Oxford Handbook of Midwifery (150 page)

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1. White A, Freeth S, O'Brien M (1992).
   Infant Feeding 2000
   . London: HMSO.
   
2. Inch S (2009). Feeding. In: Fraser DM, Cooper MA (eds)
   Myles Textbook for Midwives
   . Chapter 41. Edinburgh: Churchill Livingstone, 1990.
   
3. Department of Health (1994).
   Weaning and the Weaning Diet
   . Report on Health and Social Subjects No. 45. London: HMSO.
   
4. Statutory Instruments No. 77 (1995).
   Food. The Infant Formula and Follow on Formula Regulations
   . London: HMSO.
   
5. Scientific Advisory Committee on Nutrition (2008).
   Consideration of the Place of Good Night Milks Products in the Diet of Infants Aged 6 Months and Above
   . London: SACN. Available at: M
   www.sacn.gov.uk/reports_position_statements/position_statements/index.html (accessed November 2009).
   

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Alternatives to modified cow’s milk formulas

Specialized formula milks are available for parents who wish their baby to have vegetarian feeds. These should only be given under the direction of a dietitian.

Soya formula

• It is recommended by the DH that these milks should only be used if a baby/infant is intolerant to cow’s milk or lactose; and, generally, only under medical guidance.
  
• There are concerns about the possible effects of oestrogen-like compounds produced by soyabeans (phyto-oestrogens), and unacceptable levels of manganese and aluminium, in such formulas.
  ¹
  
• They may contain genetically modified ingredients.
  

  Specialist formulas for babies intolerant to standard formulas
  

  Predicting allergies is an inexact science. The likelihood has been estimated
  ²
  to be:
  

• 30–35% if one parent is affected
  
• 40–60% if both parents are affected
  
• 50–70% if both parents suffer the same allergy.
  

  Lactose-free formulas
  

• Appropriate for infants who are intolerant to lactose but can tolerate the milk protein.
  
• Cow’s milk protein based with lactose replaced by glucose.
  
• Prescribable or may be purchased in pharmacies.
  
• Glucose in these formulas may be dangerous to teeth.
  

  Hydrolysate formulas
  

• Used if breastfeeding is not possible.
  
• Prescription only.
  

  •
  Some are designed to treat an existing allergy; some are designed to
  

  prevent an allergy.
  

• Prescribing guidelines: some hydrolysate formulas need proven intolerance, whereas others do not.
  

  Amino-acid-based formulas
  

• Have a completely synthetic protein base.
  
• Are very expensive.
  
  1. Minchin M (1998).
     Breastfeeding Matters
     , 4th edn. Australia: Alma Publications.
     
  2. Brostoff J, Gamlin L (1998).
     The Complete Guide to Allergy and Food Intolerance
     . London: Bloomsbury Publishing.
     

  NUTRITIONAL REQUIREMENTS OF FORMULA-FED BABIES
  

  719‌‌
  

  Nutritional requirements of formula-fed babies
  

  Three areas need to be taken into consideration:
  

Energy requirements

This is only a guide, and individual babies will take as much as they require at each feed to satisfy their needs. This amount may vary from feed to feed and the overall picture should be considered, e.g. the general health and weight gain of the baby.

Fluid requirements

Balance of ingredients

Formula feeds are developed from cow’s milk, which is balanced to meet the needs of calves and therefore requires modification for human infants. ‘Modified milks’ are those that have had the balance of ingredients adjusted to resemble human milk as closely as possible.

Modifications include:

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Management of artificial feeding

Sterilization of infant feeding equipment

All infant feeding equipment must be completely clean and sterilized prior to use. This includes any equipment used for breastfed babies or for storing EBM, e.g. bottles, teats, breast pumps, and nipple shields. This is to protect babies against any potential sources of infection. Due to their immature immune system, babies are at risk of infection, particularly gas- troenteritis (potentially life-threatening for newborn babies) and fungal infections (which can be difficult to treat).

Demonstrations of sterilization of equipment are best given on a one- to-one basis in the mother’s home environment.

Types of sterilization

• Boiling
  
• Chemical sterilization
  
• Steam sterilization
  
• Microwave sterilization using a microwave sterilization unit. This is not suitable for metal items or certain types of plastic.
  

  For all types of sterilization
  

  Before sterilization
  

• Wash all bottles and other equipment thoroughly in hot, soapy water, using a bottle brush. Scrub both inside and outside to remove fatty deposits. Pay special attention to the rim.
  
• Clean the teat by either:
  
  • Using a small teat brush
    
  • Turning inside out and washing in hot, soapy water.
    
• Rinse all the washed equipment thoroughly with non-soapy water before sterilizing.
  

  After sterilization
  

  Always wash your hands before removing equipment from the sterilizer.
  

  To sterilize by boiling
  

• Put the equipment in a large pan filled with water, ensuring that there
  

  is no air trapped in the bottles or teats. Cover the pan with a lid and bring to the boil.
  

• Boil for 10min
  , ensuring that the pan does not boil dry.
  
• Allow the water to cool and store the equipment in the covered pan until required. Use the equipment within 12h (if longer, repeat the process).
  
• Remove equipment from the saucepan carefully, to avoid desterilization.
  
• Check bottles and teats regularly for any signs of deterioration. If this is detected, discard them. Prolonged boiling of teats may destroy them.
  

  To sterilize using chemicals (cold water sterilization)
  

• Use the liquid or tablets to make up the solution following the manufacturer’s instructions.
  
• Either use a sterilizing tank or a large container with a well-fitting lid.
  

  MANAGEMENT OF ARTIFICIAL FEEDING
  

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