Introduction to breastfeeding, Breastfeeding Glands. 10 steps for successful breastfeeding. Weaning foods. Infant Formula and its types.

1. MATERNAL AND CHILD HEALTH
NUTRITION
Breastfeeding, infant formulas &
weaning/complementary foods
1

2. Introduction to Infant and young child feeding
Evidence shows that the nutritional status of the
infants and young children is significantly
affected by
 Inadequate infant and young child practices
 High morbidity rates, coupled with limited
accessibility to quality health care and poor
family practices with regards to seeking health
care
 High maternal malnutrition rates
 Limited knowledge and practices regarding
optimum infant and young child feeding
practices
2

3. Over view of the current Scenario
 Optimal infant and young child feeding
practices rank among the most effective
interventions to improve child health
 Every infant and child has the right to good
nutrition as Under nutrition is associated with
45% of child deaths
 In developing countries10% children are
wasted due to poor nutrition practices
3

4. The importance of infant and young child feeding
 Adequate nutrition during infancy and early
childhood is essential to ensure the growth,
health and development of children to their full
potential.
 Malnutrition during the first 2 years of life
causes stunting, leading to the adult being
several centimeters shorter than his or her
potential height
 Adults who were malnourished in early
childhood have impaired intellectual
performance
4

5. The Global Strategy for infant and young child
feeding
 The global strategy for infant and young child
feeding is based on respect, protection,
facilitation and fulfillment of accepted human
rights principles
 In 2002, the World Health Organization and
UNICEF adopted the Global Strategy for
infant and young child feeding
 The strategy was developed to focus world
attention to the impact that feeding practices
have on the nutritional status, growth and
development, health and survival of infants
5

6. Aims of the global strategy
The aim of this strategy is to improve – through
optimal feeding
 The nutritional status, growth, development
and health
 The survival of infants and young children
6

7. Recommended infant and young child feeding
practices
WHO and UNICEF’s global
recommendations for optimal infant
feeding as set out in the Global Strategy
are:
 Exclusive breastfeeding for 6 months (180
days)
 Nutritionally adequate and safe
complementary feeding starting from the
age of 6 months with continued
breastfeeding up to 2 years of age
7

8. Exclusive vs Complementary feeding
 Exclusive breastfeeding means that an
infant receives only breast milk from his or her
mother with the exception of oral rehydration
solution, drops or syrups consisting of
vitamins, minerals supplements or medicines
 Complementary feeding is defined as the
process starting when breast milk is no longer
sufficient to meet the nutritional requirements
of infants, and therefore other foods and
liquids are needed, along with breast milk
8

9. Life cycle of human
Infancy
 Infancy is categorized as lasting from birth
through the first year of life. The infant is
completely dependent upon its parents or
caretakers for survival
Childhood
 Childhood takes place between ages 1 to 11.
The first two years of childhood, the child is
called a toddler. During this time, the child
learns how to walk, talk and be more self-
sufficient
9

10. Cont….
Adolescence
 Adolescence takes place between ages 12 and 18
and is a critical turning point because it is when
puberty takes place
Adulthood
 Adulthood is the longest stage and normally lasts
from age 18 through old age. The life cycle
eventually ends in death
10

11. Stages of life
11

12. Important terms regarding
feeding
Breastfeeding
 Also known as nursing, is the feeding
of babies and young children
with milk from a woman's breast
Exclusive breastfeeding
 For 6 months an infant receives only breast milk
from his or her mother or a wet nurse, or
expressed breast milk, and no other liquids or
solids, not even water, with the exception of oral
rehydration solution, drops or syrups consisting of
vitamins, minerals supplements or medicines
12

13. Cont….
Complementary feeding
 The process starting when breast milk is no
longer sufficient to meet the nutritional
requirements of infants, and therefore other
foods and liquids are needed, along with breast
milk.
 The target range for complementary feeding is
generally taken to be 6 to 23 months of age,
even though breastfeeding may continue beyond
two years
Weaning
 The process of replacing breast milk with other
13

