Formula feeding

Formula feeding

1. Dr.Azad A Haleem AL.Mezori MBChB,DCH , FIBMS,MRCPCH Lecturer University Of Duhok College of Medical Pediatrics Department 2018 [email protected] Formula Feeding

2. Which is better, breastfeeding or formula-feeding? Human milk is the preferred feeding for all infants. Pediatricians generally advise that full-term, healthy infants exclusively breastfeed when possible for the first 12 months of life and, thereafter, for as long as mutually desired. Advantages of breastfeeding include breast milk is nutritionally sound and easy to digest; breastfeeding is believed to enhance a close mother-child relationship; breast milk contains infection-fighting antibodies ( immunoglobulins ) that may reduce the frequency of diarrhea, gastroenteritis  otitis media, and other respiratory infections in the infant; and breast milk leads to cost savings and is convenient.

3. breastfeeding or formula-feeding?

4. Formula-Feeding Some parents choose formula-feeding either because of personal preference or because medical conditions of either the mother or the infant make breastfeeding ill-advised. Some common reasons for choosing formula-feeding include: There is an inadequate supply of maternal breast milk. The baby is sucking inefficiently. Parents are unable to quantify the amount of breast milk received by the baby. Some parents want to know exactly how much their baby is receiving at each feeding, and formula/bottle-feeding allows exact measurement.

5. Formula-Feeding A significant reason for not breastfeeding is concern about transferring certain drugs the mother is taking through the breast milk to the infant. An increasing number of mothers must return to work shortly after their baby's delivery. A benefit of bottle-feeding is that the entire family can immediately become intimately involved in all aspects of the baby's care, including feedings.

6. Which formula is best for my baby? There is no evidence that one brand of formula is better than another. However, you should consider: Choosing a formula based on cow’s milk, unless there is a cultural, religious or health reason to use a different formula If possible, choosing a formula with a lower protein level, which may reduce your baby’s risk of being overweight or obese in later life Only using special formulas (HA, AR, lactose-free or soy formula) if they are recommended by a doctor Taking into account price and affordability

7. What infant formula preparations are available? Infant formulas come in three forms. The best choice depends on your budget and desire for convenience: Powdered formula .  Powdered formula is the least expensive. Each scoop of powdered formula must be mixed with water. Concentrated liquid formula .  This type of formula also must be mixed with water. Ready-to-use formula .  Ready-to-use formula is the most convenient type of infant formula. It doesn't need to be mixed with water. It's also the most expensive option.

8. What's the difference between generic and brand-name infant formula? All infant formulas sold in the United States must meet the nutrient standards set by the FDA. Although manufacturers might vary in their formula recipes, the FDA requires that all formulas contain the minimum recommended amount of nutrients that infants need.

9. What about enhanced infant formula? Some infant formulas are enhanced with docosahexaenoic acid ( DHA ) and arachidonic acid ( ARA ). These are omega-3 fatty acids found in breast milk and certain foods, such as fish and eggs. Some studies suggest that including DHA and ARA in infant formula can help infant eyesight and brain development . In addition, many infant formulas include pre- and probiotics — substances that promote the presence of healthy bacteria in the intestines — in an effort to mimic the immune benefits of breast milk. In addition to the core ingredients, some formulas contain extra ingredients, These include LCPs (long-chain polyunsaturated fatty acids), nucleotides and prebiotics .  Some formulas have an additional prebiotic ingredient (Oligosaccharides, which are often referred to as FOS/GOS).

10. How long should a child drink infant formula? Infant formula is generally recommended until age 1, followed by whole milk until age 2 — but talk to your child's doctor for specific guidance. Reduced-fat or skim milk generally isn't appropriate before age 2 because it doesn't have enough calories or fat to promote early brain development.

11. Types of formula milk Commercial infant formulas are regulated by the Food and Drug Administration (FDA). Three major types are available: Cow milk protein-based formulas .  Most infant formula is made with cow's milk that's been altered to resemble breast milk. This gives the formula the right balance of nutrients — and makes the formula easier to digest. Most babies do well on cow's milk formula. Some babies, however — such as those allergic to the proteins in cow's milk — need other types of infant formula.

