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