14. Cont….
Colostrum
The special milk that is secreted in the first 2–3
days after delivery. Colostrum is rich source of
antibodies, fat soluble vitamins and proteins
14

15. 15

16. Cont…
Transitional milk
 It is the breast milk that is produced between 7-
21days post-partum, rich in fats, lactose and water
soluble vitamins
Mature milk
 It is the milk that is produced after 21 days post-
partum and watery consistency, fulfills all hydration
need
Fore milk
Foremilk is rich in proteins, lactose and other essential
nutrients but contains less fat
Hind milk
 It is the milk that is produced in normal consistency
after initial secretions, rich in fats
16

17. Importance of breastfeeding
Optimum infant and young feeding (IYCF)
practices are essential for
- Survival
- Growth
- Development of infants and young children
These feeding practices comprise of breastfeeding
and complementary feeding
17

18. The WHO/UNICEF Global Strategy for infant and
young child feeding states that:
1) Infants should be initiated to breastfeeding within the
first half to 1 hour following their birth
2) They should be exclusively breastfed up to 6 months
of age and from then on
3) They should receive safe, nutritionally adequate and
age appropriate complementary foods while
continuing to breastfeed up to 2 years
18

19. Breastfeeding is a preferred mode of feeding
considering benefits:
 Nutritional
 Immunological
 Health (morbidity, mortality)
 Developmental
 Economical a ecological
19

20. Nutritional benefits
 Optimal concentration of nutrients
 High bioavailability
 Lower intake of calories
 Growth factors – epidermal growth factor, hormons
 Protective factors - immunoglobulins, macrophages,
lysozym, bifidus factor etc.
20

21. Reviews of studies from developing countries show
that infants who are not breastfed are 6 to 10 times
more likely to die in the first months of life than
infants who are breastfed
Malnutrition, Diarrhoea and pneumonia are more
common and more severe in children who are
artificially fed and are responsible for many of these
death
21

22. Benefits of Breastfeeding
to Infants
Decreased morbidity and mortality from
infections
• Respiratory
• Gastrointestinal
Optimal nutrition
• Species-specific nutrients
• No overfeeding
Improved outcomes for premature infants
• Fewer infections
• Earlier discharge
22

23. Benefits of Breastfeeding
to Mothers
Immediately after birth
 Decreased risk of postpartum hemorrhage
 Delayed onset of menses
- Decreased incidence of iron deficiency
Long-term health
 Decreased risk of breast, ovarian, and uterine
cancers
 Decreased risk of central obesity and metabolic
syndrome
23

24. 24

25. Immunological benefits
Breastfeeding confers short-term and long-term
benefits on both child and mother including helping to
protect children against a variety of acute and chronic
disorders
Artificially-fed children have an increased risk of long
term diseases with an immunological basis, including
asthma and other atopic conditions, type 1 diabetes,
celiac disease and ulcerative colitis
Artificial feeding is also associated with a greater risk
of childhood leukaemia
25

26. Immediate causes of malnutrition
a) Poor food intake
Children nutritional status is negatively affected by
inadequate food intake and by illnesses
b) Illnesses
Poor nutritional status compromises the child’s ability
to resist and recover rapidly from infections
It is estimated that more than 1/3 of the child deaths
are, globally, attributable to under nutrition
26

27. Underlying causes of
malnutrition
Inadequate infant and young child feeding practices
Maternal nutritional status
27

28. 28

29. Importance of optimum IYCF
practices and child survival
Exclusive breastfeeding up to 6 months and
breastfeeding up to 12 months ranked as the single
greatest nutrition intervention for effectively
reducing child mortality
Research result reported that exclusive breastfeeding
could potentially prevent 1.4 million deaths every
year among children under five years of age out of
the 10 million child deaths estimated globally
29

30. Importance of IYCF on growth
and development of children
Optimum IYCF is essential for child growth and
development
Adequate complementary feeding as well as freedom
from illnesses are essential for achieving proper infant
and young child growth and development
30

