USING THIS BOOKLET - PDF document

Infant Formula: What You Need To Know USING THIS BOOKLET Familie s fee d formul a fo r medica l o r persona l reasons , exclusivel y o r a s a supplement . Thi s booklet wil l hel p parents , families , caregivers , an d childcar e provider s prepare , fee d an d stor e formul a safely. Th e informatio n i s mean t fo r healthy , ter m babies . Thi s bookle t include s informatio n abou t th e risk s and cost s o f formul a feedin g t o hel p familie s mak e a n informe d decision. Throughout this document “ parents ” may refer to other guardians or caregivers . Thi s bookle t wil l guid e yo u to: • Mak e a n informe d decision. • Prepar e thre e type s o f formul a safely. • Fee d you r bab y accordin g t o your baby’ s feedin g cues. • Stor e an d transpor t formul a safely. TABLE OF CONTENTS I n thi s booklet , th e wor d “formula ” is used . Othe r name s fo r formul a are: • Artificia l bab y milk. • Human Milk substitutes. • Commercia l infan t formula. • Manufacture d infan t milk. • Manufacture d mother’ s milk. • Non - huma n milk. Considerin g Formul a Feedin g ................................................................................................. . 2 Supplementin g a Breastfe d Bab y ........................................................................................... . 4 Ho w t o Choos e Formul a ......................................................................................................... . 5 Cleanin g Bottle s an d Equipmen t ............................................................................................. . 6 Sterilizin g Bottle s an d Equipmen t .......................................................................................... . 7 Choosin g Wate r t o Mak e Formul a .......................................................................................... . 8 Ho w t o Steriliz e Wa

ter , Choos e Formul a an d Bottle - Feedin g Supplie s ................................. . 9 Preparin g Ready - to - fee d Liqui d Formul a .............................................................................. . 10 Preparin g Concentrate d Liqui d Formul a ............................................................................... . 11 Preparin g Powdere d Formul a ............................................................................................... . 12 Safel y Storin g Formul a .......................................................................................................... . 14 Warmin g Formul a t o Fee d .................................................................................................... . 15 Whe n t o Fee d You r Bab y ...................................................................................................... . 16 Ho w t o Bottl e Fee d You r Bab y .............................................................................................. . 17 Fee d Accordin g t o You r Baby’ s Cue s ................................................................................... . 18 Feedin g You r Growin g Bab y ................................................................................................. . 20 Transportin g Formul a ............................................................................................................ . 20 Fo r Mor e Informatio n ............................................................................................................. . 21 1 INFAN T FORMULA : WHA T YO U NEE D T O KNOW CONSIDERING FORMULA FEEDING Th e Worl d Healt h Organization , Healt h Canada , Dietitian s o f Canada , an d th e Canadia n Paediatric Societ y recommen d breastfeedin g fo r babie s an d toddlers , exclusivel y fo r th e firs t si x months , and sustaine d fo r u p t o tw o year s o r longe r wit h appropriat e complementar y solid foods. Parents ma y giv e thei r bab y infan t formul a fo r a variet y o f reasons . Parents ma y fee d thei r baby formul a only , o r giv e s

om e formul a an d som e breas t milk . Givin g formul a ma y no t b e thei r firs t choice. I f yo u nee d t o supplemen t you r breastfe d baby , se e pag e 4. Some parents ma y fee l uncomfortabl e o r have mixed emotions abou t givin g thei r bab y formula . I f yo u fee l thi s way , i t may b e helpfu l t o tal k wit h a healt h car e provider. I f feedin g formul a i s th e righ t decisio n fo r yo u an d you r baby , i t i s importan t t o hav e th e information yo u nee d t o fee l comfortabl e wit h you r plan . I f yo u ar e hopin g t o retur n t o breastfeeding , contac t your healt h car e provide r o r a lactatio n consultan t t o hel p pu t i n plac e plan s an d support s t o achiev e this. 2 www.beststart.org Typ e o f formul a Cos t pe r year Read y T o Fee d $3,800 pe r year Liqui d Concentrat e $1,400 per year Powde r $1,100 pe r year I t i s importan t tha t al l families , wh o ar e thinking abou t givin g thei r bab y formula , hav e th e following informatio n t o mak e a n informe d decision. Effec t o n Health • Givin g formul a t o a breastfe d bab y can reduc e a mother’ s breas t mil k suppl y and impac t he r pla n t o breastfeed. • Babie s wh o ar e no t breastfe d hav e a higher ris k o f ea r infections , lun g an d breathing issues , diarrhea , an d Sudde n Infan t Death Syndrom e (SIDS) . Late r i n lif e ther e are increase d healt h risk s including chroni c diseases lik e diabetes. • Mother s wh o d o no t breastfee d hav e a highe r ris k o f healt h issue s lik e postpartum bleeding , typ e 2 diabetes , breas t cancer an d ovaria n cancer. I n th e earl y day s afte r introducin g formula, mother s ma y experienc e ful l an d painfu l breasts. Ther e ar e man y comfor t measure s yo u can discus s wit h you r healt h car e provider , including col d