12. Cow’s milk-based formula Most baby formula milks are based on modified cow's milk, which is recommended over other types of formulas for most babies. The protein in milk can be broken down into curds (casein) and whey. Casein is lumpy and whey is watery. The ratio of casein to whey can vary according to the type of baby formula milk. There are two main types:   First-stage formula . These milks are based mostly on whey, with a casein:whey ratio of 40:60, which is about the same as breastmilk . They are suitable for your baby from birth up to about a year, and are thought to be easier for baby to digest than casein-based milks. Second-stage, follow-on or hungry-baby formula . These milks consist of mostly casein, with a casein:whey ratio of 80:20. Manufacturers claim that the higher casein content means the milk takes longer to digest, keeping baby fuller for longer. Types of formula milk

13. Soy-based formulas Soy-based formulas can be useful if you want to exclude animal proteins from your child's diet. Soy-based infant formulas might also be an option for babies who are intolerant or allergic to cow's milk formula or to lactose, a carbohydrate naturally found in cow's milk. However, babies who are allergic to cow's milk might also be allergic to soy milk. Types of formula milk

14. Goats' milk formula Different kinds of goats' milk formula are available in the shops.  They are produced to the same nutritional standards as cow's milk-based formula. Goats' milk formula is not less likely to cause allergies in babies than cows' milk formula. Types of formula milk

15. Anti-reflux ( staydown ) formula This type of formula is thickened with the aim of preventing reflux in babies (when babies bring up milk during or after a feed). Types of formula milk

16. Lactose-free formula This formula is suitable for babies who are  lactose intolerant . This means they can't absorb lactose, a sugar found in milk and dairy products. Lactose intolerance Symptoms include diarrhoea , abdominal pain, wind and bloating. Types of formula milk

17. Hydrolysed -protein formula If thebaby is diagnosed as being allergic to cows' milk, the appropriate infant formula is fully hydrolysed (broken down) proteins. There are two versions of hydrolysed milk available: fully hydrolysed formula partially hydrolysed formula Fully hydrolysed formula is specially designed for babies with an allergy or intolerance to cow's milk. Partially hydrolysed formula ( Comfort formula) This type of formula milk is made completely from whey protein. It is marketed as being easier to digest, and as suitable for babies suffering from colic, wind, and stomach pain. They are also sometimes promoted as being good for babies with allergies.   Types of formula milk

18. Good night milk Some follow-on formula has cereal added to it and is sold as a special formula for babies to have at bedtime. This type of formula isn't needed, and there's no evidence that babies settle better or sleep longer after having it. Good night formula should never be given to babies under six months old. Types of formula milk

19. Growing-up milk (toddler milk) Growing-up and toddler milks are marketed as an alternative to whole cows' milk for toddlers and children aged over one. Whole cows' milk is a suitable choice as a main drink for your child from age one. Semi-skimmed cows' milk is a suitable main drink for children over two who are eating a balanced diet. It's recommended that all children aged six months to five years have vitamin drops containing vitamins A, C and D every day. Types of formula milk

20. Types of milk to avoid Not all milk is suitable for feeding babies. You should never give the following types of milk to a baby under one year: condensed milk evaporated milk dried milk   goats' or sheep's milk  (but it's fine to use them when cooking for your baby, as long as they are pasteurised ) other types of drinks known as "milks", such as  soya, rice, oat or almond drinks cows' milk  as a drink (but it's fine to use it in cooking)

21. What kind of bottle should I use? Bottles come in different shapes and sizes, can be made of glass or plastic, and may be reusable or have disposable liners inside. Some babies do better with certain shapes or bottles with liners on the inside. It's important to note that some plastic bottles are labeled "BPA-free"— meaning that they do not contain the chemical bisphenol A, which is found in some plastics and may affect kids' health. Glass bottles are free of BPA and can last for a long time, but can crack and chip, so they need to be checked often to avoid harm to baby.

22. kinds of nipples Nipples come in silicone (clear) or latex (brown). The many different varieties include orthodontic nipples, rounded nipples, wide-based nipples, and flat-top nipples. And some are advertised as "being closer to the natural shape of a mother's breast." But which kind is best really depends on your baby and what he or she seems to prefer. After all, every baby is different. Nipples also often come in different numbers, "stages," or "flow rates" to reflect the size of the nipple's hole, which affects the flow (i.e., slow, medium, or fast) of formula or breast milk. For example, fast flows may cause younger babies to gag or may simply give them more than they can handle, whereas slower flows may frustrate some babies and cause them to suck harder and gulp too much air.

23. Cleaning and sterilising baby bottles A baby’s immune system is not yet fully developed, and babies are more susceptible to infection and illness than an older child or adult. Cleanliness is therefore very important when preparing baby’s bottles.