31. Importance of IYCF practices
for the mother
Breast milk confers to the baby 0-6 month protection
from illness thanks to its antibodies; it is adequately
nutritious for the infant and is a uniquely balanced
and complete food for this age group
On the other hand, a 0-6 month old infant who is
artificially fed is faced with a threefold risk:
- he/she does not receive the necessary antibodies from
the breast milk
- he/she is at risk of being contaminated from unhygienic
milk preparations
- his/her diet may not be adequate
31

32. The benefits of breastfeeding are also enormous for
the mother
For the mother, breastfeeding is associated with
decreased maternal postpartum blood loss, breast
cancer, ovarian cancer and endometrial cancer and
reduced osteoporosis
32

33. Major Gaps
Every mother can breastfeed her baby provide
- she is in good health
- she has the right information, attitudes and support
from the family, the community and the health care
system
33

34. A. At household level
Limited knowledge by the mothers and caregivers on
optimum infant and young child feeding practices
Widespread social and cultural beliefs affecting proper
infant feeding practices. For instance, that colostrums
is harmful to the baby or that early initiation of
breastfeeding and exclusive breastfeeding for 6
months and continuation of breastfeeding up to 24
months and beyond are not possible
Early or late introduction of complementary feeding,
inadequate knowledge on and practices of optimum
complementary feeding practices
Poverty, lack of diversity in the diet
Unhygienic preparation, sanitation and storage of
complementary feeds
34

35. B) At community and health
facility level
Early marriage, adolescent pregnancies and maternal
malnutrition
Limited number and adequately trained health
workers and community health workers on IYCF
Lack of community mother support groups to
promote optimum infant and young child feeding
practices
Lack of work on creating a supportive community as
a whole
35

36. C) At management/coordination
level
Weak coordination and partnership in promoting
and supporting optimum feeding practices
Limited implementing partners in support,
promotion and protection of optimum IYCF
practices, especially in special circumstances
Lack of supportive policies, IYCF guidelines and
legislation aimed at promoting, protecting and
supporting optimum infant and young child
feeding
Limited human and financial resources for
adequate IYCF programming
Limited supervision of service providers
36

37. IYCF Interventions
Most recently, major key interventions that are currently
being scaled up for the promotion, support and
protection of the IYCF practices include:
Sensitization of families and caregivers on
breastfeeding practices through various channels, the
main important being:
 Support IYCF programming through outreach
activities
Development of an IYCF promotion package aimed at
changing behavior of grandmothers and other
influential people on young mothers such as religious
leaders and fathers
37

38. Advocacy for the IYCF strategy and for improvement
on maternal nutrition
On-going counseling and promotional support which
are integrated into the various nutrition programs
 In-service training of service providers has also
being on-going
38

39. 5 W’s
 Who? Every woman
 What? Feed breast milk to her child
 Where? Any where & Every where
 When? After an hour of baby being born the
mother can breast feed her child and continue
exclusive breast feeding up to six months
 Why? Breast milk provide 100 of the essential
nutrients that are essential for the optimal growth
& development of baby
39

40. TEN STEPS TO SUCCESSFUL
BREASTFEEDING
1. Have a written breastfeeding policy that is routinely
communicated to all health care staff
2. Train all health care staff in skills necessary to
implement this policy
3. Inform all pregnant women about the benefits and
management of breastfeeding
4. Help mothers initiate breastfeeding within a half-hour
of birth.
5. Show mothers how to breastfeed, and how to maintain
lactation even if they are separated from their infants
40

41. Cont…
6. Give newborn infants no food or drink other than
breast milk, unless medically indicated
7. Practice rooming-in - allow mothers and infants to
remain together - 24 hours a day
8. Encourage breastfeeding on demand
9. Give no artificial teats or pacifiers (also called
dummies or soothers) to breastfeeding infants
10. Foster the establishment of breastfeeding support
groups and refer mothers to them on discharge
from the hospital or clinic
41

