NON BREASTFEEDING MOTHERS:

Teaching mothers
to prepare formula milk feed
Breastfeeding Promotion and Support
A Training Course for Health Professionals

Guideline by
Department of Food Safety, Zoonoses and Foodborne Diseases, WHO,
in collaboration with
the Food and Agriculture Organization of the United Nations (FAO).
World Health Organization, 2007

Breast is best
WHO recommends that infants are exclusively breastfed
for the first six months of life.
Babies who are exclusively breastfed will get the best start
for growth, development and health.
Infants who are not breast fed need a suitable breast-milk
substitute, for example, infant formula.

Supplementary feeding
A feeding that substitutes a breastfeeding
Powdered infant formula is not sterile. It may contain
bacteria that can cause serious illness in infants.
Correct preparation and handling can reduce the risk of
illness in infants.

Formula milk: The breach in sterility

Enterobacter contamination
A group of bacteria that are found naturally in the
environment.
These bacteria can survive in very dry conditions.
In some outbreak investigations, this bacteria were found in
powdered infant formula that had been contaminated in
the factory.
This bacteria might have also contaminated the powdered
infant formula after it was opened at home or elsewhere
during preparation.

Powdered infant formula is not sterile

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Other factors

If a mother is NOT breastfeeding

Assist with replacement feeding.
type of replacement feeding

A
F
A
S
S

Acceptable

Feasible
Affordable
Sustainable

Safe
obtain the replacement milk in sufficient quantities
safely prepare and feed the replacement milk
reduce risks associated with replacement feeding
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If a mother is NOT breastfeeding

A health worker should observe that the mother
(or other caregiver) is able to :
prepare a replacement feed
feed the baby in a safe manner
before the mother and baby are
discharged from the maternity
unit.

Teaching checklist:
1.
2.
3.
4.
5.
6.
7.

Cleaning feeding equipments

Sterilizing feeding equipments
Storing feeding equipments
How to prepare a bottle feed at home
How to feed the baby
Bottle feeding when outside home/ travelling
Rewarming milk in bottle

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Teaching checklist:
1.
2.
3.
4.
5.
6.
7.

Cleaning feeding equipments

Sterilizing feeding equipments
Storing feeding equipments
How to prepare a bottle feed at home
How to feed the baby
Bottle feeding when outside home/ travelling
Rewarming milk in bottle

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Cleaning feeding equipments

*Wash feeding equipments soon after feeding to ease cleaning before the milk gets dried up.
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Teaching checklist:
1.
2.
3.
4.
5.
6.
7.

Cleaning feeding equipments

Sterilizing feeding equipments
Storing feeding equipments
How to prepare a bottle feed at home
How to feed the baby
Bottle feeding when outside home/ travelling
Rewarming milk in bottle

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Sterilizing feeding equipments

Boiling over a stove

Steamer in a microwave

Sterilizing
methods

Electrical steam
sterilizer

Sterilizing tablets/ liquid

in cool water

Dish washing
machine

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Sterilizing feeding equipments - boiling

Boil for not less than

10 minutes

If using boiling method, teats will wear off sooner compared to other sterilizing method.
Hence, teats needs to be discarded if it appears sticky or signs of wear and tear.
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Teaching checklist:
1.
2.
3.
4.
5.
6.
7.

Cleaning feeding equipments

Sterilizing feeding equipments
Storing feeding equipments
How to prepare a bottle feed at home
How to feed the baby
Bottle feeding when outside home/ travelling
Rewarming milk in bottle

15
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Storing feeding equipments

Wash and dry your hands before handling sterilized equipment.
Use clean forceps for handling sterilized equipment.
If feeding equipments are removed from the sterilizer before
use, keep it covered in a clean place. Fully assemble feeding
bottles before storing as this prevents the inside of the bottle,
and the inside and outside of the teat becoming contaminated.

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Storing refillable milk powder

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Teaching checklist:
1.
2.
3.
4.
5.
6.
7.

Cleaning feeding equipments

Sterilizing feeding equipments
Storing feeding equipments
How to prepare a bottle feed at home
How to feed the baby
Bottle feeding when outside home/ travelling
Rewarming milk in bottle

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How to prepare a bottle feed

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How to prepare a bottle feed

Always pour the required amount of water into

the bottle first. Stand the bottle on the table and
crouch down to look at the water level.

Loosely fill the scoop and level it off using the back
of a clean knife, or the leveler provided .

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How to prepare a bottle feed

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Teaching checklist:
1.
2.
3.
4.
5.
6.
7.

Cleaning feeding equipments

Sterilizing feeding equipments
Storing feeding equipments
How to prepare a bottle feed at home
How to feed the baby
Bottle feeding when outside home/ travelling
Rewarming milk in bottle

22
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How to bottle feed the baby

Choose a comfortable place.
Position baby.
Stimulate rooting reflex
Tilt the bottle slightly so that end of teat is always
filled with milk.
Feed the infant in a smooth and continuous fashion.

