Guidance for Nurses on Infant 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.

Reference

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