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