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Feeding

babyeatingChoosing how to feed your baby is an important decision for you. In the past, many women breastfed their babies, and there has been a lot of research carried out which has shown that, in most cases, breast milk is the best choice for both mother and child. However, during the 1950s, formula milk became commercially available, and it is now widely used and is considered by many, to be a safe and convenient alternative.

One of the main advantages of using breast milk to feed your baby is that it is naturally manufactured by your body during pregnancy and, therefore, contains all the essential nutrients that your baby needs to develop healthily. Breast milk is nutritionally balanced, and contains the perfect amount of proteins, carbohydrates, fats, vitamins, and iron. It also contains antibodies that protect your baby against infection, and strengthens their immune system.

Despite the nutritional advantages associated with breastfeeding, some women may be unable to breastfeed for medical, or practical, reasons. For example, if you have a blood-borne virus, such as hepatitis B, or HIV, or if you are taking a certain type of medication, these can be passed on to your baby through your breast milk. In these circumstances, bottle feeding your baby, using formula milk, will usually be recommended.

Before deciding whether to breastfeed or bottle feed your baby, you should ensure that you are fully aware of the advantages and disadvantages of both methods. If you have any questions or concerns about a particular method, your GP, practice nurse, midwife, or a breastfeeding counsellor will be able to help and advise you further.

Advantages

There are advantages associated with both breastfeeding and bottle feeding your baby.

Advantages of breastfeeding

The advantages of breastfeeding include:

  • it is free and naturally manufactured by your body to contain all the nutrients that your baby requires to grow and develop healthily. It is perfect nutritionally for your baby, and changes its composition to meet the baby’s needs as it grows. And, you don’t need to follow a special diet to produce breast milk,
  • it protects your baby against illnesses such as diarrhoea, vomiting, chest, ear and urine infections, eczema and wheezing,
  • it may give you protection against developing ovarian cancer, breast cancer, and it strengthens your bones, reducing your risk of hip fracture,
  • it will help you to lose weight by getting rid of any excess fat that you stored while you were pregnant,
  • it may help your child’s mental development as it has been shown that children who were breastfed were able to achieve more, and had higher IQ (Intelligence Quotient) scores than those who were given formula milk,
  • it can give you a feeling of satisfaction, and helps to encourage the sense of closeness between you and your newborn baby, and
  • breast milk is available at the perfect temperature wherever you are, and you therefore do not need any special equipment to heat it to the right temperature.

Advantages of bottle feeding

The advantages of bottle feeding include:

  • your baby may sleep for longer in between feeds,
  • you can ask someone else, such as your partner, or a family member, to feed your baby if you need to take a break, and
  • formula milk has added vitamin K – vitamin K helps the blood to clot, but the body’s ability to store it is low. In rare cases (affecting approximately 1 in 10,000 babies) a vitamin K deficiency can cause a bleeding condition, known as haemorrhagic disease of the newborn (HDN). It can occur anytime between the first few days of life to the first few months, and it can be life threatening. Typical bleed sites include the gums, nose, and gastrointestinal tract. The condition is most common in babies who are born prematurely, or who had a complicated delivery, such as a breech delivery. There may also be an increased risk of the condition developing if the mother was taking certain drugs during pregnancy, such as anticonvulsants to treat epilepsy. However, HDN can be prevented by giving a baby extra vitamin K after birth, and breastfed babies may be given vitamin K supplements (orally or by injection) with their parents informed consent.

Disadvantages

There are disadvantages associated with both breastfeeding and bottle feeding your baby.

Disadvantages of breastfeeding

The disadvantages of breastfeeding include:

  • if you have a blood-borne virus, such as Hepatitis B or HIV, or you are taking certain types of medication, they can be passed on to your baby through your breast milk,
  • in rare cases (about 2%), you may not be able to produce enough breast milk to feed your baby,
  • you may feel uncomfortable about breastfeeding your baby in public, and
  • if you are employed, and you breastfeed your baby, you may need to arrange to breastfeed your baby during working hours, or you may need to extend your maternity leave, which could have financial implications for you.