24. Cleaning bottles Bottles, lids, teats and other equipment use to prepare a feed should always be thoroughly cleaned after each use: As soon as possible after baby finishes a feed, wash the bottle, teat and lid in hot soapy water. Use a bottle brush, and be sure to clean out any dried milk stuck inside the bottle and teat. Once it is clean, rinse the equipment with some fresh water and allow it to air dry. This kind of cleaning is important for getting rid of all traces of milk or formula left inside the bottles, but it does not ensure that the feeding equipment is completely germ-free.

25. Sterilising bottles Sterilising is the process of killing any harmful germs that may be clinging to surfaces of the bottles and other equipment. It is important to sterilise baby bottles before each use, for at least the first 12 months of your baby’s life.

26. How to sterilise feeding equipment There are a few different ways to sterilise baby’s bottles, teats, lids and other feeding equipment.

27. Boiling Boiling works by raising the temperature high enough to kill any bacteria left over after washing. Place clean bottles, teats, caps and utensils in a large saucepan on the back burner of the stove. Add enough water to cover all the equipment, making sure there are no air bubbles. Bring water to the boil, and boil rapidly for 5 minutes. Turn off the stove and allow the water to cool down. Wash your hands  thoroughly before you handle the equipment, and disinfect the surface where you plan to make up the bottle. Take the equipment from the saucepan and shake off any excess water. If you are not using them straight away, put the lid and teat onto the bottle, and store in a clean container in the fridge. Re-boil the bottle and other equipment if it is not used within 24 hours.

28. Chemicals Chemical sterilisers are disinfectant solutions that come as liquids or tablets that dilute with water. Make sure bottles, teats, caps and utensils are thoroughly clean before you begin. Read and follow the manufacturer’s instructions for making up the sterilising solution. Place the feeding equipment in the sterilising solution, making sure it is completely under water and there are no air bubbles. Leave the equipment in the sterilising solution for the recommended amount of time (usually about 30 minutes – check the manufacturer’s instructions). You can then leave the equipment in the solution until you need to use it. Allow bottles, teats and lids to drain before you use them – don’t rinse off the sterilising solution, as this exposes equipment to germs again. Throw away the solution after 24 hours. Clean the sterilising container thoroughly in warm, soapy water, before making up a fresh lot of solution.

29. Steam (microwave or electric sterilisers ) Much like boiling, steaming works by raising the temperature high enough to kill bacteria. There are several different types of sterilisers available – follow the instructions provided by the manufacturer. Make sure bottles, teats, caps and utensils are thoroughly clean before you begin. Make sure that bottles and teats are placed with openings facing down in the steriliser . Follow instructions for adding water to the unit and turning it on. Leave bottles in the steriliser until they are needed. If you are not using the bottles straight away, check instructions for how long you can leave them in the steriliser before you have to re- sterilise them.

30. How to feed your baby with formula There are a few important guidelines to remember when feeding your baby using a bottle. You will also find some helpful tips and commonly asked questions.

31. A step-by-step guide to preparing a powdered-formula feed: Step 1  Fill the kettle with at least 1 litre of fresh tap water (don’t use water that has been boiled before). Step 2  Boil the water. Then leave and allow it to cool until lukewarm at least 30 minutes. Step 3  Clean and disinfect the surface you are going to use to prepare the formula. Step 4  Wash your hands thoroughly, using soap, and dry them. Step 5  If you are using a cold-water steriliser , shake off any excess solution from the bottle and the teat, or rinse the bottle with cooled boiled water from the kettle (not the tap). Step 6  Stand the bottle on a clean surface. Step 7  Keep the teat and cap on the upturned lid of the steriliser . Avoid putting them on the work surface.

32. Step 8  Follow the manufacturer’s instructions and pour the correct amount of previously boiled (now cooled) water that you need into the bottle. Double check that the water level is correct. Always put the water in the bottle first before adding the powdered infant formula. Step 9  Loosely fill the scoop with formula, according to the manufacturer’s instructions, and level it off using either the flat edge of a clean, dry knife or the leveller provided. Different tins of formula come with different scoops. Make sure you use only the scoop that is enclosed with the powdered infant formula that you are using. Step 10  Holding the edge of the teat, put it on the bottle. Then screw the retaining ring onto the bottle. Step 11  Cover the teat with the cap and shake the bottle until the powder is dissolved. Step 12  Test the temperature of the infant formula on the inside of your wrist before giving it to your baby. It should be body-temperature, which means it should feel just warm, but not hot. Step 13  If there is any made-up infant formula left after a feed, throw it away.

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