compresses , gentl e han d expressio n and th e us e o f anti - inflammator y pai n medications. Financia l Cost Th e tabl e show s th e averag e cos t o f feedin g a bab y wit h basi c formul a fo r on e year . Thi s does no t includ e th e cos t o f bottles , nipples , othe r feedin g equipment , o r th e cos t o f preparin g and storin g formula. This is an approximate cost of formula from birth to one year. The cost will be different with time and will depend on where you live. Numbers are based o n estimate s i n four part s o f Newfoundland and Labrador in 2017. Qualit y o f Formula Sometime s thing s ca n g o wron g whil e formul a i s bein g mad e i n th e factory . Fo r example , i t ma y come i n contac t wit h bacteria , o r i t ma y hav e missin g o r wron g ingredients . Th e Health y Canadian s website list s safet y concern s an d recal l alerts . Compar e th e lo t number s o f you r formul a cans t o th e lo t number s o n thi s website . T o vie w thi s websit e an d sig n u p fo r alerts , g o to: http://healthycanadians.gc.ca/recall - alert - rappel - avis/index - eng.ph p . I f yo u decid e t o fee d you r bab y formula , thi s bookle t provide s th e informatio n yo u nee d to prepare , stor e an d transpor t formula , an d t o fee d you r bab y safely. Pleas e revie w thi s bookle t an d discus s an y concern s wit h your nurse, community healt h nurse , lactatio n consultant , registere d dietitian , o r othe r health care providers . 3 INFAN T FORMULA : WHA T YO U NEE D T O KNOW SUPPLEMENTING A BREA STFED BABY I f yo u breastfee d an d you r bab y requires a supplement , t h e best optio n i s breas t milk . Thi s ca n b e expresse d b y han d and/o r b y pump . Givin g formul a t o a breastfed bab y ca n decreas e you r breas t mil k supply . Supplementin g wit h formul a ma y lea d t o endin g breastfeeding befor e yo u ha d planne d t o stop . I t ca n b e har d t o

restar t breastfeedin g afte r havin g stopped . Her e i s a lis t o f supplement s i n orde r o f wha t t o tr y firs t i f available: 1 . You r ow n fres h breas t milk , han d expresse d and/o r pumped. 2 . You r ow n breas t mil k tha t ha s bee n froze n an d thawe d jus t befor e using. 3 . Pasteurize d huma n mil k (breas t milk ) fro m a huma n mil k bank . Som e mil k bank s may onl y hav e enoug h mil k fo r babie s wit h specia l need s suc h a s preter m babies. 4 . Commercia l formul a tha t i s co w milk - based. Mos t babie s wh o drin k formul a d o bes t wit h a co w milk - based formula . Specialize d formula s shoul d onl y b e use d i f your healt h car e provide r recommend s them. Man y parent s us e a bottl e t o giv e a supplement , bu t thi s is not alway s th e bes t metho d o f feedin g a supplemen t t o a baby. Babie s wh o ar e fe d b y bottl e ma y fin d i t harde r t o breastfeed. Yo u ca n fee d you r bab y a supplemen t usin g on e o r more o f th e followin g methods . Wit h th e hel p o f a knowledgeable professiona l conside r a: • Cu p (ope n cup , no t sipp y cup ) o r spoon (see photo) • Lactatio n ai d whic h use s a tub e a t you r breast. • Finge r feede r wit h a tub e attache d t o you r clea n finger. • Mor e specialize d feedin g devices. Thi s bookle t ha s informatio n o n bottle - feedin g supplie s o n pag e 9 , an d ho w t o bottl e fee d o n pag e 17. I f yo u ar e thinkin g abou t usin g formula , o r nee d t o giv e formula , consider: • Gettin g knowledgeable help t o maintai n you r breas t milk suppl y an d improv e breastfeeding. • Breastfeedin g AN D feedin g formul a a s a supplement. • Feedin g expresse d breas t mil k an d formula. Resource s t o suppor t breastfeeding: • Y ou r Community Health Nurse • Baby - Friendly NL: http://www.babyfriendly.ca/ • La Leche League: www.lllc.ca/find -

group - newfoundland - labrador • Newfoundland and Labrador HealthLine at: 811/TTY 1 - 888 - 709 - 3555 • Baby - Friendly NL on Facebook: www.facebook.com/babyfriendlynl/ • Breastfeeding Support – Newfoundland & Labrador: 4 www.beststart.org HOW TO CHOOSE FORMUL A Recommendation s fo r choosin g formula: • Co w milk - base d formul a i s recommende d fo r mos t babie s wh o ge t formula . Mos t formulas hav e a co w milk - bas e wit h adde d nutrients. • Soy - base d formula s ar e NO T recommende d excep t fo r babie s wit h a particula r medica l condition. Sometime s parents decid e t o us e so y fo r personal , cultura l o r religiou s reasons. • D o NO T us e homemad e formula s an d d o NO T us e regula r co w mil k , other animal milks or non - dairy beverages such as almond milk. Thes e d o no t hav e th e righ t amoun t o f nutrient s an d ma y b e harmfu l t o you r baby. • Follo w th e exac t direction s o n th e packag e fo r th e amount s o f wate r an d formula . Adding extr a wate r t o formul a t o mak e i t thinner , o r les s wate r t o mak e i t thicker , ca n b e unhealthy an d dangerou s fo r you r baby. • Formula s sol d a s organic , mad e wit h prebiotics , probiotics , adde d DH A fats , o r mad e with “partiall y broke n down ” protein s ar e not necessary . Researc h is unclear whether or not these are helpful . • Formul a fe d babie s nee d t o sta y o n commercia l formul a unti l 9 - 1 2 month s o f age . “Follow - up” formul a i s NO T needed. • Some babies may be prescribed a special type of formula that only comes in powered form. It is important to follow the directions given by your health care provider. Ther e ar e thre e type s o f formulas: • Ready - to - fee d – n o wate r needed. • Liqui d concentrat e – need s t o be mixe d wit h sterilize d water. • Powde r – need s t o b e mixe d with sterilize d water. Follow the exact directions on the formula label for t

