Week 5 - Module - Infant feeding Part 2 - Formula Feeding

Question 1

The only alternative to breast milk for infants up to 6 months of age is infant formula, which supports bodily growth along parameters different from those of the breast-fed child, and provides no immunity against disease. Is infant formula or breast milk an inferior choice of feeding for infants up to 6 months of age?

Answer 1

Infant formula will always be an inferior choice to breast milk

Question 2

Give some reasons why infant formula will always be an inferior choice to breast milk?

Answer 2

* Because infant formulas are synthetic foods made from a large number of ingredients - they carry contamination risks * Formula fed babies also receive the immunological benefits of breast milk * Infant formulas are also made to standard recipes and therefore the constituents do not vary with the different needs of the infant over time as breast milk does

Question 3

Formula fed infants lose less weight in the first few days following birth but gain weight more quickly around 4-6 months What may this increase their risk of?

Answer 3

This may increase their risk of cardiovascular disease in the future

Question 4

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Answer 4

A - True - feeds should be prepared one bottle at a time B - False - Eye contact and skin to contact is promoted - skin contacts helps release of oxytocin C - False - can lead to over feeding D - True E - False

Question 5

When is oxytocin released and where is it released from? What does oxytocin cause?

Answer 5

Oxytocin - released in response to the baby suckling (also released during sex and to cause uterine contractions) and in response to skin to skin contact with baby Oxytocin causes the ejection of milk from the nipple

Question 6

When should unfinished formula milk be discarded?

Answer 6

Unfinished formula milk should be discarded within 2 hours

Question 7

In hot weather, formula-fed infants become thirsty in between their usual feeds What can be offered as a drink for formula fed infants in hot conditions? Why are breast-fed babies not offered this?

Answer 7

They can be offered plain, cooled, boiled water in hot weather to quench their thirst Breast fed babies are not offered this as breast milk composition changes in response to the babies need for fluids - exclusive breast feeding for first 6 months of life unless medical conditions

Question 8

Infants formulas are suitable from birth. In the EU they can be bases on which of the following? A - Cows’ milk protein B - Soya protein C - Goats’ milk protein D - Rats’ milk protein

Answer 8

A,B,C Infant formula in the EU can be based only on Cows’ milk, goats’ milk or soya protein

Question 9

There are different types of cow’s milk formula Whey-dominant formulas Casein-dominant formulas and Modified formulas for minor digestive problems What is the whey:casein ratio in the why and casein dominant formulas?

Answer 9

Whey dominant formula Whey:casein ratio - 60:40 Casein dominant formula Why:Casein ratio - 20:80 (remember casein is a longer word so in its dominant formula, it has a higher casein percentage than the whey does in whey dominant formula)

Question 10

What is the whey:casein ratio in whey dominant formula? What are whey dominant infant formulas labelled with? What is the why:casein ratio in casein dominant formulas? What are casein dominant formulas labelled with?

Answer 10

Whey dominant formula 60whey:40casein ratio Labelled with a ‘1’

Casein dominant formula 20whey:80casein Labelled with ‘hungry babies’

Question 11

Is the whey dominant or casein dominant formula similar to the composition of mature breast or cow’s milk?

Answer 11

Why dominant formula whey:casein ratio is similar to that in mature breast milk Casein dominant formula whey:casein ratio is similar to that in cows’ milk (hence the term hungry babies) Both dominant formulas have the same energy content

Question 12

Follow on formulas are not suitable for infants under 6 months and should never be used for this age group Are follow on formulas casein based or whey based? How does the casein reduce feed frequency? What are the follow on formulas also known as?

Answer 12

Follow on formulas are casein based (whey 20 : casein 80) Casein delays stomach emptying and therefore reduces feed frequency They are also known as Hungry baby formulas as - they ARE MARKETED TO SATISFY HUNGRIER BABIES BEFORE THEY START WEANING

Question 13

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Answer 13

A - True - modified formulas have been developed for infants with minor digestive problems B - True C - False - soya based formulas should not be given before 6months of age - high content of phytooestrogens of which the consequences are unkown D - True

Question 14

What formula is generally given for infants with milk allergy? Is it cows’ milk, goats’ milk or soya protein?

