- Formula feeding is a safe alternative to breastfeeding
- A mother's informed decision not to breastfeed should be respected and supported
- Maternal consent is obtained before initiating formula feeds
- Support from a health worker and/or other members of the multi-disciplinary team should be provided.
While clinicians have a responsibility to promote breastfeeding first; where it is needed, they should educate and support parents about formula feeding.
Some mothers may experience feelings of grief or loss if they are unable to breastfeed or decide not to breastfeed.
A mother’s informed decision not to breastfeed should be respected and health care workers and other members of the multidisciplinary team should provide support.
For mothers who do not breastfeed, or do so only partially, advice should include:
- a suitable infant formula should be used until the infant is 12 months of age
- the costs associated with formula feeding
- methods for safe formula preparation and storage.
Feed volume is calculated on birth weight until initial weight loss is regained.
As with breastfeeding, bottle feeding according to appetite is appropriate.
Formula is designed to remain at a constant strength; as an infant grows the amount of formula should increase, not the strength of the formula.
Feeding volumes for neonates > 1500 g on full enteral feeds
|Preterm (mL/kg/day)||Small for gestational age (mL/kg/day)|
|< 24 hours||30||60||30-60**|
|6-14 + days||180|
> 180mL/kg at medical discretion.
** Local practices may vary and consideration taken for Total Fluid Intake (TFI) when oral feeds are given in combination with parenteral fluids.
Signs that the baby is feeding adequately
Signs that the baby is feeding adequately include:
- six or more wet nappies per day
- consistent (but not excessive) weight gain
- thriving, active infant.
Advise parents that:
- infants may vary in the amount of feed and the number of bottles consumed each 24 hours
- information on formula packaging recommending certain amounts for various ages is a guide only and does not necessarily suit every infant.
Regular monitoring of the infants’ progress is important. Constipation may occur after formula is introduced. While formula-fed infants tend to pass firmer and fewer stools than breastfed infants, hard, dry stools may indicate incorrect preparation of formula.
Types of formula
Cow’s milk-based formula is suitable for most healthy full-term infants and is recommended over formulas made from soybeans, goat’s milk or modified lactose formula.
A health facility or practitioner should not recommend one particular standard ‘newborn’ formula preparation over any other.
Babies receiving formula in SCN must be given ready-to-feed formulas.
Infant formulas generally have the following characteristics:
- standard ‘newborn’ formulas have a lactalbumin:casein ratio of 60:40, which is similar to that of breast milk
- energy density is about 67 kcal/100 mL, or 20 kcal/30 mL
- have added iron and vitamins, so most term babies who are predominantly formula fed do not require further
- there is a similar composition between different brands of formula, so changing brands is unlikely to make any difference to ‘wind’ or unsettled behaviour
- some formulas (eg ‘Gold’) may contain long-chain polyunsaturated fatty acids (LCPUFAs), prebiotics or probiotics. While manufacturers claim benefits for ‘neurodevelopment’ and ‘immunological health’, evidence for benefits in otherwise normal healthy babies is lacking
- some formulas may be described as partially hydrolysed formulas (‘HA’ or hypoallergenic); however research shows that this does not reduce the incidence of allergic disease.
Special formulas designed for infants with nutritional problems should be used only in the case of medically diagnosed conditions and on the advice of a paediatrician.
Extensively hydrolysed (for example, Pepti Junior, Alfare) and amino acid formulas (Neocate, Elecare) are appropriate to treat cow’s milk protein intolerance or conditions like food protein-induced enterocolitis/proctitis syndrome or eosinophilic oesophagitis.
Extensively hydrolysed formulas are only available on authority prescription by a paediatrician and a gastroenterologist or allergist must order amino acid formulas.
Soy formulas may be suitable alternatives in ‘allergic’ babies over six months of age, but are not recommended in the newborn.
Changing the type of formula because of minor rashes, irritability or infant or parent distress, is usually of no benefit.
Provide information to parents about:
- equipment required for bottle feeding and how to sterilise it
- the correct formula preparation, including advising parents to use the number of scoops of formula as indicated on the tin (the scoops to water ratio varies between brands)
- the WHO advocates the use of water at 70°C for preparing formula as this temperature will destroy bacteria; however, vitamins and nutrients may also be destroyed
- boiled water should be left for 30 minutes to reduce the risk of serious burns before making formula.
Ballarat Health, Enteral nutrition guideline, retrieved 2017
National Health and Medical Research Council 2012, Infant Feeding Guidelines. NHMRC Canberra.
US Department of Agriculture (USDA) National Nutrient Database for Standard Reference 2011
Reviewed 21 March 2018