he amounts of water and formula. Adding extra water to formula to make it thinner or less water to make it thicker can be unhealthy and dangerous for your baby. Ready - to - fee d an d liqui d concentrat e formulas ar e steril e unti l th e ca n i s opened . Powdered formul a i s no t steril e an d ma y carr y harmful bacteri a tha t ca n mak e you r bab y sick. Babie s wh o hav e th e greates t chanc e of infection s shoul d hav e steril e liqui d formula suc h a s ready - to - fee d o r liqui d concentrate formulas. Babie s wh o ar e a t th e greates t ris k of infection s fro m powdere d infan t formula ar e thos e who: • Ar e premature. • Ha d lo w birt h weigh t an d ar e under tw o month s o f age. • Hav e a weakene d immun e system. 5 househol d bleac h wit h 75 0 m INFAN T FORMULA : WHA T YO U NEE D T O KNOW CLEANING BOTTLES AND EQUIPMENT Bottle Cap Alway s clea n al l bottl e an d feedin g equipment fo r babie s o f an y ag e wh o ar e bein g fe d formula. Thi s wil l remov e unsee n bit s o f formul a o r specks o f dir t befor e sterilization. Us e glas s bottle s o r Bisphenol - A (BPA) - free plasti c bottles . Mak e sur e al l part s hav e no cracks , ar e no t discoloure d an d hav e n o loose part s tha t coul d brea k off. Ring Disc Nipple Was h you r hands wit h soa p an d warm water . Was h your sin k an d wor k area wit h a clea n dishcloth, soa p an d war m water. Then , i t i s a goo d idea t o sanitiz e th e counter 1 b y mixin g 5 ml ( 1 teaspoon) L ( 3 cups ) o f water. Pu t thi s solutio n i n a spra y bottl e an d label th e bottle . Spra y you r counte r an d wip e i t with a clea n towel. 2 Was h al l bottles , nipples , rings , caps , discs, measuring cup, can opener if needed, mixing utensils, and tongs in hot soapy water. If needed also wash containers for storing sterilized water.

3 4 Us e a bottl e brus h tha t i s use d onl y fo r infant feedin g equipment . Scru b insid e th e bottles an d nipple s t o mak e sur e the y ar e fre e of an y sig n o f formula. Clean and discard brush as per instructions on package. Rins e wel l i n ho t water . Se t th e bottle s and feedin g equipmen t t o ai r dr y o n a clea n towel, o n a clea n surface . No w yo u ar e read y to steriliz e thi s equipment. 6 www.beststart.org 7 STERILIZING BOTTLES AND EQUIPMENT Steriliz e al l bottles , feedin g equipment , an d wate r fo r formul a fo r babie s o f an y age . Ther e i s no researc h tha t say s whe n t o safel y sto p sterilizing . Tha t mean s i t i s safes t t o steriliz e wate r and bottl e feedin g supplie s a s lon g a s you r bab y i s drinkin g formula. T o steriliz e th e bottle s an d feedin g equipmen t afte r washing: 1 F il l a larg e po t wit h water . Add: • Bottles. • Nipples. • Rings. • Caps. • Discs. • Measurin g cu p an d knife. • Ca n opene r (i f needed) , an d mixin g utensils. • Tong s wit h handl e stickin g out. Mak e sur e al l you r equipmen t i s covered wit h wate r an d ther e ar e n o ai r bubbles trapped in the bottles and nipple. 2 Brin g th e wate r i n th e po t t o a boil. Le t i t boi l fo r tw o minutes , withou t th e li d on. 3 Us e th e sterilize d tong s t o remov e th e bottle s an d feedin g equipmen t fro m the water . Shak e exces s wate r off . Se t th e equipmen t t o ai r dr y o n a clea n towel. Th e equipmen t i s no w read y t o use. 4 I f th e item s ar e no t use d righ t away , le t the m dry , an d store the m i n a clea n place . The y coul d b e kep t o n a clea n and dr y towe l o n th e counte r wit h anothe r clea n towe l ove r them. The y coul d b e store d i n a ne w resealable bag or container . D o no t touc h the

insid e o f equipmen t wher e formul a wil l hav e contact . Fit bottles, nipples, discs and ring s together . Pu t th e nippl e o n th e inside o f th e bottl e t o kee p i t clea n unti l yo u ar e read y t o us e it. I t i s saf e t o us e hom e sterilizer s tha t yo u ca n bu y i n th e store . Thi s include s microwav e sterilizers. B e sur e t o follo w th e manufacturer’ s instruction s t o mak e sur e th e plastic s an d metal s wil l b e safe. A po t o n th e stov e als o work s well . Dishwasher s d o no t normall y steriliz e formul a equipment. I f yo u ar e usin g a disposabl e bottl e system , was h al l th e non - disposabl e part s lik e nipple s an d caps an d the n steriliz e them . Ne w liner s ar e clea n an d read y t o us e fo r one - tim e us e only. 7 Automati c formul a preparatio n machine s fo r us e a t hom e ar e NO T recommended . Th e water tha t i s use d ma y si t in the machine fo r a lon g time . Mor e bacteri a ma y gro w i n thi s water . Whe n th e water i s heated , i t i s no t ho t enoug h t o kil l bacteri a tha t ma y b e i n powdere d formula . Thes e machines als o d o no t consistentl y mi x powdere d formul a well . INFAN T FORMULA : WHA T YO U NEE D T O KNOW CHOOSING WATER TO MA KE FORMULA Fo r concentrate d liqui d an d powdered formulas , i t i s saf e t o us e thes e waters afte r yo u steriliz e the m (se e pag e 9): • Ta p wate r fro m you r community , tow n o r city. • Bottle d wate r tha t yo u ca n buy. • Private w el l wate r tha t ha s bee n teste d regularly and has satisfactory bacteriological and chemical quality. Be sure the nitrate concentration of well water is below 45 mg/L (or 10 mg/L measured as nitrate/nitrogen). If the water is high in nitrates, boiling it will increase the amount of nitrates even m ore. High nitrates are very dangerous to babies under 6 months of age. Call your local Government Service Centre about using well water to prepare formula, or, if

