1. Feeding the Baby Artificial feeding or Formula feeding1

2. Feeding choice and your role
Your role as a Healthy Weight Advisor is to promote breastfeeding amongst your clients. However, there will be some clients who will feed their babies with artificial formula. In relation to those clients, you need to be aware of the safety advice in relation to formula feeding and key points on reducing potential obesity by limiting over-feeding and not using Stage 2 milks. 2

3. Bottle feeding - Safety Aspects
Powdered infant formula is not sterile and good hygiene practices are essential in preparing and storing feeds.
It is very important that all equipment used for feeding and preparing feeds has been thoroughly cleaned and sterilised before use.
Links between formula feeding and gastroenteritis are increased due to poor practices in making up bottles 3

4. Clients should be advised to make up bottles according to the guidelines issued by the Department of Health. This information should have been given to them by their Midwife or Health Visitor. It is useful to keep a copy with you and be familiar with the key points. 4

5. Key points Every bottle needs to be made freshly – not in advance
Use freshly boiled water, cooled for no longer than 30 minutes
Discard any milk not used within 2 hours
Clean and sterilise equipment before use 5

6. Types of Formula Birth – 1year
There are several main milk manufacturers who produce first infant milks, second stage milks and ‘follow-on or toddler milks.’ Due to changes in advertising permissions, manufacturers promote the follow-on milks more aggressively.
Babies only require first stage milks. Those sold for ‘hungrier babies’ contain casein which curds in the baby’s stomach and takes longer to digest.
You should never be drawn into discussions about which milk is ‘best’ – it is a parental choice. 6

7. Types of Formula Birth – 1year
Recent additions to milk being marketed are ‘night-time milks’. These suggest that they will help babies to sleep longer and are labelled as suitable from 6 months plus. They have added potato starch. This often leaves babies feeling like you do after a heavy 3 course dinner – uncomfortable and sleepy. There is no reason for parents to use these milks as they are not proven to help babies sleep. 7

8. Guidelines for feeding
Use breast milk or infant formula milk until one year of age.
After one year use full fat cows’ milk until 2 years.
Use semi skimmed milk at 2 years if rest of diet is good.
Use skimmed milk after 5 years.
There is no necessity to use second stage milks
Nothing should ever be added to feeds (examples quoted may include rusks, sugar, cereal, cerelac). 8

9. Recommendations Breast milk or Infant Formula until one year as
main drink because
reduces risk of childhood anaemia as both contain iron and cows’ milk does not contain iron.
Early introduction of cows milk has been linked to diabetes
Can lead to allergies such as eczema
Cows milk can be used in cooking and added to foods but should not be used as a drink until after 12 months. 9

10. Problems? Medical type problems with bottle feeding.
eg colic, poor weight gain, carer concerned about intake, constipation.
Refer to Health Visitor/GP/Dietitian.
Other problems.
eg mum needs support.
Refer to Children’s Centre, Family Support worker or Health Visitor. 10