Intro

All content of this blog is my own opinion only. It does not represent the views of any organisation or association I may work for, or be associated with. Nothing within this blog should be considered as medical advice and you should always consult your Doctor.

5 Reasons Infant Formula Isn't The Lazy Option

I seem to have come across loads of comments recently suggesting formula is an easy/lazy option, both from parents using formula and those who don't. And I have to be honest and say it really baffles me.

Sure I can see how in the very early days if a mum has breastfeeding problems, is getting passive support and has problems nobody can seem to resolve - formula is easier in comparison.  Pain stops, a baby who hasn't been feeding well is likely to look more settled when given a bottle, anyone can make up the bottles and feed the baby, mum can sleep!

But let's be honest, this time is but fleeting.  Relatives who may flock to see the new arrival, soon head home.  Partners return back to work, often far less agreeable to making and delivering night feeds when they have a full day of work ahead compared to mum who is at home and can sleep when baby does.  For many, especially if family and friends work - by 3-4 weeks postpartum the days (and often the nights) are mum's alone; yet baby will need milk feeds for a further 11 months +.

Take out these early few weeks and directly compare breast and bottle feeding (in this sense to mean formula), and let's compare how easy it is:

1.  Making A Feed
Bottle:  
1. Clean the surface thoroughly on which to prepare the feed  
2. Wash hands with soap and water and then dry.
3. Boil fresh tap water in a kettle.  Alternatively bottled water that is suitable for infants can be used for making up feeds and should be boiled in the same way as tap water.   
4.  Important:  Allow the boiled water to cool to no less than 70º C.  This means in practice using water that has been left covered, for less than 30 minutes after boiling.
5. Pour the amount of boiled water required into the sterilised bottle.
6. Add the exact amount of formula as instructed on the label. Adding more or less powder than instructed could make the baby ill.
7. Re-assemble the bottle following manufacturer’s instructions.
8. Shake the bottle well to mix the contents.
9. Cool quickly to feeding temperature by holding under a running tap, or placing in a container of cold water.
10. Check the temperature by shaking a few drops onto the inside of your wrist – it should feel lukewarm, not hot. 
11. Discard any feed that has not been used within two hours (Department of Health & Food Standards Agency).  Note the Infant Feeding Council recommend feeds are discarded within 1 hour.

Breast: 
1.  Lift/open shirt/top
2.  Unclip Bra

2.  Night Feeds
Bottle:
1. Get up and go to kitchen
2. Follow guidance as above
3. Try and pacify baby whilst waiting for feed to be ready
4. Go back to bed
5. Sit up and feed baby
6. Wind baby
7. Settle baby back to sleep

Breast:
1.  Roll over before baby fully awakens
Optional stage 2: open nightclothes if wearing

3.  Out And About
Bottle:
Option 1 - Ready to use liquid feeds are sterile and are the safest option.  However, they are a more expensive option and therefore may not suit all parents.

Option 2 - Take & make as required, next safest from microbial contamination/infection point of view
1.  Put boiling water in a sealed vacuum flask and use this to make up fresh formula milk when needed. 
2.  Pack large bag with powder, pre boiled water in a flask & pre sterilised bottles.
2.  Find somewhere to mix and serve.

Note:  Ensure you've packed sufficient bottles/powder/water for the duration of your outing, plus extra in case of travel delays/unforeseen circumstances.  Care should be taken to avoid scalding when making up the feed.

Option 3 - Preparing powdered feeds for later use.  It is the length of time for which the reconstituted formula is stored that increases the risk of bacterial growth. Reducing the storage time will therefore reduce the risk.  

1. Prepare feeds in separate bottles, not in one large container (e.g. a jug)
2.  Follows steps above ‘Making a feed".
3.  Store the feed in the fridge at below 5º C. Prepared bottles are best kept in the back of the fridge and not in the door. 
4.  The temperature of the fridge should be checked regularly.   A fridge that is opened frequently may need to be set at a lower temperature to ensure that it does not rise above 5 ºC during times of frequent access.  The thermostat in older fridges without temperature settings may need to be adjusted to ensure that the temperature is below 5º C. 
5. The risk of infection to a baby will be lower if the feed is only stored for a short time. Feeds should never be stored for longer than 24 hours and this length of time is no longer considered ideal especially for young babies.  

Because of the potential for growth of harmful bacteria during transport, feeds should first be cooled in a fridge (below 5º C) and then transported.