you have questions about your water supply. I f ther e i s boil wate r advisor y or a drinking water non - consumption advisory i n you r community , bu y wate r an d steriliz e i t (se e pag e 9). Be ready for an emergency (like a long power outage) by having enough ready - to - feed formula for 72 hours. Pleas e note: • Hom e wate r treatmen t equipmen t doe s no t replac e th e nee d t o steriliz e wate r fo r babies. • Use the cold water tap. To be safe, first run the cold water for two minutes to flush away toxins. Hot tap water may contain metal toxins, such as lead from the pipes. Fo r saf e preparation , wate r need s t o b e boiled . I f th e wate r i s hig h i n lead , boilin g i t wil l increas e the concentratio n o f lea d eve n more . To learn more about lead pipes, or a filter for houses with lead pipes, look here: https://www.canada.ca/en/health - canada - services/env ironmental - workplace - health/reports - publications/water - quality/water - talk - minimizing - exposure - lead - drinking - water - distribution - systems.html • Exercise caution when handling boiled water. To avoid scalding, place the pot on the inside burner out of the reach of children. As well, do not put more water in the pot than you can comfortably lift. D o NO T us e thes e water s fo r formula: • Softene d wate r whic h i s hig h i n sodium. • Minera l wate r whic h i s hig h i n sodiu m an d othe r minerals. • Carbonate d water : Carbonatio n an d adde d flavour s ar e no t appropriat e fo r babies. Carbonate d wate r ma y als o hav e adde d salt. • Roadside spring water. • Waters in areas that have naturally occurring high levels of contaminants such as arsenic, fluoride and uranium. Th e safet y o f th e followin g type s o f wate r fo r formul a i s no t know n s o d o NO T use: • Purifie d water . • Distille d water. • Wate r treate d b y revers e osmosis . • Deionize d water. • Demineralize d water . • Specialt y nurser y o r bab y waters. Note : I f yo u d o no t hav e a saf e wate r source , us e re

ady - to - fee d liqui d formula. 8 www.beststart.org HOW TO STERILIZE WAT ER, CHOOSE FORMULA AND BOTTLE - FEEDING SUPPLIES Steriliz e al l wate r use d fo r formul a fo r babie s o f an y age. Ther e i s n o researc h tha t say s whe n t o safel y sto p sterilizing . Tha t mean s i t i s safes t t o sterilize wate r an d bottl e - feedin g supplie s a s lon g a s you r bab y i s usin g formula. T o prepar e wate r fo r formula : • Brin g wate r t o a rollin g boi l i n a pot , o n th e stove . Continu e t o boi l fo r tw o minutes . D o no t us e kettle s tha t shu t of f befor e th e wate r ha s boile d fo r tw o minutes. • I f yo u ar e usin g liqui d concentrat e formula: – Boi l wate r fo r tw o minute s an d coo l i t befor e mixin g i t wit h formula. – Wate r ma y als o b e sterilize d b y boilin g fo r tw o minute s an d the n stored . Sterilize d water ma y b e kep t i n a sterilized , close d containe r fo r 2 4 hour s a t roo m temperatur e o r unopened for 2 – 3 day s i n th e fridge . Fee d you r bab y formul a tha t i s clos e t o bod y temperature. • I f yo u ar e usin g powdere d formula: – Brin g you r wate r t o a rollin g boi l fo r tw o minutes . The n mi x i t wit h formul a whe n th e wate r i s a t leas t 70° C ( 1 litr e o f wate r cool s t o abou t 70° C afte r abou t 3 0 minutes , bu t i t i s different fo r differen t type s o f pot s an d amount s o f water) . Whe n wate r i s les s tha n 70° C i t i s not ho t enoug h t o kil l harmfu l bacteri a i n th e formula . Coo l th e mixe d formul a quickl y t o body temperatur e befor e feedin g you r baby. – Fo r babie s no t “a t risk ” a s writte n o n page s 5 an d 12 , yo u ca n mi x powdere d formula wit h wate r tha t wa s sterilized , cooled , an d store d i n a sterilized , tightl y close d container a s above . Thi s mus t b e fe d t

o you r bab y righ t away. Choosing formul a cans: • Mak e sur e tha t th e formul a can i s no t dente d o r bulgin g becaus e thes e ar e sign s that th e formul a ma y hav e gon e bad. • Chec k th e expir y dat e o n th e can . D o no t us e formul a afte r th e expir y date. • The type of fo rmula packaging (i.e. tetrapak, can) can be different depending on where you live. Selectin g bottle - feedin g supplies: • Watc h you r bab y an d us e a nippl e tha t help s you r bab y fee d i n a stress - free , relaxe d way. Fo r mor e o n feedin g cue s an d stres s cue s se e pag e 18. • Bottl e nipple s ca n b e differen t shape s an d sizes. • Th e flo w rat e o f a nippl e i s ho w fas t th e mil k o r formula come s out . Th e flo w rat e plu s th e siz e o f th e nippl e hole ma y b e differen t fro m on e nippl e t o another , eve n for nipple s i n th e sam e package. • Differen t nipple s wor k bette r a t differen t times. Bu y on e packag e an d watc h tha t you r bab y is relaxe d whil e feeding . I f you r bab y i s havin g problems, tr y a differen t type. • Bottl e nipple s ca n b e mad e o f variou s materials. • Chec k bottl e nipple s often . Replac e the m when the y ar e cracked , sticky , torn , discoloure d o r i f the hol e get s large r an d th e formul a drip s ou t quickly. 9 9 INFAN T FORMULA : WHA T YO U NEE D T O KNOW PREPARING READY - TO - FEED LIQUID FORMULA Ready - to - fee d liqui d formul a i s th e safes t formul a especiall y fo r prematur e infants , lo w birt h weight infants o r babie s whos e immun e syste m ma y b e weak . Thi s typ e o f formul a is sterile . Always read the label when preparing formula . • Was h you r hand s wit h soa p an d war m water , an d sanitiz e th e counte r are a accordin g t o the direction s o n pag e 6. • Hav e al l you r steril e supplie s read y (se e page s 6 a

