Breastfeeding is the normal way to feed an infant. It is known that artificial feeding with a bottle poses potential risks for the health of an infant. In particular, it has been related in scientific studies to an increased likelihood of overeating, obesity, otitis media, dental problems, obstructive apnea during sleep, facial asymmetry, respiratory and gastrointestinal infections, sudden infant death syndrome, vomiting, colic, and constipation.
However, feeding babies formula with a bottle remains a dominant practice. This is why health professionals have a significant responsibility to fully inform mothers of the best ways possible to feed with a bottle, in an attempt to reduce the above risks.
The basic principles in order to limit the likelihood of harmful effects are:
1. Offer unlimited hugs to the baby, skin to skin contact, and your smell. While feeding the baby, bring her in very close to your body. It is wrong to believe that a baby under six months of age will become spoiled when held in your lap. Modern science puts forward the emotional security and the bonding of an infant with its parents as a fundamental goal during this period of its life, critical for the child’s subsequent emotional and mental health. Always keep the baby close, abdomen to abdomen, looking into her eyes, in order for her to feel safe and loved.
2. It is the baby that should decide when he needs to be fed, as is the case with breastfeeding. This means reading the signs of hunger, not keeping to a timetable, disregarding watches, not limiting the baby’s access to milk during the day or night.
3. Let the baby decide the quantity of milk he wants to drink at each feed. It is important for the child to learn to listen to his body and needs. His impulses should be respected and satisfied without exception. In the same way that adults don’t eat the same amount of food every day, the baby’s appetite also varies depending on his hunger and mood. We should respect this, “teach” the baby to demand food only when he is hungry, and to stop eating as soon as he has had enough.
4. Use a teat with the smallest hole possible, so that there is resistance in the flow of the milk. Bottles with free flow make the child swallow almost “coercively”. The result may be an easy and quick feeding for the carer, but these are recipes for health problems for the infant.
5. Use a bottle teat with as broad a base as possible, so that the baby takes it deep into his mouth, and has his mouth wide open while he drinks, something that happens naturally with breastfeeding.
6. Use a bottle teat that is long enough, and can be prolonged in the baby’s mouth, similar to the mother’s nipple.
7. Make sure that the baby is in a semi-sitting position while she eats, that she is not lying down horizontally. Position the bottle horizontally to the ground, not vertically, so that flow of milk is limited. Make sure that the bottle teat does not contain air on the one hand, but, on the other hand, that it is barely filled with milk.
8. Respect the breaks that the baby takes while drinking. If she seems to splutter or choke, interrupt the feed. If she swallows continuously more than five times, it means that the flow is fast, and the way the bottle is given should be changed. Stop the feeding regularly to give the baby the chance to feel her hunger or satiety, and to decide whether to continue, instead of swallowing continually and “coercively”.
9. Place the child on your left side and then on the right, the same way as when exchanging breasts. This way balanced visual and tactile stimuli for the baby are ensured.
10. The infant needs to bond emotionally with a main care person. Limit the number of people who feed him to the lowest possible number. The child should always be held by an adult during feeding, and not be left unsupervised with the bottle in his hands or with a sibling.
Common mistakes made when bottle feeding.
The mother is not provided with exact advice on the proper preparation of the milk. Processed powdered cow’s milk for babies, despite the false common perception, is not a sterile product. Potentially dangerous bacteria are found in 15% of packages. Moreover, bacteria may also be present in water that has not completely boiled. This is why the water used should be well boiled, left to slightly cool, up to 70 degrees Celsius. Then the powder should be added to the water, so that the bacteria that already exist in it are destroyed. Finally, leave the milk to further cool to 37 degrees, before giving it to the child. If the powder is added to lukewarm or body temperature water, the bacteria that may exist in it will not be destroyed.
Do not put overly warm or boiled water in a plastic bottle. It has been proven that this practice is dangerous, because substances from the plastic, for instance bisphenol, are released and enter the milk, thus reaching the baby’s mouth.
The milk powder should be stored in proper conditions, in a dark, cool, and dry place. In particular during transport, when out on a trip or a walk, make sure that the box remains in a shady and cool place. A box that has been opened should be thrown away after 2-3 days. It is very important to check the expiration date of the product.
The carer should wash their hands with soap and water before preparing the bottle. On the contrary, hands and breast washing don’t constitute necessary practices during breastfeeding, because breast milk has strong antibacterial properties.
The bottle and its teat should be sterilized between meals. For older children, they should always be meticulously cleaned with a special brush.
Warming of formula milk for infants in a microwave oven is prohibited.
Formula milk that has been prepared, and has remained on the counter for more than an hour, should not be given to the child.
Never put infant food like cereals, rice flour etc., into the bottle with the milk. Always give solid foods to the infant from a plate with a spoon.
Never give juice or other liquids to the child in a bottle.
Don’t allow the baby to sleep with the bottle in her mouth. Sucking on the bottle for a long time predisposes babies to caries and other dental problems.
After the first six to twelve months encourage other ways for the child to drink liquids: from a training cup, an open glass, or with a straw. It is not necessary for mothers who are weaning from the breast to feed their children milk from a bottle. It’s best to avoid the potentially harmful habit of feeding bottles during early childhood – the child should cease to use them before the age of two to two and a half years.
Breastfeeding is the healthiest way to feed your baby. Be aware that if you decide not to breastfeed or to stop breastfeeding, it is difficult to start over if you regret your decision. Giving processed cow’s milk to a breastfeeding baby results in a decrease in breast milk production.
S Papaventsis MBBS MRCPCH DCH IBCLC 2010