Disadvantages of bottle feeding

The disadvantages of bottle feeding include:

  • babies who are bottle fed using formula milk are more likely to develop illnesses, such as diarrhoea, or a chest, ear, or urine infection. There is also an increased risk of premature babies who are bottle fed developing a rare, but serious condition called necrotizing enterocolitis (NEC), where the intestines are damaged due to infection and a poor supply of blood,
  • when making formula milk, it is possible to get the mixture wrong and make it too strong, too weak, or too hot. There is also a lot of work involved in thoroughly washing and sterilising all of the equipment that is needed for bottle feeding,
  • in studies carried out comparing babies who were breastfed with those who were bottle fed, bottle fed babies were found to have an increased risk of obesity at least until six years of age,
  • bottle feeding using formula milk can be expensive. It has been estimated that it costs at least £450 a year to feed a baby using formula milk, and
  • once you have decided not to breastfeed your baby it is difficult to reverse the decision and begin breastfeeding. Also, if you decide to combine bottle feeding with breastfeeding, you should not introduce bottle feeding during the first six weeks of life, because the difference between nipples can confuse the baby, cause feeding problems, and it can interfere with the establishment of breastfeeding.

How it is performed

A young baby’s immune system is not as strong or as well developed as an adults, and they are much more susceptible to illness and infection. So, if you do decide to bottle feed your baby, its vital that you ensure meticulous hygiene standards when preparing feeds, and that all equipment is cleaned and sterilised thoroughly before use.

Bottle feeding using formula milk

If you decide to bottle feed your baby using infant formula milk, you need to make sure that you clean and sterilise the bottles and teats after each use, in order to reduce the chances of your baby getting sickness and diarrhoea. You should also follow the manufacturers instructions on the packaging carefully. The ratio of powder to liquid has been calculated to give your baby the right amount of food and water, in order to prevent them becoming constipated or dehydrated.

Cleaning and rinsing equipment

Sterilising bottle feeding equipment is essential for at least the first 12 months of a baby’s life. A baby’s immune system becomes more resistant to germs after the age of 12 months. Cups and mugs need only be sterilised for six months, and after this time they just require careful cleaning. Bottles must be sterilised for longer because they have areas that are hard to clean properly, such as the teats. Even if a tiny amount of milk gets trapped inside the bottle, bacteria can start to grow.

You should clean the bottle and teat using hot soapy water as soon as possible after a feed, using a clean brush that reaches to the bottom of the bottle to remove all traces of milk. All equipment should be rinsed thoroughly before sterilising it.

Steam sterilising

Steam sterilising can be carried out using a microwave steriliser, or a purpose made steam steriliser. You should make sure that you follow the manufacturers instructions carefully:

  • pour the specified amount of water into the steriliser, place the bottles and teats into the steriliser, and put the lid on. Switch on the microwave or steam steriliser for the recommended length of time,
  • ensure that you only put in equipment that is safe to heat. Bottles, teats and so on must be placed upside down to make sure that they are fully sterilised,
  • be careful of steam when removing the lid, and
  • use sterilised equipment straight away (it needs to be re-sterilised if it is not used immediately). However, microwave sterilisers can keep feeding equipment sterile for up to three hours if the lid is kept on.

Cold water sterilising

Cold water sterilising is an effective method of sterilisation, and provides a good standby method for when you do not have a microwave or steam steriliser available. When cold water sterilising, you should follow the manufacturers instructions carefully:

  • put the equipment into a container with cold water and a sterilising tablet for the prescribed length of time (usually at least 30 minutes),
  • check that there are no air bubbles trapped in the bottles or teats, and that they are totally submerged in the solution by using a floating cover or plate,
  • wash your hands before removing the equipment from the container, and
  • change the sterilising solution every 24 hours.

Boiling

You can also sterilise equipment by boiling it in water for at least 10 minutes. Boiling is another useful standby method of sterilisation. However, teats tend to rot faster, and you must ensure that whatever you sterilise in this way is safe to boil.