n d 7). Was h th e to p o f th e ca n wit h ho t water an d soap , usin g a clea n dishcloth. Then rinse the top with hot water. Shak e th e ca n o r bottl e wel l an d ope n with a sterilize d ca n opene r i f needed. 3 4 Pou r th e formul a directl y int o clea n and sterilize d bottles . D o no t ad d water. Us e sterilize d tong s t o pic k u p nipples , rings and caps an d pu t thes e o n th e bottles Rea d guideline s o n ho w an d whe n to fee d you r bab y late r i n thi s booklet. 5 Tighte n th e rin g wit h you r hands. B e carefu l no t t o touc h th e nipple. 10 www.beststart.org PREPARING CONCENTRAT ED LIQUID FORMULA Concentrate d liqui d formul a i s sterile . Concentrate d liqui d formul a mixe d wit h wate r accordin g to directions , i s th e nex t safes t typ e o f formul a t o fee d you r baby. • Was h you r hand s wit h soa p an d war m water , an d sanitiz e th e counte r area s accordin g t o the direction s o n pag e 6. • Hav e al l you r steril e supplie s read y (se e page s 6 an d 7). Was h th e to p o f th e ca n with ho t wate r an d soap , usin g a clea n dishcloth. Then rinse the top with hot water. Shak e th e ca n wel l an d open wit h a sterilize d ca n opener i f needed. Measur e th e formul a i n a sterilized measurin g cup . Rea d th e labe l to se e yo u ho w muc h formul a and wate r t o use. 4 5 6 Ad d sterilize d wate r whic h ha s bee n coole d dow n t o room temperature. Mi x gentl y wit h a sterilize d utensil. Pou r th e formul a int o sterilized bottles. Rea d guideline s on ho w an d whe n to fee d you r bab y later i n thi s booklet. Us e sterilize d tong s t o pic k up nipples , caps and rings and put these on the bottles . Tighte n th e rin g wit h you r hands. B e carefu l no t t o touc

h th e nipple. 11 INFAN T FORMULA : WHA T YO U NEE D T O KNOW PREPARING POWDERED F ORMULA Powdere d formul a i s no t steril e an d ha s mad e som e babie s sick . I t i s importan t t o prepar e powdered formul a correctl y t o lowe r th e ris k o f you r bab y gettin g sick . Th e cos t o f liqui d concentrate , bough t b y th e case , an d th e cos t o f powdere d formul a ar e ver y simila r onc e mixe d (se e pag e 3). Babie s wh o are at the greates t risk o f infection s shoul d hav e steril e liqui d formul a suc h as ready - to - fee d o r liqui d concentrat e formulas . Babie s a t greates t ris k o f infection s fro m powdered infan t formul a ar e thos e who: • Ar e premature. • Ha d lo w birt h weigh t an d ar e unde r tw o month s o f age. • Hav e a weakene d immun e system. I f yo u ar e no t sur e abou t feedin g you r bab y powdere d formula , chec k wit h you r healt h car e provider. I f yo u absolutel y hav e t o fee d powdere d formul a t o a bab y wit h on e o r mor e o f thes e risks , follo w the direction s ver y closel y. Note: Some babies may be prescribed a special type of formula that only comes in powered form. It is important to follow the directions given by your health c are provider. Directions: • Was h you r hand s wit h soa p an d war m water , an d sanitiz e th e counte r are a accordin g t o the direction s o n pag e 6. • Hav e al l you r steril e supplie s read y (se e page s 6 an d 7). Us e sterilize d ho t wate r t o mak e powdere d formula . I t i s bes t t o make th e formul a fres h an d us e i t righ t awa y afte r i t ha s cooled. 2 3 Boi l th e wate r fo r tw o minutes. Turn off the heat and let the water cool a bit, but not below 70 o C. You can use a clean, digital food thermometer to check the temperature. Mak e th e formul a whe n the wate r temperatur e i s a t least 70°C . Th e temperatur e must b e

ove r 70° C t o kil l harmful bacteri a tha t ma y b e i n the powder . I f th e boile d wate r has bee n sittin g a t roo m temperature fo r mor e tha n 3 0 minutes , you wil l nee d t o rehea t i t t o 70 o C o r higher befor e mixin g i t with formula. Rea d th e formul a label . I t will tel l yo u ho w muc h formul a and wate r t o use . Pou r th e needed amoun t o f sterilize d wate r int o a sterilize d glas s measurin g cup. 12 www.beststart.org PREPARIN G POWDERE D FORMUL A (CONTINUED) 4 Measur e th e neede d amount o f powdere d formula . Us e the scoo p fro m insid e th e can. 5 Level the scoop with the flat side of sterilized knife. 6 Ad d powde r t o th e sterilized ho t water. 7 Mi x wit h a sterilize d utensi l until n o lump s o f powde r ar e left. 8 Pou r th e amoun t o f formula fo r on e feedin g int o a sterilized bottle. 9 Us e sterilize d tong s t o pic k up nipples , ring s an d caps , and pu t o n bottles. 10 Tighte n th e rin g wit h your hands . B e carefu l no t t o touch th e nipple. 11 Quickl y coo l th e bottl e o f formula unde r cold , runnin g wate r or i n a containe r o f col d water. Whe n i t i s a t bod y o r room temperature , fee d you r baby. 12 I t i s bette r t o mi x thi s typ e of formul a fres h fo r eac h feed . I f for som e reaso n thi s i s no t possible, pu t th e prepare d formul a in th e fridge (in the back of the fridge and not the door). Us e i t within 2 4 hours . Rea d guideline s on ho w an d whe n t o fee d your Fo r babie s no t “a t risk ” (se e to p o f pag e 12) , yo u can mi x powdere d formul a wit h wate r tha t wa s sterilized an d cooled . Thi s mus t b e fe d t o you r bab y righ t away. bab y late r i n thi s booklet. 13 INFAN T FORMULA : WHA T YO U NEE D T O KNOW SAF

