Guidance for Nurses on Infant Formula Feeding

Thursday, Feb 01, 2018

Reference

Royal College of Nursing (RCN). Formula feeds – RCN guidance for nurses caring for infants and mothers. 2016. Link to the guidance


Other article that you might be interested in:

The Nutrition Association of Thailand and the Early Nutrition Academy on Composition of Follow-up Formula

Objective of this guidance:

  • To provide an overview of formula feeding to enable healthcare professionals (HCPs) to support mothers who, for whatever reason, have made the decision of formula feeding.

Target audience of this guidance:

  • Children’s nurses, neonatal nurses, adult nurses, midwives, health visitors and health care support workers.

Key points on formula feeding covered in this guidance:

  • Provision of information about bottle feeding:
    All parents who have chosen to bottle feed their babies should be demonstrated how to sterilize bottle feeding equipment and offered a 1-to-1 demonstration on making up formula feeds safely before they leave hospital.
     
  • Common types of infant formulas (intended for babies from birth to 12 months):
    First milks Follow-on formulas Soy protein-based formula
    • Can be started from birth
    • Proteins in such formula that based on cow’s milk tend to be whey dominant (but no requirement in legislation on the whey/casein ratio in UK)
    • From 6 months of age and as part of a weaning diet, not regarded as breast milk substitutes
    • Featured increased levels of iron and vitamin D compared to formula designed to be given from birth (while this is based on the fact that UK infants aged > 6 months are often lacking in these 2 nutrients)
    • The only option for baby who follows a vegetarian diet
    • Can also be used in infants with galactosemia or galactokinase deficiency
    • Current advice in the UK is that babies should not have soy formula unless advised by a general practitioner (GP) or health visitor

  • Common types of special formulas for different special medical purposes:
    Colic and constipation Cow’s milk allergy (CMA) Prevention of food allergy
    • Commonly called “comfort” formula, developed to manage everyday feeding problems such as wind, crying, symptoms of colic and being generally unsettled
    • Common features of such formula may include:
      - Partially hydrolyzed protein
      - Adapted fat blend
      - Reduced lactose content
      - Prebiotic oligosaccharides
    • Extensively hydrolyzed formula
    • Amino acid formula – often used in more severe CMA where even extensively hydrolyzed formula cannot be tolerated
    • Hydrolyzed formula – either partially or extensively hydrolyzed
    • Suitable for high risk infants with family history of allergy

 

  • Preparation of formula feeds (water temperature):
    • HCPs and carers should follow good hygiene when preparing feeds and strictly follow the manufacturer’s instructions on the formula label.
    • Boiled water with no less than 70°C should be used, both fresh tap water or bottled water (< 200 mg/L of sodium and < 250 mg/L of sulphate) can be used. While note that some specialist formulas may require different preparation so always refer to manufacturer’s instructions.
       
  • Feeding guidelines (for term infants):
    • All infants should be fed on demand, regardless of the types of formula that they received.
    • As a general guide, the fluid requirement from ~1 week to 3 months of age is 150 mL/kg body weight daily.
    • Initially, most infants will need to be fed every 2 to 4 hours, day and night.
    • Limiting the number of people involved with feeding may help the baby feel secure and support a stronger bonding between mother and baby.
    • Follow responsive feeding and attending carefully to the cues of hunger and satiety may be important to prevent overfeeding and help reducing the risk of excessive weight gain.
       
  • Water consumption:
    • Exclusively breastfed infants should not be given water until after they have started eating complementary food.
    • Formula-fed infants should be given additional drinks of freshly boiled and cooled water in hot weather.
       
  • During weaning:
    • Breastfeeding and/or formula should continue after 6 months in addition to solid foods.
    • Cow’s milk should not be used as a main drink until after 12 months of age.

Guidance for Nurses on Infant Formula Feeding

Thursday, Feb 01, 2018

Reference

Royal College of Nursing (RCN). Formula feeds – RCN guidance for nurses caring for infants and mothers. 2016. Link to the guidance


Other article that you might be interested in:

The Nutrition Association of Thailand and the Early Nutrition Academy on Composition of Follow-up Formula

Objective of this guidance:

  • To provide an overview of formula feeding to enable healthcare professionals (HCPs) to support mothers who, for whatever reason, have made the decision of formula feeding.

Target audience of this guidance:

  • Children’s nurses, neonatal nurses, adult nurses, midwives, health visitors and health care support workers.

Key points on formula feeding covered in this guidance:

  • Provision of information about bottle feeding:
    All parents who have chosen to bottle feed their babies should be demonstrated how to sterilize bottle feeding equipment and offered a 1-to-1 demonstration on making up formula feeds safely before they leave hospital.
     
  • Common types of infant formulas (intended for babies from birth to 12 months):
    First milks Follow-on formulas Soy protein-based formula
    • Can be started from birth
    • Proteins in such formula that based on cow’s milk tend to be whey dominant (but no requirement in legislation on the whey/casein ratio in UK)
    • From 6 months of age and as part of a weaning diet, not regarded as breast milk substitutes
    • Featured increased levels of iron and vitamin D compared to formula designed to be given from birth (while this is based on the fact that UK infants aged > 6 months are often lacking in these 2 nutrients)
    • The only option for baby who follows a vegetarian diet
    • Can also be used in infants with galactosemia or galactokinase deficiency
    • Current advice in the UK is that babies should not have soy formula unless advised by a general practitioner (GP) or health visitor

  • Common types of special formulas for different special medical purposes:
    Colic and constipation Cow’s milk allergy (CMA) Prevention of food allergy
    • Commonly called “comfort” formula, developed to manage everyday feeding problems such as wind, crying, symptoms of colic and being generally unsettled
    • Common features of such formula may include:
      - Partially hydrolyzed protein
      - Adapted fat blend
      - Reduced lactose content
      - Prebiotic oligosaccharides
    • Extensively hydrolyzed formula
    • Amino acid formula – often used in more severe CMA where even extensively hydrolyzed formula cannot be tolerated
    • Hydrolyzed formula – either partially or extensively hydrolyzed
    • Suitable for high risk infants with family history of allergy

 

  • Preparation of formula feeds (water temperature):
    • HCPs and carers should follow good hygiene when preparing feeds and strictly follow the manufacturer’s instructions on the formula label.
    • Boiled water with no less than 70°C should be used, both fresh tap water or bottled water (< 200 mg/L of sodium and < 250 mg/L of sulphate) can be used. While note that some specialist formulas may require different preparation so always refer to manufacturer’s instructions.
       
  • Feeding guidelines (for term infants):
    • All infants should be fed on demand, regardless of the types of formula that they received.
    • As a general guide, the fluid requirement from ~1 week to 3 months of age is 150 mL/kg body weight daily.
    • Initially, most infants will need to be fed every 2 to 4 hours, day and night.
    • Limiting the number of people involved with feeding may help the baby feel secure and support a stronger bonding between mother and baby.
    • Follow responsive feeding and attending carefully to the cues of hunger and satiety may be important to prevent overfeeding and help reducing the risk of excessive weight gain.
       
  • Water consumption:
    • Exclusively breastfed infants should not be given water until after they have started eating complementary food.
    • Formula-fed infants should be given additional drinks of freshly boiled and cooled water in hot weather.
       
  • During weaning:
    • Breastfeeding and/or formula should continue after 6 months in addition to solid foods.
    • Cow’s milk should not be used as a main drink until after 12 months of age.


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