Making up formula feeds

To make up formula feeds:

  • clean the kitchen surface that you are going to use,
  • it is very important that you wash your hands,
  • if you are using a cold water steriliser, shake off any excess solution from the bottle and teat, or rinse the bottle with cooled boiled water from the kettle,
  • stand the bottle on the clean surface, but make sure that you keep the teat and cap on the upturned lid of the steriliser, not the work surface,
  • boil the water using a kettle, and after it has boiled, let it cool for no more than 30 minutes. Fill the bottle to the correct level (as specified by the formula manufacturer), and always put the cooled, boiled water into the bottle first,
  • using the scoop provided, loosely fill it with milk powder and, using a clean knife, level it off without compacting it. You should only use one scoop of powder to 30mls (1oz) of water,
  • add the milk powder to the water in the bottle,
  • holding the edge of the teat, put it on to the bottle, screw the retaining ring into place, and cover the teat with the cap, and
  • shake the bottle until all the powder has dissolved.

It is best to feed your baby using freshly made formula milk because using formula milk that has been stored may increase the chance of your baby becoming ill. If you need a feed for later, you can put boiling water into a sterilised flask or bottle, and make up fresh formula milk when required.

Feeding your baby

To cool your baby’s milk, hold the bottle, with the cap covering the teat, under cold running water. You can test the temperature of the milk by squeezing a little bit on to the inside of your wrist. Make sure that you keep the teat full of milk when feeding your baby, otherwise they will take in air. Always throw away any left over milk.

Bottle feeding using expressed breast milk

You can express (squeeze) breast milk into a bottle, either by hand, or using a manual or electric breast pump. This allows you to give your baby all the health benefits of breast milk, while also being able to share the feeding with your partner or other carer. It can be a particularly useful feeding method if you are returning to work or going out for the evening. You must sterilise the bottles, teats and pump in the same way as if using formula milk. Expressed breast milk can be kept in a fridge for a maximum of 24 hours, or stored in a freezer for up to 3 months for later use. It should never be re-frozen once thawed.

Combining breastfeeding with bottle feeding

Some women find that combining breastfeeding with bottle feeding is a convenient option for them. However, if you decide to breastfeed your baby, you should avoid introducing bottle feeding during the first six weeks of life, as it can confuse your baby, cause feeding problems, and can interfere with the establishment of breastfeeding.

Any breastfeeding is good for both you and your baby, and you should continue to breastfeed for as long as possible. Also, if you decide to breastfeed, it is important to maintain it for a sustained period because if you stop, it can be very difficult to start again.

If you decide to bottle feed your baby from birth, you can switch to breastfeeding if you decide to do so within the first few days. However, if you are considering breastfeeding, it is best to try it as soon as possible after birth. This will ensure that your baby receives the benefits of colostrum, the thick, yellowish milk that is produced during the first few days after birth, and is particularly rich in disease fighting antibodies. Starting to breastfeed soon after birth will also help your body to adjust to the process of breastfeeding, and it will help you to establish a routine.

Who can use it

There are a variety of factors that are known to influence a woman’s decision to breastfeed or bottle feed her baby. A woman’s age, level of education, cultural background, the advice that she receives from healthcare professionals and her past experience of breastfeeding can all affect her decision. The attitude of her partner can also be a significant factor.

Before making your decision about whether to breastfeed or bottle feed your baby, it is a good idea to discuss the matter with a healthcare professional, such as your midwife, or health visitor. If you decide to bottle feed your baby using formula milk, it is particularly important that you receive professional advice. Whatever decision you make, you should be given the full support of both your family and your healthcare advisors.

Infant formula milks

For the first 12 months of life, there are only two types of milk that you should use to feed your baby breast milk or infant formula milk (unless you are recommended otherwise by a doctor). Any other type of milk, such as cow’s milk, or goat’s milk, will not satisfy your baby’s nutritional needs, and should not be given to babies under one year of age. A young baby’s digestive system is unable to cope with the high protein content of cows milk, or goats milk, and it is likely to cause an adverse reaction.

Most infant formula milks are dried and packaged in tins, but they can also be bought ready-made in cartons. This is an expensive option, but it can be useful for holidays or days out. Some organic varieties of formula milk are also available.