ELY STORING FORMU LA • I t i s bes t t o us e formul a immediatel y afte r preparin g it. • I f formul a is stored in a container, on the label mark the date and time when you opened the container. Ready - to - fee d or Concentrate d Liquid Formula: – Store d i n Containers: • Cove r can s wit h a plasti c ca p o r plasti c wrap. • Kee p opene d can s o f concentrate d an d ready - to - us e formul a i n th e fridge. • Thro w can s ou t afte r 4 8 hour s o r a s you r labe l tell s yo u o n th e can. – Store d i n Bottles: • Kee p bottle s wit h formul a i n th e fridg e fo r 2 4 hour s a t th e most. • Thro w ou t prepare d formul a afte r 2 4 hours. • Stor e bottle s nea r th e bac k o f th e fridg e wher e i t stay s cooler, not in the fridge door. Powdere d Formula: • Kee p bottle s wit h formul a i n th e fridg e fo r 2 4 hour s a t th e most. • Stor e ope n can s o f powde r wit h th e li d tightl y closed , i n a cool , dr y place (no t i n th e fridge). • Afte r a ca n i s open , us e th e res t o f th e powdere d formul a withi n on e month, an d befor e th e expir y date. Neve r freez e formula t o us e late r a s thi s can chang e th e texture a n d nutrient levels. 14 www.beststart.org WARMING FORMULA TO F EED Warming • Remov e th e formul a fro m th e fridg e just befor e yo u nee d t o fee d you r baby. • Man y babie s prefe r formul a a t bod y temperature (warm) , an d other s lik e i t cool . Eithe r wa y i s fine. You r bab y wil l le t yo u kno w wha t they prefer . • War m th e bottl e o f formul a i n a containe r of war m water , o r a bottl e warmer . Kee p the nippl e are a ou t o f th e water. • D o no t hea t an y bottle s i n th e microwave. Thi s heat s th e formul a an d create s “ho t spots” tha t coul d b u r n you r baby’ s m

outh. • War m th e bottl e fo r n o mor e tha n 1 5 minutes. Shak e th e bottl e a fe w time s durin g warming. • Chec k t o mak e sur e th e formul a i s no t too ho t befor e th e feeding . Pu t a fe w drop s of formul a o n th e insid e o f you r wrist . I t should fee l slightl y warm , no t hot. • Onc e yo u hav e warme d th e formula , feed you r bab y righ t away. • D o no t rehea t formul a durin g a fee d or refrigerat e a partl y use d bottle. • A bottl e shoul d b e use d withi n tw o hours o f heating , o r a s i t tell s yo u o n th e can. • Thro w ou t an y leftove r formula. 15 INFAN T FORMULA : WHA T YO U NEE D T O KNOW WHEN TO FEED YOUR BA BY I n th e firs t fe w month s o f life , mos t babie s ea t a t leas t eigh t time s i n 2 4 hours . Thi s doe s no t mean the y fee d ever y thre e hours . The y wil l fee d whe n the y ar e hungry . The y wil l fee d durin g th e night, an d i t i s norma l t o fee d durin g th e nigh t fo r man y months . Olde r babie s ma y nee d t o ea t les s often. I t i s importan t t o follo w an d respec t wha t you r bab y i s tellin g you through their feeding cues, and to respond to those cues. Hav e you r bab y i n you r roo m wit h yo u whethe r i n hospita l o r a t home . I t is recommende d tha t you r bab y sleep s i n you r roo m o n their ow n slee p surfac e for si x months . Thi s i s bes t becaus e i t can: • Hel p yo u notic e whe n you r bab y i s hungry. • Hel p yo u bette r lear n you r ne w rol e a s a parent. • Hel p lowe r th e ris k o f Sudde n Infan t Deat h Syndrome, als o know n a s SIDS. You r bab y ’s behavior wil l tel l yo u whe n they are hungry . I t is importan t t o understan d thes e cues . I t i s bes t t o feed whe n you r bab y i s showin g earl y feedin g cues. F

ee d you r bab y whe n yo u se e earl y sign s o f hunge r suc h as: • Stirring , movin g arms. • Rapi d ey e movement s unde r th e eyelids. • Mout h opening , yawning , li p smacking. • Turnin g their hea d toward s yo u o r somethin g tha t is touchin g their cheek , wit h their mout h ope n (rooting). Thi s i s a goo d tim e t o fee d you r baby. You r bab y i s muc h hungrie r whe n yo u see: • Hand s goin g t o their mouth. • Suckin g o r lickin g movements. • Restlessness. • Sof t cooin g o r sighin g sounds , gettin g louder. Lat e feedin g cue s showin g you r bab y i s extremely hungr y include: • Fussing. • Crying. • Bein g agitated. • Exhaustion. • Fallin g asleep. I f you r bab y i s showin g lat e feedin g cues , yo u ma y have t o cal m them dow n o r le t them slee p briefl y befor e feeding. On e grea t wa y t o cal m you r bab y i s holdin g them skin - to - skin agains t you r chest. Earl y Feedin g Cues : Mouth opening , yawning , li p smacking. Moderat e Feedin g Cues: Restlessness , sighin g sounds gettin g louder. Lat e Feedin g Cues : Fussing, crying , agitated. 16 www.beststart.org HOW TO BOTTLE FEED YOUR BABY • Cuddl e o r hol d you r bab y clos e whe n feeding . Make feedin g a specia l time. • Hol d you r bab y i n a n uprigh t positio n , s o that their hea d i s muc h highe r tha n their body , keepin g the hea d supported. • Pu t th e bottl e nippl e jus t belo w th e lowe r li p an d wait fo r a n “invitation ” t o pu t th e bottl e in . Th e invitatio n is you r bab y respondin g t o thi s touc h wit h a big , wide - open mouth. Ensure much of the nipple is in the baby’s mouth so that during feeding, your baby has a wide open mouth on a large part of the nipple. Avoid just pushin g th e nippl e o f th e bottl e int o you r baby’ s mouth. • Til t th e bottl e onl y

