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Bottles
and Bottle-feeding
Cow’s
milk, which is designed for calves rather than babies, is quite
different from breast milk, and has to be altered before it can
be used as food for babies. In fact, as has already been described,
the composition of breast milk changes during a feed, as the baby
grows, and from feed to feed in the same woman, so defining what
an ‘average’ sample of breast milk contains is difficult. It is
not possible to make up an artificial feed which is exactly like
breast milk since we do not know all the properties of breast milk
yet, the content varies and the immunising and anti-infective qualities
cannot be reproduced artificially. But cow’s milk can be modified
to make a very safe food that your baby can thrive on, though it
is necessary to get all the ingredients in the right proportions.
As
we have already seen, although the calorie content of cow’s milk
and breast milk is the same, cow’s milk has two to three times as
much protein as breast milk, and this protein is of a different
composition. Cow’s milk contains less lactose (milk sugar), the
fat is less easily absorbed, and the minerals are very much higher:
sodium, potassium, calcium and chloride are two to three times higher.
To make a baby’s milk formula the levels of protein and these minerals
are reduced by diluting the cow’s milk. This will also reduce the
calorie and vitamin content to levels much lower than in breast
milk. To remedy this, extra lactose and other essential nutrients
are added to make it suitable for your baby.
Commercially
modified baby milks must be used for bottle-feeding. Your hospital
or community midwife will advise you which brands to choose from
and, having made your choice, stick to the same formula. Modified
whey-based milks have been the most extensively modified to mimic
the content of breast milk as far as possible. You must dilute the
powdered varieties correctly by mixing the right quantity of cool,
boiled water.
In
the days before commercially modified milks were available, mothers
simply diluted doorstep milk and added sugar. Today’s formula feeds
are much better tailored to a new baby’s digestion and should always
be used when breast milk is not available. If you do get caught
out and need to make up an emergency bottle from doorstep milk,
it should be boiled first and then diluted with half as much boiled
water (i.e. about 125 ml milk to 75 ml water). Sugar is added in
a ratio of 15g or 1 level tablespoon to every 200 ml of diluted
milk.
It
is important to offer properly diluted feeds, as well as extra water
when your baby is thirsty. Make up more than the recommended amount
for his weight. At some feeds he will take more, at others less,
but do not try to force him to finish a bottle once his hunger is
satisfied.
Establishing
Bottle-Feeding
‘I
Ioved taking a warm, fresh bottle of milk and seeing _it disappear
bit by bit as my baby fed.’
After
delivery do not let the fact that you plan to bottle-feed deprive
you and your baby of the pleasure of physical closeness and contact.
Even if you do not want to put your baby to the breast there is
no reason why you should not enjoy skin-to-skin contact in the same
way. Loosen his wrappings while still keeping him warm and lay him
on your tummy or between your breasts, gently stroke and caress
him to help him uncurl and relax. For more discussion of handling
the newborn click
here.
On
day one it is sufficient to give a bottle-fed baby a glucose and
water solution. There is no artificial replacement for colostrum,
and at this stage he mostly needs fluid rather than food.
There
is great pleasure in feeding a bottle to a hungry baby but you need
to make an extra effort to see that feeding time stays a time for
special enjoyment and closeness, not just another chore to be done
by anyone. Always hold your baby very close – at night-time especially
it is easy to cradle him against your skin – and support him in
a fairly upright position.
Feed
your baby whenever he seems interested in just the same way as if
he were breastfed. Trying to force him into a routine of four-hourly
feeds before he is mature enough will only lead to several hours
with a crying, upset baby and misery for both of you. Remember that
in the womb his body has been nourished continually and at first
his pattern of feeding, just like a baby that is being breastfed,
needs to be little and often. Offer him a bottle whenever he wakes
and roots for food or cries. If he takes only a few sucks and goes
back to sleep or loses interest, nothing is lost and you have given
him the comfort of sucking. Do not think that offering him food
whenever he wants will encourage him to go on asking for it at irregular
intervals. The fact is that his digestive system is still immature
and needs time to adjust – he is not able to cope with any other
way of feeding. Usually, by about two weeks, some sort of pattern
is beginning to emerge. He may sleep for three to four hours, perhaps
in the morning, and have another time, possibly early evening, when
he needs small feeds more often. Do not be tempted to add cereal
to a feed in the belief that it will help him to sleep through.