42. 42

43. 43

44. Awareness campaigns
44

45. How breastfeeding works
Two hormones that directly affect breastfeeding:
Prolactin
Oxytocin
When a baby suckles at the breast:
 Sensory impulses pass from the nipple to the brain
In response:
 The anterior lobe of the pituitary gland
secretes prolactin and
 The posterior lobe secretes oxytocin
45

46. Anatomy of breast
46

47. SUCKING REFLEX
47

48. Prolactin
 Necessary for the secretion of milk by the cells of the
alveoli
 When a baby suckles, the level of Prolactin in the
blood increases, and stimulates production of milk by
the alveoli
 More Prolactin is produced at night, so breastfeeding
at night is especially helpful for keeping up the milk
supply
 The Prolactin level is highest about 30 minutes after
the beginning of the feed
48

49. 49
 The level of prolactin in the blood increases markedly
during pregnancy, and stimulates the growth and
development of the mammary tissue, in preparation
for the production of milk (19).
 However, milk is not secreted then, because
progesterone and oestrogen, the hormones of
pregnancy, block this action of prolactin.
 After delivery, levels of progesterone and oestrogen
fall rapidly, prolactin is no longer blocked, and milk
secretion begins. Suckling affects the release of other
pituitary hormones, including gonadotrophin releasing
hormone (GnRH), follicle stimulating hormone, and
luteinising hormone, which results in suppression of
ovulation and menstruation. Therefore, frequent
breastfeeding can help to delay a new pregnancy.

50. 50

51. Oxytocin
 Oxytocin makes the myoepithelial cells around
the alveoli contract. This makes the milk, which
has collected in the alveoli, flow along and fill the
ducts
 The oxytocin reflex is also sometimes called the
“letdown reflex” or the “milk ejection reflex”.
 In humans, oxytocin induces a state of calm, and
reduces stress
 Enhance feelings of affection between mother
and child
51

52. 52

53. 53

54. Breastfeeding pattern
 To ensure adequate milk production and flow for
6 months of exclusive breastfeeding:
 Baby needs to feed as often and for as long as he
or she wants, both day and night
 Babies feed with different frequencies, and take
different amounts of milk at each feed
 The 24-hour intake of milk varies between mother-
infant pairs from 440–1220 ml, averaging about 800
ml per day throughout the first 6 months
 Prolonged, frequent feeds can be a sign of
ineffective suckling and inefficient transfer of milk to
the baby
54

55. Recommendations
WHO and UNICEF recommendations
 Early initiation of breastfeeding within 1 hour of
birth;
 Exclusive breastfeeding for the first 6 months of
life; and
 Introduction of nutritionally-adequate and safe
complementary (solid) foods at 6 months
 Newborn babies typically express demand for
feeding every one to three hours (8–12 times in
24 hours) for the first two to four weeks
55

56. BREASTFEEDING WILL BE
SUCCESSFUL IN MOST CASES IF
 The mother feels good about herself
 The baby is well attached to the breast so that he
suckles effectively
 The baby suckles as often and for as long as he
wants
 The environment supports breastfeeding
56

57. Conclusion
 Skin-to-skin contact between mother and baby
immediately after birth and initiation of
breastfeeding within the first hour of life
 Breastfeeding on demand (that is, as often as the
child wants, day and night)
 Rooming-in (allowing mothers and infants to
remain together 24 hours a day)
 Not giving babies additional food or drink, even
water, unless medically necessary
57

58. 58

59. 59
Infant milk formulas

60. The most commonly used infant formulas
contain:
Purified cow's milk whey and casein as
a protein source.
A blend of vegetable oils as a fat source.
Lactose as a carbohydrate source.
Vitamin-mineral mix.
Other ingredients depending on the
manufacturer.
n

61. Proteins: plain cow's milk is unsuited for
infants because of its high casein content
and low whey content, and untreated cow's
milk is not recommended before the age of
12 months. So cow's milk used for formula
undergoes processing to be made into
infant formula. This includes steps to make
protein more easily digestible and alter the
whey-to-casein protein balance to one
closer to human milk.
n

62. Compositio
n
Fat: the partial or total replacement of dairy
fatwith fats of vegetable or marine origin.
Carbohydrates: in most cow's milk-based
formulas, lactose is the main source of
carbohydrates present.