a little , keepin g i t almos t flat , so tha t i t i s easie r fo r you r bab y t o manag e th e flo w of th e formula . Som e ai r i n th e nippl e wil l no t caus e a proble m fo r you r baby. • D o no t pro p a bottl e o r pu t you r bab y t o be d wit h a bottle . You r bab y ma y drin k to o much o r to o littl e an d i t ca n als o caus e choking , toot h deca y (cavities) , an d ea r infections . I t i s important fo r babie s t o b e hel d an d touche d durin g feedin g . • Hol d you r bab y i n on e ar m fo r som e feed s an d i n anothe r ar m fo r others . Thi s help s you r bab y with muscl e developmen t whil e they are turnin g their hea d t o loo k a t you. • Feedin g i s a specia l time . Enjo y you r baby ; talk , smile , sing, cuddle. Skin - to - Skin Hol d you r newbor n bab y skin - to - ski n every day . Continu e t o hold you r bab y skin - to - ski n ofte n durin g th e firs t fe w months. Researc h show s tha t spendin g lot s o f tim e skin - to - ski n can: • Hel p you r bab y fee l saf e an d secure. • Kee p you r bab y warm. • Stabiliz e you r baby’ s hear t rate , breathin g an d blood suga r afte r they are born. • Kee p you r bab y cal m an d decreas e crying. • Hel p yo u t o recogniz e whe n you r bab y i s hungry. • Hel p mothers , famil y member s an d babie s lear n to respon d bette r t o eac h other. • Hel p babie s lear n t o socializ e better. • Hel p brai n development. • Decreas e postpartu m depressio n fo r mothers. Partner s an d othe r caregiver s i n th e famil y ca n als o enjo y skin - to - ski n tim e wit h thei r babies. Practic e durin g feedin g time , bat h time , whe n you r bab y i s fussy , o r an y time . See: http://library.stfx.ca/abigelow/skin_to_skin/skin_to_skin.parents.mp 4 . 17 17 INFAN T FORMULA : WHA T YO U NEE D T O KNOW FEED ACCORDING TO YO UR BABY’S CUES

Pac e th e feedin g s o tha t i t i s a t a rat e comfortabl e fo r you r baby . You r bab y shoul d loo k relaxed whil e feeding . Watc h fo r a cal m fac e an d relaxe d hand s an d arms , especiall y afte r th e feedin g starts. D o no t rus h th e feeding . Tak e you r tim e an d d o no t forc e you r bab y t o fee d mor e tha n they want . I t i s importan t t o watc h you r baby’ s cues . Watc h fo r sign s o f discomfor t o r stres s durin g feeding. Sign s o f stres s durin g feedin g ma y be: • Mil k leakin g o r dribblin g ou t o f their mouth. • Chokin g o r gaggin g whil e feeding. • Gulpin g o r swallowin g quickl y without takin g a breat h afte r eac h swallow. • Breathin g fas t o r workin g har d t o catch a breath. • Smackin g o r squeakin g noises. • Squirmin g o r strugglin g durin g th e feed. • Pushin g th e bottl e awa y wit h their hands o r tongu e o r movin g their hea d away. • Stresse d loo k o n their forehead. I f you r bab y show s sign s o f stres s durin g a feed , slo w dow n th e fee d fo r a fe w moment s o r stop. Giv e you r bab y a brea k b y tiltin g th e bottl e s o tha t les s mil k i s i n th e nipple , o r mayb e n o mil k is ther e fo r a shor t while . Yo u ca n als o tak e th e bottl e ou t o f their mouth , cuddl e you r baby , bur p your baby , an d watc h fo r sign s o f hunge r t o restart. Restar t th e fee d whe n you r baby’ s breathin g i s relaxe d an d you r bab y i s askin g fo r more . Watch fo r feedin g cue s (pag e 16) . I f ther e ar e feedin g cues , continu e feeding . I f ther e ar e n o mor e feeding cues , en d th e feeding. I f you r bab y keep s showin g sign s o f stres s durin g feedings , chec k i f you r feedin g supplie s ar e right fo r you r baby . Fo r example , th e flo w o f mil k fro m th e nippl e yo u ar e usin g m

a y b e to o fast . I f you hav e troubl e fixin g th e problem , ge t hel p fro m a health care provider . Sto p th e feedin g whe n you r bab y show s sign s o f having had enough . Thes e include: • Slowin g dow n o r stoppin g sucking. • Closin g their mouth. • Turnin g their hea d away. • Pushin g awa y fro m th e bottl e o r th e perso n feedin g them . • Fallin g aslee p an d n o longe r intereste d i n feeding. D o no t pressur e you r bab y t o finis h a bottle . Pa y attentio n t o you r baby’ s feedin g cue s an d le t your bab y decid e ho w muc h o r ho w littl e t o eat . B e responsiv e t o you r baby. You r bab y ma y stil l hav e smal l suckin g movement s afte r a feed . Thi s i s norma l bab y behaviour. [ 18 www.beststart.org Burping • Tr y t o bur p you r bab y jus t fo r a few minute s par t wa y throug h th e fee d and afte r th e feed. • Burpin g ma y brin g u p ai r tha t was swallowe d durin g a feed. Sign s tha t you r bab y need s t o bur p are: • Archin g their back. • Gettin g crank y o r fussy. • Pullin g awa y fro m th e bottle. • Suckin g slow s dow n o r stops. Bur p you r bab y b y gentl y pattin g their bac k wit h a cuppe d hand . Tr y these position s t o bur p you r baby: Hol d you r bab y uprigh t over you r shoulder. Hol d you r bab y i n a sitting positio n o n you r lap . Your bab y wil l b e leanin g slightly forwar d wit h you r hand supportin g their jaw. Plac e you r bab y o n their stomac h acros s you r lap. Afte r th e feeding: • Thro w ou t unuse d formula . Neve r reuse , rehea t o r pu t i t i n th e fridg e t o us e later. Leftove r formul a ma y star t t o gro w harmfu l bacteri a afte r tw o hours. • Rins e th e bottl e an d bottl e part s righ t afte r th e feeding. • Clea n you r baby’ s gum s