1. Prepare feed(s) and place in the fridge as outlined in section ‘preparing feeds for use later’.
2. Ensure feed has been in the fridge for at least one hour before transporting.
3. Only remove feed from the fridge immediately before transporting.
4. Transport feeds in a cool bag containing a frozen ice brick.
5. Feeds transported in a cool bag should be used within 4 hours.
6. Re-warm at the destination as in section ‘Re-warming stored feeds’.
7. Alternatively if you reach the destination within 4 hours, feeds transported in a cool bag can be placed in a fridge and kept for up to a maximum of 24 hours from the time of preparation - this is not ideal as the risk of illness increases the longer it is stored.

Rewarming stored feeds:
1.  Re-warm using a bottle warmer, or by placing in a container of warm water (if out and about you also need to find somewhere to access this if not carried).
2.  Microwaves should never be used for re-warming a feed.
3.  Never leave a feed warming for more than 15 minutes.
4.  Shake the bottle to ensure the feed has heated evenly.
5. Check the feeding temperature by shaking a few drops onto the inside of the wrist - it should be lukewarm, not hot.

Breast:
1. Lift/open shirt/top
2.  Unclip Bra

4.  Cleaning
Bottle:
1. Wash hands thoroughly before cleaning and sterilising feeding equipment
2. Wash feeding and preparation equipment thoroughly in hot soapy water
3. Bottle and teat brushes should be used to scrub inside and outside of bottles and teats to ensure that all remaining feed is removed
4. After washing feeding equipment rinse it thoroughly under the tap
5. If using a commercial steriliser, follow manufacturer’s instructions.  If your bottles are suitable for sterilising by boiling: fill a large pan with water and completely submerge all feeding equipment, ensuring there are no air bubbles trapped; cover the pan and boil for at least 10 minutes, making sure the pan does not boil dry.
6. Keep the pan covered until equipment is needed.
7. Wash hands thoroughly and clean the surface around the steriliser before removing equipment.
8. It is best to remove the bottles just before they are used. If the bottles are not being used immediately, they should be fully assembled with the teat and lid in place to prevent the inside of the sterilised bottle and the inside and outside of the teat from being contaminated.

Breast:
Shower/Bath/Wash as desired.

5.  If Baby Needs To Be Left With Friend Or Relative
Bottle:
1. Give baby, formula powder, equipment and full guidelines above about preparing formula safely.
2.  Ensure caregiver understands failure to make appropriately could lead to serious illness for baby.

Breast:
1.  Express and give fresh breastmilk or frozen previously expressed and relevant feeding equipment (bottle, cup or syringe) with guidance that fresh breastmilk is fine at room temperature for 6 hours, frozen can be stored in the fridge until needed and gently warmed in warm water before use (or is fine served room temp)
2.  Reassure caregiver that breastmilk is antimicrobial and antibacterial and doesn't need high heating to kill bacteria.


Now really - still think formula is a lazy option?


References:
http://www.food.gov.uk
The Breastfeeding Network: Expressing & Storing Breastmilk

17 comments:

  1. fab and something i have been trying to explain to my ff friends for years

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  2. never thought about formula being lazy.i always thought that i could never be bothered with so much stuff to do around bottle feeding cause i'm lazy so I breastfed (that's not the only reason). plus why would i pay for fiat when i have bentley for free??

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  3. Some breastmilk (mine, for example) can be quite bitter at room temperature, so the friend or relative may need to be told to warm it.

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  4. Those are all good reasons why it wouldn't be lazier but think about the fact that a breastfed newborn eats every 2 hours... and you would time that at the start of the feed until the next. So you are nursing literary every 2 hours around the clock and if your me even more often then that. That's a whole lot harder then preparing bottles say every 4 hours, plus in the early stages of breastfeeding you aren't suppose to induce a bottle which means no one else can take over a feed for you. And lets not forget the very sore nipples most mothers get from nursing a newborn. So in the beginning I would say formula is easier but if you stick with breastfeeding it is definitely the easier option! I wouldn't say its the lazy way but neither is breastfeeding!!!

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  5. Yep that's why I said at the start "Take out these early few weeks".

    The early days can be intense, 8-12 feeds per 24 hours - but within weeks evidence shows a large percentage have a 5hr gap at night.

    Mothers SHOULD NOT get sore nipples from nursing a newborn - if mum is sore and baby is feeding very frequently constantly, that in itself suggests mum needs support to evaluate how effectively baby is transferring milk.

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  6. Section 11 of the prep guide is wrong. This from infantformula.org states this
    "Baby formula that is removed from refrigeration should be used within two hours or discarded. Because of possible bacterial contamination, formula remaining in a bottle one hour after the start of feeding should also be discarded."

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  7. Man my kids never had a 5 hr gap at night of sleep until 4 months of age. Just my luck!

