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Formula feeding

Thursday, June 26, 2008

Basic equipment needed for bottle feeding

We advocate breastfeeding and suggest that if you are having problems or doubts about breastfeeding it would be best to talk to your parenting coach about your concerns.  If on the other hand you choose to bottle feed possibly because of a bad experience or there is some other reason you can’t, or you have just chosen not to breastfeed this chapter will help you with the next best thing.  Bottle feeding.   If you are expressing and giving breast milk in a bottle this chapter can help you understand such things as sterilising, choosing the right bottle and teats.

Formula

There are many different formulas on the market no brand is better than another but some babies may react to certain formulas.  Their reaction may be seen as a rash, diarrhoea, constipation, unsettled irritable baby.   Some babies may have lactose intolerance or a cow’s milk intolerance.  Some of the ‘Gold’ formulas are renowned for causing constipation.  If your baby begins to shows any of these signs it may be wise to change formula within the brand or to a different brand all together. 

Teats and Bottles

Again there are a variety of types of teats and bottles available.  The most popular brand are not always the best.  The long thin bottles or the wide bottles are suitable but make sure they have clear measurements.  If you are going to exclusively bottle feed I suggest you invest in six large bottle.  Look for teats that are long and straight or slightly cone shaped.  Avoid short or irregular shaped teat and those that bulge at the neck.  These may cause baby to slurp and are not assisting in the development of the correct muscles for speech.  For this reason I don’t recommend buying orthodontic or anti colic bottles or teats.  When feeding, if baby is heard to be slurping the teat is not fitting snugly in her mouth.  Baby’s lips should flange out while drinking and not role in.  Some teats are interchangeable with other brands of bottles so I suggest you try a few before purchasing the type that suits your baby best.  The most recommended brand (at the publication of this book) is Pigeon Peristaltic slow flow for newborns and ‘Y’ teat for three months and older. 

Preparation of formula

Before starting make sure you have all the necessary equipment – formula, sterilised bottles and teats.  There are several ways to store your bottles ready for use two of which are as follows:

  1. Make up bottles of formula and keep them ready-to-go in the fridge.  With this method you will need to warm the milk either in a bottle warmer or boil a kettle and pour the water into a cup or container into which the bottle of milk is immersed.   Takes 5-8 minutes.  Never microwave milk as some of the nutrition is destroyed.
  2. Keep bottles of measured cooled boiled water in the fridge and add the formula when needed.  Take off the teat and cap before warming the bottled of water in the microwave for 20 -30 seconds then add the formula and shake thoroughly.  This disperses the hot-spots while dissolving the formula.

Always test the temperature of the milk on the inside of your writs before offering it to baby – it should be luke warm.
 
Once you have decided on the method you will be using both will require the following instructions:

  • Always wash your hands before handling food and in particular baby’s food and formula.
  • All equipment should be thoroughly washed with hot soapy water and sterilised.
  • Prepare your boiled water (5 mins of rapid boiling) and allow it to cool slightly before measuring it into the bottles.  Never use bottled water as many have high sodium and mineral contents which may be harmful to baby.  Bottle water is not sterilised.
  • Read the instructions on the formula label and make up to the exact proportions of water to powder.   Always measure the water first then add the powder.   * Never add more water to a formula as this will dilute the calories and nutrition, too much powder can cause constipation or dehydration.  
  • If you would like to give your baby additional cooled boiled water it is advisable to offer it a short time after she has finished her formula feed or twenty minutes before bed.  This insures she has had her quota of nutrition and gives some time for the milk to go down.
  • Always use the ladle provided.  This ladle should not be packed down or knocked against the side of the tin to compact the powder.  Scoop the ladle into the powder to fill it and level it flat with the back edge of a sterile knife.  Tap the bottom of the ladle with the knife to empty the powder into the bottle.  If the water is too hot the steam will cause the powder to stick to the ladle.   Seal and shake thoroughly.
  • When making up the bottle the powder will always increase the quantity in the bottle.  Only give the amount necessary for baby’s weight don’t force her to take the whole bottle just because there is some left.  It is better to decant the excess before offering it to her and keeping it in the fridge to be added to then next feed if need be.
  • Store pre-prepared bottles in the fridge with their caps over the teats.
  • Formula or sterile water stored in the fridge will last 24 hours.  Discard any remaining bottles, wash and sterilise before reusing.
  • Never reheat milk.  Always discard used milk after one hour of warming.  Bacteria breeds quickly in warm milk.

Tips on bottle feeding

Baby should take fifteen to twenty minutes to take a bottle feed.  If your baby drinks her bottle quicker than this then the teat is to fast and may cause discomfort and possibly vomiting.  Try a slower teat.  If baby is taking longer than this there may be several reasons.  Is she sleeping on the bottle?  Is she feeding more than four hourly from the beginning of one feed to the beginning of the next?  Is she getting the correct quota for her weight?  Is the teat too slow?  Is the teat on to tightly and baby is finding it difficult to suck out.  Some bottle fed babies don’t know when to stop and can be over fed.  Avoid overfeeding by only feeding three and a half (for premature or small babies) and four hourly for term babies.  All healthy babies should be on four hourly feeds by three weeks. 
Something to be aware of is not to over tighten the collar of the teat.  When attaching the teat to the bottle tighten just till you feel it catching.  Loose enough to allow bubbles to be seen rising in the milk. But not to loose as the milk will leak out.  You can then adjust the flow of the milk by tightening or loosing the collar making sure you can see the bubbles rising.  This allows the air to flow freely into the bottle through the collar releasing the vacuum which allows a steady flow of milk.  If there are no bubbles rising the vacuum will prevent the milk from flowing and eventually baby will need to break her seal to allow the air to enter the bottle through the hole of the teat.  If it is a cross cut or ‘Y’ teat the teat may invert into the bottle.
  
Watch when you are feeding as the bottle should always be inline with her nose and parallel to her lips not angled to high or to low.   You may like to support your arm while feeding baby.   Rest her in the crook of your arm tilted back at an angle that will allow the milk to always be in the teat which means she is being satisfied.  To dispel a myth - sucking on air does not cause wind.   Allow her to drink as much as she wants, she will generally show you when she needs a break.  Sit her upright holding her under her chin with two fingers under her arm and the palm of your hand against her chest.  The other hand, firmly support her back with your fingers supporting her head.   This straight upright or slightly backward leaning position will allow the wind to rise without obstruction.  It is not necessary to pat her back.  Sitting upright will also help her to stay awake and eventually take an interest in her surroundings whereas resting over your shoulder will very often put baby off to sleep.
 
Never prop baby up with a bottle or leave them alone with a bottle, this is very dangerous as baby may choke.   This includes putting a baby to bed with a bottle when they are older. 
If need be change the nappy towards the end of the feed to wake her up.  When she becomes more alert leave the nappy change till just before bed so that you know she is clean for bed.  Because bottle feeding is quicker than breastfeed you will have a longer play time so encourage lots of tummy time.  

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