Answer 14

* Extensively hydrolysed formula is generally given to infants with milk allergy * This is type of cows milk protien * Extensively hydrolysed formulas are made with cow’s milk protein (e.g. casein or whey) but the milk proteins have been hydrolysed, or ‘broken down’ into very small fragments which are less likely to trigger an allergic reaction

Question 15

Infant formulas in the UK come in tow formats. What are they?

Answer 15

Dried powder which is not sterile Sterile UHT (Ultra-high temperature) treated ready to feed liquid which is sterile but more expensive

Question 16

Which infants are most at risk of severe illness if their formula is contaminated? (3 different reasons)

Answer 16

Young infants up to 4 weeks old Low birthweight infants Infants with compromised immunity

Question 17

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Answer 17

A - Use liquid ready-to-feed formulas are sterile (prepped in ultra high temperatures) - True B - False - water should be freshly boiled and above 70 degrees C - False - freshly boiled water should be left no longer than 30 minutes in a lidded kettle D - False E - Correct

Question 18

What is the bacteria that causes botulism?

Answer 18

The bacterium causing botulism is clostridium botulinism Anerobic gram positive bacilli

Question 19

Only safe water sources should be used in formula prep. Which of the following sources is safe to use when making infant formula? (only said H2O instead of water for space) * A - Water from hot tap * B - Well water * C - Spring or mineral water that does not comply with tap water regulations * D - Water that has been softened with a sodium exchange pump * E - BottledH20complying with tapH20 regulations

Answer 19

E - bottled water that complies with tap water regulations

Question 20

Storing prepaed infant formula is not recommended as the risk of bacterial growth therefore increases If feeds need to be prepped in advance, how must they be stored? When must they be used? How can expressed breast milk be stored?

Answer 20

If feeds are prepped in advance, they must be stored at 5 degrees celsius or below and used within 24 hours Expressed breast milk Store in fridge - 4 degress or below for up to 5 days Stored in freezeer compartment of fridge for up to 2weeks Store in domestic freezer for up to six months - minus 18 degrees or less

Question 21

Expressed breast milk should be defrosted in the fridge and used within 24 hours Refrigerated feeds should be warmed to room temp by standing in a jug of hot water for a few minutes immediately before heating WHy is microwaving feeds not recommended practice?

Answer 21

Ongoing heating - the milk will continue to heat after removal from microwave Hot-spots - the milk heats unevenly and hot milk in centre of bottle may be undetected and scald the infant

Question 22

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Answer 22

A - chemical sterilisation - True B and C - False Recommended methods of sterilisation include chemical, steam, microwave oven with steamer, boiling water immersion for 10 minutes

Question 23

What are the risks of formula feeding?

Answer 23

Bacterial contaimantion of formula and bottles Childhood obesity due to rapid weight gain around 4-6 months in infancy Increased risk of cardiovascular disease in future Increased illnesses due to lack of antibodies

Question 24

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Answer 24

Formula labelled ‘1’ is whey dominant formula (similar to mature breast milk) A - False - no evidence changing to a different brand will make a difference B - False - can make infant more constipated C - True D - Flase - not recommended to be given before 6 months in the UK E - True - check for cow’s protein allergy

Question 25

Why is soya formula not recommended for infants under 6 months of age?

Answer 25

This is because there is a high content of phyto-oestrogens of which the consequences are uncertain

Question 26

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Answer 26

A - False Formula fed babies may be given plain, cooled, boiled water in very hot weather to help thirst between feeds wheres breast milk composition should change in response to babies needs B - False - Sterile UHT ready-to-feed liquid formula is sterile C - False- no advantage of follow on formula and should not be given before 6 months D - True - ongoing heat and hot spots

Question 27

What temperature water should powdered formula be added to, to sterilise it?

Answer 27

Should be added to fresh boiled water that is above 70degrees

Question 28

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Answer 28

A - True (come in dried powder (not sterile but less expensive) and sterile UHT-treated ready-to-feed liquid) B - False - Cows’ milk, goats’ milk and soya protein C - True D - False - overfeeding can lead to excessive weight gain E - False Whey dominant formula 60whey:40casein Casein dominant formula 20whey:80casein