63. Dates Events
1867 A formula containing wheat flour, cow's milk, malt flour, and potassium
bicarbonate was developed.
1915 A powder form of infant formula was introduced, containing cow's milk,
lactose, oleo oils, and vegetable oils.
1929 Soy formula was introduced.
1935 Protein was added because it was believed cow's milk protein content was
lower than human milk protein content.
1959 Iron fortification was introduced because a large amount of iron.
1962
The whey:casein ratio was made similar to human milk because producers
were aware that human milk contains a higher ratio of whey protein, and
cow's milk contains a higher ratio of casein.
Early
2000
Polyunsaturated fatty acid fortification was introduced. Omega 3 and
Omega 6 were added because those fatty acids play an important role in
infant brain development.
Probiotics and prebiotics were added.
Lysozyme and Lactoferrin were added. Both have antimicrobial activity.
Compared to human milk, cow’s milk has a signifactly lower levels of
lysozyme and lactoferrin; therefore, the industry has an increasing interest in
adding them into infant formulas.

64. Which is better, breastfeeding
or formula-feeding?
• Human milk is the preferred feeding for all infants.
• Pediatricians generally advise that full-term, healthy infants
exclusively breastfeed when possible for the first 12 months
of life and, thereafter, for as long as mutually desired.
• Advantages of breastfeeding include
 breast milk is nutritionally sound and easy to digest;
 breastfeeding is believed to enhance a close mother-child
relationship;
 breast milk contains infection-fighting
antibodies (immunoglobulins) that may
reduce the frequency
of diarrhea, gastroenteritis otitis media, and other
respiratory infections in the infant; and
 breast milk leads to cost savings and is convenient.

65. Breastfeeding or formula-
feeding?

67. Formula-Feeding
• Some parents choose formula-feeding either
because of personal preference or because
medical conditions of either the mother or the
infant make breastfeeding ill-advised.
• Some common reasons for choosing formula-
feeding include:
 There is an inadequate supply of maternal breast
milk.
 The baby is sucking inefficiently.
 Parents are unable to quantify the amount of
breast milk received by the baby.
 Some parents want to know exactly how much
their baby is receiving at each feeding, and
formula/bottle- feeding allows exact
measurement.

68. Formula-Feeding
A significant reason for not breastfeeding is
concern about transferring certain drugs
the mother is taking through the breast
milk to the infant.
An increasing number of mothers must
return to work shortly after their baby's
delivery.
A benefit of bottle-feeding is that the
entire family can immediately become
intimately involved in all aspects of the
baby's care, including feedings.

69. Which formula is best for my baby?
• There is no evidence that one brand of formula is better than another. However,
you should consider:
 Choosing a formula based on cow’s milk, unless there is a cultural, religious or health
reason to use a different formula
 If possible, choosing a formula with a lower protein level, which may reduce your
baby’s risk of being overweight or obese in later life
 Only using special formulas (HA, AR, lactose-free or soy formula) if they are
recommended by a doctor
 Taking into account price and affordability
 AR stands for anti-regurgitation and these formulas are often used for babies with reflux.
 HA stands for hypo-allergenic and are for babies at high risk of allergies like asthma,
eczema, hay fever or food allergies. The protein has been broken down into smaller parts.
This formula is not for babies with a cow's milk allergy.

70. What infant formula preparations
are available?
• Infant formulas come in three forms. The best
choice depends on your budget and desire for
convenience:
• Powdered formula. Powdered formula is the
least expensive. Each scoop of powdered
formula must be mixed with water.
• Concentrated liquid formula. This type of
formula also must be mixed with water.
• Ready-to-use formula. Ready-to-use formula is
the most convenient type of infant formula. It
doesn't need to be mixed with water. It's also the
most expensive option.