Follow the infants lead.

Avoid disruption.

If you can't see any bubbles or the teat collapses,

move it gently around her mouth or break the
suction to let air back into the bottle.
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Bottle feeding - DOs

Continue to feed until the baby indicates being full.
- Signs of fullness include sealing the lips, spitting out the nipple, and turning away
from the breast or bottle.

Never force the baby to finish what is in the bottle.

Make eye contact with the baby and enjoy the feeding time.
Try to keep the number of people who feed the baby to a
minimum. This will give the baby a chance to build a
relationship with those closest to her.
Keep the environment relaxed. As the baby grows she will
associate feeding and mealtimes as a calm and enjoyable part
of her daily routine.

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Burping the baby

A MUST
Wait for the baby to stop drinking before burping.
Sit her up on your lap facing away from you with one hand
cupping her chin, or put her over your shoulder. Then gently
rub or pat her back while talking to her so that she feels
comforted.

She may give a good burp and bring up a little milk, this is normal. If your baby regularly brings
up large amounts of milk after feeds, consult health personnel.
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Bottle feeding DONTS

NEVER feed your baby lying flat or leave her alone propped
up with a bottle, as she may choke. Milk will flow back down
her throat to her middle ear, causing an ear infection.
Do not feed the baby in the bouncer or cradle.
Do not let your baby fall asleep with a bottle in her mouth
either, as this can lead to tooth decay
Do not put cereal or other foods in a bottle.

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Teaching checklist:
1.
2.
3.
4.
5.
6.
7.

Cleaning feeding equipments

Sterilizing feeding equipments
Storing feeding equipments
How to prepare a bottle feed at home
How to feed the baby
Bottle feeding when outside home/ travelling
Rewarming milk in bottle

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Bottle feeding when outside

home/ traveling
Can I bring pre-prepared feeds
with me when I am travelling?

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Bottle feeding when outside home/ traveling

Yes - but make sure the feed is cold before it is transported, and
is kept cold during transport. This will slow down or stop the
growth of harmful bacteria.
Prepare feeds as normal, cool quickly and place in the
refrigerator (no warmer than 5C).
Immediately before you leave home, remove the cold feeds
from the refrigerator and place in a cool bag with ice packs.
You can then place the feeds in a refrigerator at your
destination, or re-warm a feed when you need one.

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Bottle feeding when outside home/ traveling

If your trip is longer than two hours, you may not be able to
keep the pre-prepared feeds cold.
Prepare feeds as you need them.
Bring individual portions of powdered formula with you in a
cleaned and sterilized container, and prepare feeds as normal
using boiled water that has been cooled to no less than 70C.
If you do not have access to boiling water;
Prepare feeds using fresh, safe water at room temperature
and consume immediately.
Feeds prepared with water cooler than 70C should not be
stored. Throw away any left-over feed after two hours.
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Teaching checklist:
1.
2.
3.
4.
5.
6.
7.

Cleaning feeding equipments

Sterilizing feeding equipments
Storing feeding equipments
How to prepare a bottle feed at home
How to feed the baby
Bottle feeding when outside home/ travelling
Rewarming milk in bottle

32
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Rewarming milk in bottle

Remove a bottle of feed from the refrigerator just before it
is needed.
Re-warm for no more than 15 minutes by placing in a
container of warm water.
Occasionally shake or swirl the bottle to make sure that it
heats evenly.
Check the temperature of the feed by dripping a little onto
the inside of your wrist. It should feel lukewarm, not hot.
Throw away any re-warmed feed that has not been
consumed within two hours.

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ON-GOING SUPPORT
Follow-up of the mother who is
replacement feeding :
She is using the option
properly
She may change feeding
option at any time

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Teaching checklist:
1.
2.
3.
4.
5.
6.
7.

Cleaning feeding equipments

Sterilizing feeding equipments
Storing feeding equipments
How to prepare a bottle feed at home
How to feed the baby
Bottle feeding when outside home/ travelling
Rewarming milk in bottle

Session 11 : If Baby Cannot Feed at the Breast

Ministry of Health Malaysia

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Bottle feeding safety issues

BPA (bisphenol A) health concerns
- Avoidance to BPA exposure: use glass bottles, OR use a hot
water-filled jug or bottle warmer to heat existing
polycarbonate bottles, OR to switch to BPA- free bottles
- If BPA bottles are used: clean with soft bottle brush to avoid
scratches, do not boil bottles.

Other issues
- bottle need to be changed at least every 6 months without signs
of wear and tear
- change bottle immediately if signs of wear and tear
- Teat needs to be changed if: it became hardened, distorted, torn
or the hole gets larger than initial.

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THANK YOU
Session 11 : If Baby Cannot Feed at the Breast
Ministry of Health Malaysia

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