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  8. For me, formula is the lazy option because it's so simple for the mother to just hand over her baby to another caregiver and not have to worry about her baby while she goes and parties/weekend away etc. My mother left me to go back to work at 9 weeks, she stopped breastfeeding me at two weeks because she wanted to 'sleep' so formula was easier for her in that she could hand me to someone else to look after while she 'recovered'. Because of this, i find it hard to see formula any other way. The optimum choice for selfish lazy mothers.

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    Replies
    1. Or mothers with premature babies and/or with undiagnosed tongue tie that can't breastfeed. Oh then I'd say that it was...erm....lifesaving. I expressed exclusively for 4 months topping up with formula when my supply reduced and it's this kind of attitude that pisses me off.

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  9. I would have to 100% agree with the above comment. Even if you expressed breast milk so someone could feed the baby you still have to spend the time pumping during the feed. To me formula would be the lazy option. Many of woman plan on nursing but never stick with it. Why would that be? I think its mainly because they want it to be easy...help from the father or other caregiver so they can sleep and recover. I do understand your point but i think there much more to it that.

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  10. This would be true if most people didn't just make up batches of bottles in advance! Most of my friends FF and none of them follow the proper guidelines, despite being aware of them. For me though BF is by far the lazy option- I don't even need to get up for night feeds!

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  11. My youngest is really colicy and at three months STILL doesn't go longer than 1.5hrs between feeds. It hurts every time he feeds and I also suffer from D-MER (not great when you're also nursing a nearly 3 yo 5 times a day). My son has a posterior TT that doesn't meet NICE's guidelines so they wont snip. Due to his gassiness (also due to the TT), he will NOT be put down. Formula would absolutley be the easy/lazy option for me, and know that to be true of many others.

    If people actually made each feed fresh, as per guidelines, then yes, I'd possibly agree (still would probably be easier to FF in my case), but the fact is they don't! I've actually NEVER met anyone who mixes feeds at 60-70 degrees!!!

    Also, being the ONLY person to be able to feed baby can be stifling in today's culture where so much is expected of new mums. Expressing is nowhere near as straightforward for most as suggested above - often needing to express several times for a single feed - not to mention that my son won't take a bottle and alternate possible care givers would no way be prepared to us an infant feeding cup or syringe!

    I fear this post is, at best, rather naive, not something I've come to expect from AA!

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  12. QUOTe My son has a posterior TT that doesn't meet NICE's guidelines so they wont snip. END

    I'm confused by this as NICE don't set criteria as to which tongue ties can and can't be divided in terms of anterior/posterior, they state "Many tongue-ties are asymptomatic and cause no problems. Some babies with tongue-tie have breastfeeding difficulties. Conservative management includes breastfeeding advice, and careful assessment is important to determine whether the frenulum is interfering with feeding and whether its division is appropriate. Some practitioners believe that if division is required, this should be undertaken as early as possible. This may enable the mother to continue to breastfeed, rather than having to feed artificially."

    When tongue tie is involved bottle feeding can be hugely difficult - as you say he wont take a bottle, so how would you get it into him? And I DO meet mums who follow the guidelines. I can't really compare breastfeeding to someone formula feeding but not making up formula as advised can I?

    AA

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  13. NICE's practitioner guidelines dictate that a tie should only be sipped if a) it's negatively affecting baby's weight; or b) is damaging mum... Neither apply in my situation. I haven't looked into this personally, it's what my IBCLC & and the local guy who does the procedures relayed to me, on separate occasions.

    As for my son refusing a bottle, I'm certain this would not be the case if a bottle were all that were on offer.

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    Replies
    1. Hi - I'm not deliberately being difficult but could you show me where the guidelines mention damage? I've read the practitioner guidelines many times and have never noted this?

      Re bottles - I see lots of mums who bottle feed because their baby can only manage 1-2oz per feeding due to TT, therefore requiring round the clock feeds which are typically v stressful

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    2. Like I said, I'm going on what an IBCLC & a Dr told me - I've heard similar from other parts of the country too. I haven't looked at the text but it's a moot point anyway - if they wont snip, they wont snip!

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  14. I have always wondered why anyone would say formula is easier. So what if your kid nurses every 2 hours, your breastfeeding co-sleeping and napping when he naps right? even in the US we don't have to go back until 6-8 weeks soooo sleep whenyou newborn sleeps. feed him when he's hungry and (generally speaking) all is well. Mr son nursed every 2 hours aroung the clock until he was six months and we added table food. Until 10-12 weeks he slept in 20 min increments for maybe a total of 6 hrs a day. Thankfully he was a happy baby, just a child who didn't believe in sleep. My ex and i were exhausted. if we had had to prepare formula we would not have survived that period.
    Breastfeeding is by far the laziest option.

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