71. What's the difference between generic and
brand-name infant formula?
• All infant formulas sold in the United
States must meet the nutrient standards
set by the FDA.
• Although manufacturers might vary in their
formula recipes, the FDA requires that all
formulas contain the minimum
recommended amount of nutrients that
infants need.

72. What about enhanced infant
formula?
• Some infant formulas are enhanced with docosahexaenoic
acid (DHA) and arachidonic acid (ARA). These are omega-3
fatty acids found in breast milk and certain foods, such as
fish and eggs. Some studies suggest that including DHA and
ARA in infant formula can help infant eyesight and brain
development.
• In addition, many infant formulas include pre- and
probiotics — substances that promote the presence of
healthy bacteria in the intestines — in an effort to mimic
the immune benefits of breast milk.
• In addition to the core ingredients, some formulas contain
extra ingredients, These include LCPs(long-chain
polyunsaturated fatty acids), nucleotides and
prebiotics.
• Some formulas have an additional prebiotic ingredien
• Oligosaccharides, which are often referred to as FOS/GOS

73. How long should a child drink
infant formula?
• Infant formula is generally recommended
until age 1, followed by whole milk until
age 2 — but talk to your child's doctor for
specific guidance.
• Reduced-fat or skim milk generally isn't
appropriate before age 2 because it
doesn't have enough calories or fat to
promote early brain development.

74. Types of formula milk
• Commercial infant formulas are regulated by the
Food and Drug Administration (FDA). Three
major types are available:
• Cow milk protein-based formulas. Most infant
formula is made with cow's milk that's been
altered to resemble breast milk. This gives the
formula the right balance of nutrients — and
makes the formula easier to digest. Most babies
do well on cow's milk formula. Some babies,
however — such as those allergic to the proteins
in cow's milk — need other types of infant
formula.

75. Cow’s milk-based formula
• Most baby formula milks are based on modified cow's milk,
which is
recommended over other types of formulas for most babies.
• The protein in milk can be broken down into curds
(casein) and whey. Casein is lumpy and whey is watery.
• The ratio of casein to whey can vary according to the type of
baby formula milk.
• There are two main types:
• First-stage formula. These milks are based mostly on whey,
with a casein:whey ratio of 40:60, which is about the same as
breastmilk. They are suitable for your baby from birth up to
about a year, and are thought to be easier for baby to digest
than casein-based milks.
• Second-stage, follow-on or hungry-baby formula. These
milks consist of mostly casein, with a casein:whey ratio of
80:20. Manufacturers claim that the higher casein content
means the milk takes longer to digest, keeping baby fuller
for longer.

76. Soy-based formulas
• Soy-based formulas can be useful if you
want to exclude animal proteins from your
child's diet.
• Soy-based infant formulas might also be an
option for babies who are intolerant or
allergic to cow's milk formula or to lactose,
a carbohydrate naturally found in cow's
milk. However, babies who are allergic to
cow's milk might also be allergic to soy
milk.

77. Goats' milk formula
• Different kinds of goats' milk formula
are available in the shops.
• They are produced to the same
nutritional standards as cow's milk-
based formula.
• Goats' milk formula is not less likely to
cause allergies in babies than cows'
milk formula.
Types of formula

78. Anti-reflux (staydown) formula
• This type of formula is thickened with the
aim of preventing reflux in babies (when
babies bring up milk during or after a
feed)

79. Lactose-free formula
• This formula is suitable for babies who
are lactose intolerant. This means they
can't absorb lactose, a sugar found in milk
and dairy products.
• Lactose intolerance Symptoms include
diarrhoea, abdominal pain, wind and
bloating.
Types of formula
milk