There are two types of infant formula milks; one for babies from birth onwards, which is designed to be digested easily and quickly, and one marketed for the ‘hungrier baby’, which is suitable for older babies and takes longer to digest. Your midwife or health visitor can give you advice about which milk might be best for your baby.

A number of specialised formula milks are also available to cater for particular needs. These are outlined below.

  • Pre-term formula is for small, or premature, babies, and is designed specifically for immature digestive systems. It is it high in calories to aid weight gain in low birth weight babies.
  • Soya formula milk may be useful, in exceptional circumstances, if your baby is sensitive to cow’s milk, or has lactose intolerance. A report published in 2004 by the Committee on Toxicity of Chemicals in Food (COT) emphasised that soya-based formulas should only be used to ensure adequate nutrition in a small number of cases, such as in infants who have cow’s milk intolerance, and refuse extensively hydrolysed formulas, or for vegan mothers who are unable to breastfeed, or choose not to. You should therefore seek advice from your midwife, health visitor, or GP, before using soya formula milk.
  • Follow-on milks are suitable for babies from the age of six months onwards, who are on solids. They are designed to bridge the gap between infant formula and ordinary cows milk. You should not give your baby cow’s milk before they are a year old (12 months) because young babies are unable to digest the protein that it contains.

If your baby is enjoying breast or formula milk, it is not necessary to switch to follow-on milks. They do contain an increased amount of iron, but the Department of Health has stated that only 3-4% of this can be absorbed by a baby, and once you introduce solid food into your baby’s diet (normally at around the age of six months) they should get enough iron and other nutrients from other food sources.

From March 1, 2007, infant formula milks that are based on goats milk protein will no longer be sold in the UK, as they are not a suitable source of nutrition for babies less than one year old (12 months). Current European legislation only permits infant formula and follow-on formula to be based on cows milk protein, hydrolysed protein, or soya protein. As the protein in goats milk formula is very similar to cows milk protein, most babies who have an allergic reaction to cows milk will have a similar reaction to goats milk. This is also the case for babies who are lactose intolerant.

Babies who have a proven intolerance to cows milk protein may be prescribed an extensively hydrolysed infant formula. In a hydrolysed formula, the structure of the milk is changed so that a baby’s body does not recognise the protein as a foreign object, making it less likely to trigger an allergic reaction. However, the nutritional value of extensively hydrolysed infant formula is the same as other infant formulas.

Recommendations

The Department of Health supports the World Health Organisation’s (WHO) recommendation that breast milk is the best form of nutrition for babies because it provides everything that a baby needs for optimal growth, development, and health. Exclusive breastfeeding is recommended for the first six months (26 weeks) of life in order to protect your baby from illness and infection.

Six months is the recommended age to start weaning babies (gradually introducing solid foods). While weaning your baby, you should carry on breastfeeding and/or bottle feeding beyond the first six months. If you are unable to follow these recommendations, or you choose not to, make sure that you get advice from your GP or health visitor.

Mothers’ nutrition

As well as maintaining a balanced and nutritious diet during pregnancy, it is very important for you to maintain a healthy diet while you are breastfeeding your baby. During the first days, weeks, and months of life, your baby is totally dependent on you for their nutritional needs. Although you do not need to follow a special diet to be able to breastfeed, you should make sure that you have a balanced, varied diet, and that you drink plenty of fluids (at least eight glasses of water a day). This will ensure that both you and your baby are in the best of health.

Breastfeeding requires at least an additional 500 calories per day. Much of this energy can be derived from fat stores laid down during pregnancy. However, remembering to eat when you are hungry, and to drink when thirsty, is essential. Ideally, you should ensure that your diet includes milk and milk products, meat, poultry, fish, eggs, pulses, fruit and vegetables, bread and cereals, and some fats and oils.

If you decide to bottle feed your baby, it is still important that you eat a healthy, balanced diet, particularly during the first weeks and months of parenting. This will ensure that you are healthy and well rested throughout the period when the demands of feeding and caring for your baby are high.

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