Formula feeding
Common reasons
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Can’t breast feed – baby’s mouth too small, nipple too big
Baby’s mouth too large, nipple too small
Socially more acceptable
It’s what mum’s mum did
Poor suck (esp premature)
Maternal anxiety – baby not getting enough milk
Maternal medication/infection
Wanting to involve Dad/other family members
Tried breast feeding, became exhausted
Formula milk is fortified and specially designed for my baby
What it involves
Sterilise the bottles (with teats, retaining rings, caps and lids). Wash in hot soapy
water, leave to drip/drain dry then put in steriliser. This can be chlorinated water
bath, steam steriliser which is plugged in or microwaved.
Wash and dry your hands.
Use cooled boiled water to make up a bottle, leave it 20-30 minutes after the
kettle boils. Follow the instructions on the tin of formula. Put the water in the
bottle first (there will be measuring marks on the bottle. Then add the correct
amount of scoops of formula powder. Add the teat, retaining ring and cap using
tongs to avoid contaminating the feed. Shake the bottle to dissolve the powder
and the feed is ready to give.
Test the temperature by pouring a little out of the teat onto the inside of your wrist
to check its not too hot.
As baby feeds bubbles rise in the bottle. Be sure to give baby a break to allow
her to decide if she is full or not.
You may find that it takes a few formulas and a few different teats before you
have something works for your baby.
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How much do they need?
From newborn, baby needs from 20ml/kg up to 150ml/kg by the end of the first
week of life.
E.g. 4kg baby requires 600mls/24 hours. This equates to 4 feeds at 150mls or 5
feeds at 120mls.
After one week a baby needs 5 fluid ounces per kg per day divided over four to
five feeds.
1 ounce is approximately 30mls, mother’s often use ounces to describe the
amount baby is drinking.
Common problems
Not feeding enough – baby not gaining weight, constantly irritable, vomity.
Being fed too much – baby gaining weight, vomity, irritable.
Colic – switch teat to avoid gulping, stop mid feed for a burp, feed baby when
he’s calm, not starving, feed him in more upright position.
Constipation
Resource
 www.rcn.org.uk leaflets on breast/formula
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Reasons to choose breast feeding
Breast is best
Cheap, portable, always the right temperature
Breast milk gives baby exactly what he needs.
Colic, change position for feeding, look at mum’s diet – consider spicy foods,
cabbages, citrus or beans. Ask mum to keep a food diary if there is some
fluctuation of symptoms. Last resort, cut out dairy products. It is possible to have
a lactose intolerant baby who is unable to digest breast milk.
Sore breasts/nipples – consider thrush, red cracked sore nipples esp after a
course of antibiotics. Could also be bacterial infection, which should respond to
antibioitcs. Mastitis, tender breasts, continue breast feeding, traditional remedies
include cabbage leaves. May require I+D in severe cases.
If treating for maternal thrush, treat baby too, usually seen as white patches on
mucus membranes or tongue which do not rub off.
Feeding problems/latching on
Consult midwife, consider tongue tie, even if mild can have effect on latching on.
Jaundice
Much more common in breast fed babies, but not exclusive. Midwife usually will
check bilirubin in a yellow baby. Refer to PAU if any concerns. Treat with fluids
and UV light.
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The breastfeeding initiation rate was 74.1% in 2011/12 Quarter 2, a slight
improvement on 2010/11 outturn (73.7% ), 2009/10 outturn (72.7%) and 2008/09
outturn (71.7%).
The prevalence of breastfeeding at 6-8 weeks in 2011/12 Quarter 2 was 47.1%
of all infants due a 6-8 weeks check, slightly higher than the figure of 46.
Breastfeeding babies and their mothers are at lower risk of certain illnesses thus
providing potential cost savings for the wider health care system. It was
estimated in 1995 that the NHS spends £35 million per year in England and
Wales treating gastro-enteritis in formula-fed infants and that, for every one per
cent increase in breastfeeding at 13 weeks, £500,000 would be saved (1).
It costs approx. £500-600 each year to formula feed a baby. This is a vague
figure as it includes the cost of equipment and the cost of sterilizing and washing
as well as the cost of the milk powder itself.
The key health benefits are summarised below.
Artificially fed babies are at greater risk of:
• gastro-intestinal infection
• respiratory infections
• necrotising enterocolitis
• urinary tract infections
• ear infections
• allergic disease (eczema and wheezing)
• insulin-dependent diabetes mellitus
• sudden infant death syndrome
• childhood leukaemia.
Breastfed babies may have better:
• neurological development.
More research is needed, but breastfeeding may also provide protection for
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the infant against:
• multiple sclerosis
• acute appendicitis
• tonsillectomy
• for the mother
• rheumatoid arthritis.
And for the mother, protection against:
• rheumatoid arthritis.
Women who have breastfed are at lower risk of:
• breast cancer
• ovarian cancer
• hip fractures and bone density.
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