80. Hydrolysed-protein formula
• If thebaby is diagnosed as being allergic to cows' milk,
the appropriate infant formula is fully hydrolysed
(broken down) proteins.
• There are two versions of hydrolysed milk available:
 fully hydrolysed formula
 partially hydrolysed formula
• Fully hydrolysed formula is specially designed for babies
with
an allergy or intolerance to cow's milk.
• Partially hydrolysed formula (Comfort formula)This type
of formula milk is made completely from whey protein. It is
marketed as being easier to digest, and as suitable for
babies suffering from colic, wind, and stomach pain. They
are also sometimes promoted as being good for babies with
allergies.
Types of formula milk

81. Good night milk
• Some follow-on formula has cereal added
to it and is sold as a special formula for
babies to have at bedtime.
• This type of formula isn't needed, and
there's no evidence that babies settle
better or sleep longer after having it.
• Good night formula should never be
given to babies under six months old.
Types of formula

82. Growing-up milk toddler milk
• Growing-up and toddler milks are marketed
as an alternative to whole cows' milk for
toddlers and children aged over one.
• Whole cows' milk is a suitable choice as a
main drink for your child from age one.
• Semi-skimmed cows' milk is a suitable main
drink for children over two who are eating a
balanced diet.
• It's recommended that all children aged
six months to five years have vitamin
drops containing vitamins A, C and D
every day.

83. Types of milk to avoid
• Not all milk is suitable for feeding babies. You
should never give the following types of milk to a
baby under one year:
• condensed milk
• evaporated milk
• dried milk
• goats' or sheep's milk (but it's fine to use them
when cooking for your baby, as long as they are
pasteurised)
• other types of drinks known as "milks",
such as soya, rice, oat or almond drinks
• cows' milk as a drink (but it's fine to use it in
cooking)

84. What kind of bottle should I use?
• Bottles come in different shapes and sizes, can
be made of glass or plastic, and may be
reusable or have disposable liners inside.
• Some babies do better with certain shapes or
bottles with liners on the inside.
• It's important to note that some plastic bottles are
labeled "BPA-free"— meaning that they do not
contain the chemical bisphenol A, which is found
in some plastics and may affect kids' health.
• Glass bottles are free of BPA and can last for a
long time, but can crack and chip, so they
need to be checked often to avoid harm to
baby.

85. kinds of nipples
• Nipples come in silicone (clear) or latex (brown)
• The many different varieties include orthodontic nipples,
rounded nipples, wide-based nipples, and flat-top nipples.
And some are advertised as "being closer to the natural
shape of a mother's breast."
• But which kind is best really depends on your baby and what
he or she seems to prefer. After all, every baby is different.
• Nipples also often come in different numbers, "stages," or
"flow rates" to reflect the size of the nipple's hole, which
affects the flow (i.e., slow, medium, or fast) of formula or
breast milk.
• For example, fast flows may cause younger babies to gag or
may simply give them more than they can handle, whereas
slower flows may frustrate some babies and cause them to
suck harder and gulp too much air.

86. Cleaning and sterilising baby bottles
• A baby’s immune system is not yet fully
developed, and babies are more
susceptible to infection and illness than
an older child or adult.
• Cleanliness is therefore very important
when preparing baby’s bottles.

87. Cleaning bottles
• Bottles, lids, teats and other equipment use to
prepare a feed should always be thoroughly cleaned
after each use:
• As soon as possible after baby finishes a feed,
wash the bottle, teat and lid in hot soapy water.
• Use a bottle brush, and be sure to clean out any dried
milk stuck inside the bottle and teat.
• Once it is clean, rinse the equipment with some fresh
water and allow it to air dry.
• This kind of cleaning is important for getting rid of all
traces of milk or formula left inside the bottles, but it
does not ensure that the feeding equipment is
completely germ- free.

88. Sterilising bottles
• Sterilising is the process of killing any
harmful germs that may be clinging to
surfaces of the bottles and other equipment.
• It is important to sterilise baby bottles before
each use, for at least the first 12 months of
your baby’s life.

89. How to sterilise feeding equipment
• There are a few different ways to
sterilise baby’s bottles, teats, lids and
other feeding equipment.