Staying asleep for longer periods has to do with the maturity of
your baby’s brain as well as his digestion, and added cereal will
just make him fat.
Extra
fluid may be necessary for bottle-fed babies in hot weather. If
in doubt offer boiled water. Older babies may be offered well-diluted
unsweetened fruit juice preferably from a cup or teaspoon or in
a bottle. If he does not want it you can conclude he does not need
it. Avoid sugary drinks, which will rot emerging teeth.
Equipment
• Purpose-bought
or improvised container for sterilising bottles, but it must be
big enough to submerge everything completely. Steam sterilising
units are available though more expensive.
• Eight
wide-necked baby feeding bottles and teats designed for newborns.
• Large
plastic or Pyrex measuring jug and plastic stirrer for mixing
feeds, or you can measure the water into the baby bottles and
add the correct number of scoops of powder directly.
• Sterilising
tablets or liquid – check the instructions on how to make up the
solution and how long it takes to sterilise bottles.
• Plastic
knife.
Making
Up Feeds
Everything
you use for making up bottles must be sterilised, including the
jug and stirrer if used, so always start by washing your hands and
freshly filling and boiling a kettle of water.
It
is easiest to make up a day’s supply of bottles in one go and store
them in the fridge for up to twenty-four hours. Make up a little
more formula than you think you need – a very rough guide is that
babies need about 150 ml of milk for every kilogram (2 H fluid oz
for every pound) of body weight per day, so a 4 kg (10 lb) baby
will need approximately 600 ml (25 oz) milk in twenty-four hours.
However, the real measure is your baby’s appetite, and at some feeds
he will take more than at others.
As
long as you offer him milk whenever you think he might be hungry
and do not try to force it on him when he does not want it, you
will be giving him what he needs. Discard the rest of the feed and
never save bottles to be reheated because warm milk is an ideal
breeding ground for bacteria. It is now possible to buy ready-mixed
cartons of formula, which, though expensive, can be useful for outings.
Jug
Method
• Wash
your hands.
• Take
the measuring jug and stirrer from the steriliser. Do not rinse
them under the tap because you will de-sterilise them again. Shake
them to remove drops of sterilising solution.
• Pour
the right amount of boiled water into the jug, make sure it is
standing on a flat surface and check the quantity at eye level
rather than from above.
• As
hot water destroys vitamins, most formulas require the water only
to be warm to mix easily, so cover the jug with its own lid or
a plastic or glass saucer, which also needs to be sterilised,
while the water cools.
• When
the water is the right temperature, add the correct number of
scoops – make sure there are no distractions because it is easy
to lose count.
• Use
the scoop provided and do not fill it by dragging it up the side
of the tin or otherwise compressing the powder – these are the
commonest causes of over-concentrated feeding.
• The
milk powder should lie loosely in the scoop; use the flat edge
of a sterilised clean plastic knife (not metal) to level it off
each time. Never heat powder. The common brands of baby milk are
diluted with one scoop of powder added to 30 ml (1 oz) water.
Do not be tempted either to increase or decrease the number of
scoops recommended.
• Stir
the milk until all lumps have dissolved: they could clog the teats.
Take bottles from the steriliser. Again, shake to remove drops
of sterilising solution and do not rinse. Fill to the right level
– put slightly more in each bottle than you think your baby will
need.
• Take
teats from the steriliser, being careful to handle each teat by
the edge and not the part you put into the baby’s mouth, and fit
them into the bottles upside down. Put the caps, rings and tops
in place. Do not take out all these bits and pieces at the same
time and lay them on the work surface because you will de-sterilise
them, but take each item individually from the steriliser and
put it directly on to the bottle.
• Put
all the bottles in the fridge and leave them untouched until needed.
Bottle
Method
Wash
your hands.
• Take
the bottles from the steriliser. Again, shake but do not rinse
them because you will de-sterilise them.
• Pour
the right amount of boiled water into each bottle; make sure it
is standing on a flat surface and check the quantity at eye level
rather than from above.
• As
with the jug method, make sure the water is the right temperature,
warm but not hot.
• Use
the scoop provided and add the right number of scoops of powder
to each bottle – make sure there are no distractions so that you
can count properly.
• Again,
be careful not to fill the scoop by dragging it up the side of
the tin or otherwise compressing the powder. Level off the scoop
with the plastic knife.
