 8 months after birth. Arch Dis Child 94: 148-150.
Robbins ST, Becker LT (2005) Infant Feeding: Guidelines for Preparation of formula and Breastmilk in Healthcare Facilities. USA, American Dietetic Association.
Sadauskaite-Kuehne V, Ludvigsson J, Padaiga Z, Jasinskiene E, Samuelsson U (2004) Longer breastfeeding is an independent protective factor against development of type 1 diabetes mellitus in childhood. Diabetes Metab Res Rev 20 (2): 150-7.
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Wilson AC, Forsyth JS, Greene SA, Irvine L, Hau C, Howie PW (1998) Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ 316 (7124): 21-5.
World Health Organisation (2007): Guidelines on the Safe preparation, storage and handling of powdered infant formula
- Aptamil Profutura 1™ (70ml bottle) ABC009 - in packs of 24
- Cow & Gate First Infant Milk 1™ (70ml bottle) ABT058 - in packs of 24
- SMA Pro First™ (70ml bottle) ABT069 - in packs of 32
- SMA Pro Gold Prem 1™ (70ml bottles) ABT065
- Cow & Gate™ Distilled Sterile Water™ (90ml bottle) ABT740 - in packs of 20