90. Boilin
g
• Boiling works by raising the temperature high enough to kill any
bacteria left over after washing.
• Place clean bottles, teats, caps and utensils in a large saucepan
on the back burner of the stove.
• Add enough water to cover all the equipment, making sure there
are no air bubbles.
• Bring water to the boil, and boil rapidly for 5 minutes.
• Turn off the stove and allow the water to cool down.
• Wash your hands thoroughly before you handle the
equipment, and disinfect the surface where you plan to make
up the bottle.
• Take the equipment from the saucepan and shake off any excess
water.
• If you are not using them straight away, put the lid and teat onto
the bottle, and store in a clean container in the fridge.
• Re-boil the bottle and other equipment if it is not used within 24
hours.

91. Chemicals
• Chemical sterilisers are disinfectant solutions that come as
liquids or tablets that dilute with water.
• Make sure bottles, teats, caps and utensils are thoroughly clean
before you begin.
• Read and follow the manufacturer’s instructions for making
up the sterilising solution.
• Place the feeding equipment in the sterilising solution, making sure
it is
completely under water and there are no air bubbles.
• Leave the equipment in the sterilising solution for the
recommended amount of time (usually about 30 minutes –
check the manufacturer’s instructions).You can then leave the
equipment in the solution until you need to use it.
• Allow bottles, teats and lids to drain before you use them – don’t
rinse off
the sterilising solution, as this exposes equipment to germs again.
• Throw away the solution after 24 hours.
• Clean the sterilising container thoroughly in warm, soapy water,
before making up a fresh lot of solution.

92. Steam microwave or electric
sterilisers
• Much like boiling, steaming works by raising the temperature
high
enough to kill bacteria.
• There are several different types of sterilisers available –
follow the instructions provided by the manufacturer.
• Make sure bottles, teats, caps and utensils are thoroughly
clean before you begin.
• Make sure that bottles and teats are placed with openings
facing
down in the steriliser.
• Follow instructions for adding water to the unit and turning it
on.
• Leave bottles in the steriliser until they are needed.
• If you are not using the bottles straight away, check
instructions for how long you can leave them in the steriliser
before you have to re- sterilise them.

93. How to feed your baby with formula
• There are a few important guidelines to
remember when feeding your baby using
a bottle. You will also find some helpful
tips and commonly asked questions.

94. • A step-by-step guide to preparing a powdered-
formula feed:
• Step 1 Fill the kettle with at least 1 litre of fresh tap
water don’t use water that has been boiled before
• Step 2 Boil the water. Then leave and allow it to cool
until lukewarm at least 30 minutes.
• Step 3 Clean and disinfect the surface you are going
to use to prepare the formula.
• Step 4 Wash your hands thoroughly, using soap,
and dry them.
• Step 5 If you are using a cold-water steriliser, shake
off any excess solution from the bottle and the teat,
or rinse the bottle with cooled boiled water from the
kettle not the tap
• Step 6 Stand the bottle on a clean surface.
• Step 7 Keep the teat and cap on the upturned lid
of the steriliser. Avoid putting them on the work
surface.

95. • Step 8 Follow the manufacturer’s instructions and pour the correct
amount of previously boiled (now cooled) water that you need into
the bottle. Double check that the water level is correct. Always put
the water in the bottle first before adding the powdered infant
formula.
• Step 9 Loosely fill the scoop with formula, according to the
manufacturer’s instructions, and level it off using either the flat edge
of a clean, dry knife or the leveller provided. Different tins of formula
come with different scoops. Make sure you use only the scoop that
is enclosed with the powdered infant formula that you are using.
• Step 10 Holding the edge of the teat, put it on the bottle. Then
screw the retaining ring onto the bottle.
• Step 11 Cover the teat with the cap and shake the bottle until the
powder is dissolved.
• Step 12 Test the temperature of the infant formula on the inside of
your wrist before giving it to your baby. It should be body-
temperature, which means it should feel just warm, but not hot.
• Step 13 If there is any made-up infant formula left after a feed, throw
it
away.

96. Thank you for your listening