• Take
the teats from the steriliser, being careful to handle by the
edge and fit into the bottles upside down. Put the caps, rings
and tops in place. Again, take out each item separately and put
directly on to the bottle.
• Shake
each bottle vigorously to make sure all the formula has dissolved
and there are no lumps.
• Put
bottles in the fridge and leave them untouched until needed.
Giving
a Bottle
• Take
the bottle from the fridge and warm it by standing it in a jug
of hot water.
• Check
temperature and flow by testing it on the back of your hand or
inside a wrist – it should feel warm, not hot or cold, and flow
in rapid drips, not in a continuous stream or too slowly. Small
holes can be enlarged with a red-hot needle but if the hole is
too large you need another teat.
• Always
get yourself comfortable, which means having your back and cradling
arm supported – if you are getting uncomfortable you will get
tense and be tempted to hurry the feed.
• Touch
your finger against your baby’s cheek nearest to you and, as he
turns his head towards you, ‘rooting’ for food, touch the teat
against his lips. Always introduce the teat fully into his mouth
so that the action of his jaws as he sucks is against the lower
half. Tilt the bottle so that the opening of the teat is always
covered with milk and to ensure that the baby is not sucking in
too much air.
• You will
need to stop feeding at least once to sit your baby up, allowing
him to burp up any wind (Proplems
in early feeding).
• Do not
try to force your baby to take more than he wants – his appetite
is always your best guide.
• Never
be tempted to keep the remains of a bottle. There is a high risk
of germs contaminating warm milk that is left standing around.
Throw away unused feeds.
• Never
leave a young baby with a bottle propped for him to feed from
because there is a real danger that he could choke. You are also
denying him the closeness babies enjoy during a feed, which is
also the time when they begin to learn the skills of communicating
and taking turns that develop when an adult and a baby enjoy a
shared task.
Sterilising
Bottles and Equipment
• As your
baby finishes a bottle, rinse it out with cold water to remove
any milk left inside and leave it ready for the evening washing-up
session.
• At the
end of the day thoroughly scrub all the bottles, caps, covers
and rinse with hot soapy water – a bottle brush is essential,
but remember to keep this clean too and leave it to dry afterwards.
• Rinse
everything well.
• To clean
the teats tip a little household salt on to the teat and rub it
between your fingers; fatty milk deposits can cling to the rubber,
making it feel slimy, and soapy water alone is not enough to shift
them. Turn the teat inside out, thoroughly rinse off the salt
and any slime under running water. This also helps to reduce the
risk of your baby getting thrush. Dummies should be cleaned in
a similar way.
• Make
up a fresh sterilising solution following the instructions on
the packet or bottle and submerge everything needed for bottle-feeding
including jugs, spoons and plastic knife or stirrer. Make sure
there are no air bubbles trapped inside anything, or that the
teats are not simply floating on top which will prevent them from
being completely sterilised.
Other
People Feeding Your Baby
‘My
mother was always saying, "Let me feed him so you can get on with
things." In fact feeding my baby was the pleasure and "things" were
just chores, but it was very hard to say that I wanted to feed him
myself.’
Because
there is a great deal of satisfaction to be gained from feeding
a baby, you will not be short of willing helpers offering to do
this particular job – from well-meaning grannies to friends and
school-aged children. Indeed one of the reasons you may have chosen
bottle-feeding was so that you could more easily leave him with
other people at times, but remember that feeding time is not just
an occasion when a baby receives the right amount of calories and
protein. It is also an occasion of great pleasure to him and consequently
to the person feeding him. It is a very important part of forming
a relationship, of getting to know your baby as you and he respond
to each other’s touch, movement and facial expression. This is the
main reason why breastfeeding has so many advocates – not only does
it provide the best nutrition, but it provides a regular, continuing
form of communication between a mother and her baby.
Naturally,
you will be pleased that the baby’s father can share in this experience
and if it is to be he rather than you who is to stay at home and
look after the baby then it is right for him gradually to take over
most of the feeds. But early on guard feeding times for yourself.
Do not be afraid to say that you want to feed your baby yourself
because it is a time when you both get to know each other and feel
very close. If any relatives threaten to get offended you could
point out that it is a question that would not even arise if you
were breastfeeding. Encourage them to help you with other chores,
for example bathtime, washing, shopping and so on.
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