wit h a clean , warm , dam p clot h afte r eac h feeding. • A s you r bab y grows , wip e their gum s an d brus h their teet h t o hel p preven t cavities. B e sur e t o star t bringin g them t o th e dentis t fro m whe n they are on e yea r old. 19 INFAN T FORMULA : WHA T YO U NEE D T O KNOW FEEDING YOUR GROWING BABY Feedin g i n th e firs t week: • I n th e firs t fe w day s you r baby’ s stomac h i s quit e small . You r bab y wil l nee d onl y small amount s o f formul a a t eac h feeding. • Eac h bab y i s differen t i n ho w muc h the y wan t t o fee d an d ho w often . Fee d you r baby wheneve r they show sign s o f bein g hungry . Se e pag e 1 8 fo r mor e o n baby’ s feedin g cues. Wit h tim e yo u wil l bette r lear n ho w t o tel l i f you r bab y i s hungry. • D o no t tr y t o forc e you r bab y t o finis h a bottl e o r a certai n amount . Lik e adults , babie s are differen t i n th e amoun t the y wan t a t eac h feeding . I t i s bette r t o fee d smal l amount s and mor e often. • A s you r bab y grow s durin g th e firs t fe w weeks , they wil l tak e mor e a t a feeding. • Parents ma y wonde r i f the y ar e feedin g thei r bab y to o littl e o r to o much . Respon d t o you r baby’s feedin g cue s an d i f yo u hav e question s spea k t o you r healt h car e provider. • I f yo u hav e question s o r concern s abou t feedin g you r baby , tal k t o you r healt h car e provider. Feedin g afte r th e firs t week: • Expec t you r bab y t o fee d ofte n i n th e firs t mont h o r so . Afte r that , you r bab y ma y g o longer betwee n feeding s an d the n wil l drin k mor e a t eac h feeding. • Fee d accordin g t o you r baby’ s cues , no t certai n amounts. • Growt h spurt s ar e commo n a t abou t thre e weeks , si x weeks , thre e month s an d si x months. You r

bab y ma y wan t mor e formul a a t thes e time s o r ma y wan t t o fee d mor e often. • Babie s d o no t nee d a vitami n D supplemen t i f the y onl y receiv e formula , becaus e formul a has adde d vitami n D . Tal k wit h you r healt h car e provide r t o fin d ou t i f you r bab y need s additional v itami n D. • Man y healt h car e provider s us e growt h chart s t o trac k babies ’ measurements . Tr y no t to compar e you r bab y t o othe r babies . Babie s gro w a t differen t rates . Growt h chart s fo r babies ma y b e viewe d at : www.dietitians.ca/secondary - pages/public/who - growth - charts.asp x . Se e “I s M y Chil d Growin g Well?” TRANSPORTING FORMULA • I t i s safes t t o trave l wit h unopened ready - to - fee d formula. • Th e nex t safes t i s t o prepar e wate r for you r formul a a t th e plac e yo u ar e going. I f yo u ar e unsur e o f th e safet y o f the wate r wher e yo u ar e going , brin g safe wate r fro m hom e tha t ha s bee n boiled. Mak e sur e i t i s bein g store d and transporte d i n a sterilize d container. • I f yo u mus t prepar e th e formula ahead , onl y tak e a bottl e wit h you afte r i t i s coole d t o fridg e temperature, whic h i s abou t 4 o C. 20 www.beststart.org • Wheneve r possible , plac e th e formul a i n a refrigerato r onc e yo u reac h wher e yo u ar e going. • I f ther e i s n o refrigerato r available , kee p th e formul a i n th e coole r ba g unti l feedin g time. • Whe n formul a ha s bee n ou t o f th e fridge , i t i s safes t t o us e i t withi n tw o hours. • Th e bottl e o f formul a ca n b e pu t bac k i n a fridg e fo r u p t o 2 4 hour s fro m th e tim e i t wa s prepared a s lon g a s yo u ca n answe r “yes ” t o eac h o f thes e statements: 1 . Th e bottl e o f formul a ha s bee n kep t col d whil e travelling. 2 . Th e bottl e

o f formul a ha s bee n ou t o f th e fridg e fo r les s tha n 2 hours. 3 . Th e bab y ha s no t take n an y formul a fro m th e bottle , eve n onl y a fe w mouthfuls. Fo r mor e informatio n o n formul a an d feedin g you r baby , pleas e see: • Preparin g an d Handlin g Powdere d Infan t Formul a at: http://healthycanadians.gc.ca/eating - nutrition/healthy - eating - saine - alimentation/safety - salubrite/milk - lait/formula - nourrisson - eng.ph p • Infan t Formul a at : http://healthycanadians.gc.ca/healthy - living - vie - saine/infant - care - soins - bebe/formula - formule - eng.ph p • Government of NL: http://www.cssd.gov.nl.ca/publications/printed.html#1nut • Newfoundland and Labrador HealthLine at: 811/TTY 1 - 888 - 709 - 3555 • Fin d you r loca l Publi c Healt h Nurse at: http://www.babyfriendlynl.ca/support - services/general - information/ • Baby - Friendly NL at: http://www.babyfriendlynl.ca/ • Othe r loca l services : Than k yo u fo r takin g th e tim e t o rea d th e informatio n i n thi s booklet . Thi s i s on e o f man y ways yo u sho w ho w muc h yo u car e abou t you r baby. 21 Acknowledgements: This booklet was adapted for the province of Newfoundland and Labrador with permission from the BFI Strategy for Ontario. The BFI Strategy is a partnership of the Michael Garron Hospital, the Best Start Resource Center and the Provincial Council for Maternal and Child Health. The Ontario version of this resource was funded by the Government of Ontario and released in 2017. Thank you to the Bab y - Friendly Council of Newfoundland and Labrador & partners from the four Regional H ealth A uthorities who provided input towards the adaptation of this resource. Bookle t contac t information: T his resource is intended for use one on one with your health care provider and is also available online at www.babyfriendlynl.ca The advice provided in this resource does not replace advice from your health care provider. Adaptation of this re sourc e was completed in March