1. PREPARATION OF INFANT FEEDS Chapter 27 Doris Corkin and Andrea McDougall

2. Introduction This presentation walks you through the process of preparing a bottle feed for an infant. You should use it in your learning groups to help you recap the main points from the print chapter. Part 1 – Preparation for Bottle Feeding Part 2 – Preparing a Feed Part 3 – Before Feeding

3. PART 1: Preparation for a bottle feed

4. Preparation for Bottle Feeding Wash and dry hands then collect the required equipment: Plastic disposable apron to prevent cross- infection Steam sterilising unit and instructions Feeding bottle, disc, screw-ring, teat and cap Kettle with freshly boiled water from mains tap Container of infant milk formula with scoop Plastic knife with straight-edged back Bottle brush for washing utensils.

5. Care of Bottle Feeding Utensils All the utensils used for bottle feeding need to be thoroughly washed, with the aid of a bottle brush, in warm soapy water. Rinse the bottle with running water from the tap and then sterilise to protect against infections such as gastroenteritis and oral thrush – until infant is at least six months old. Use an appropriate bottle brush which is exclusively used for this cleaning purpose (see above) then place brush in a sterilising unit with teats, discs, screw-rings, bottles and caps.

6. Safety of Feeding Teats Clean teats carefully by squeezing the running water through the hole of the teat with the aid of brush, to ensure removal of milk residues and liquid soap. Please note that salt is no longer recommended for cleaning teats as this can damage silicone teats. Do not use teats that are cracked or split.

7. Three Methods of Sterilising Steam sterilising is carried out either by electric or microwave, both of which are quick and efficient. Follow the manufacturers instructions and add the recommended amount of water to unit Cold water sterilising requires a tank and either chemical solution or tablets. Ensure the manufacturer guidelines are followed.

8. PART 2: Preparing a feed

9. Preparing a Feed Before making up a feed: Wipe the work surface with a damp clean cloth and then dry the surface area using a hygienic paper towel. Wet hands under tepid running water, then apply liquid soap. Wash hands ensuring fingers have been interlaced. Rinse and dry hands before touching the sterilised utensils.

10. Making a Bottle Feed Bottled mineral water, filtered water and repeatedly boiled water are not recommended as they may contain high concentrations of nitrates and salts. Boil fresh, cold water, supplied from mains tap in the kettle. Leave water to cool for no more than 30 minutes. Meanwhile, read the instructions on the formula tin. Place empty bottle on flat clean surface. Always pour the cooled boiled water into the bottle first, then check water level to ensure accuracy before adding milk powder.

11. Safe Preparation of Milk Formula Remember to check expiry date on formula tin and use within four weeks of opening. Follow manufacturers instructions regarding ratio of number of scoops to amount of water.

12. Loosely fill the scoop supplied with milk powder and level it with the sterilised, straight-edged back of a plastic knife. Add scoops of powder to the cooled water in the bottle. Seal the bottle with supplied disc, screw- ring and cap, then shake bottle to dissolve milk powder.

13. PART 3: Before bottle feeding

14. Before Bottle Feeding an Infant Remove the disc and secure the sterilised teat with the screw-ring provided. Ensure the teat has a hole that lets the milk formula out in regular drops, rather than a stream.

15. Check temperature of the milk feed by dropping a few drops onto the inside of your wrist. Cool bottle of milk under cold, running water if necessary. Never reheat bottle feed in microwave as milk could scald the infants mouth. Avoid reheating bottle feed more than once and discard any remaining milk.

16. Acknowledgements Many thanks to Paul Morris, Clinical Skills Technician, School of Nursing and Midwifery, Queens University Belfast for photographic support. Also Lili Brose, a 3 rd Year Child Branch Nursing Student, who has recently completed this programme and who allowed herself to be photographed for this presentation.