Bottle-feeding: Boon or Bane?
Even while pleading ‘No contest’ to the fact that ‘Breast feeding is best feeding’, one has to understand that many a time one has to settle for an alternative option (Read ‘Bottle-feeding’!).
Let’s take a look at the rights and wrongs of bottle-feeding.
Let's start with the disadvantages first! It helps to know the pitfalls before embarking on any path.
· Infection: This is the most important drawback. Bottle, nipple, animal milk, improperly stored formula, water used in the process of cleaning/ preparation – contamination is possible at any of these levels. Gastroenteritis (Diarrhea) is the most common type of infection.
· Nutritional : Too dilute formula will lead to various nutritional deficiencies and malnutrition. Too concentrated formula can cause excessive sodium level and even fits, more often it causes obesity. Cow’s milk can lead to iron deficiency. Goat’s milk can cause folate deficiency.
· Economic: Buying fresh or formula milk is expensive. Isn’t it?
· Work-load: Preparing formula, sterilisation of bottles and nipples – all this just adds to the daily domestic chores.
· Immunity: No formula in the world can offer the additional immunity provided through various protective factors in breast-milk. Bottle- fed children are more prone for serious infections like meningitis and pneumonia. Many other illnesses like colics, atopic eczema, asthma and dental caries are more common in bottle-fed children.
Despite all raising hue and cry against it, bottle-feeding does offer some advantages which all could be grouped under one heading – Convenience.
· It makes mother ‘free’ as anyone can feed the baby with bottle and the mother can then pursue her career and other social activities without feeling tied down. There needn’t be any restrictions as regards her diet, drinks or medicines.
· It is a convenient mode of feeding while travelling or in public places.
· Bottle-fed babies need less number of feeds as they take longer to digest animal milk.
· When bottle-feeding, mother knows exactly how much milk the baby is taking and that often gives a sense of security and satisfaction about the adequacy of intake.
· It is the only method of feeding available when breast-feeding is not possible in case mother is suffering from a severe illness or is on medicines like lithium, radio-active iodine, anti-thyroid medicines and anti-cancer drugs.
Types of milk:
Since centuries animals like cows, buffaloes, goats, camels and donkeys have played the role of milk-maids for humans. Fresh whole cow-milk and buffalo-milk and various forms of processed cow-milk have been the most popular substitutes for human milk.
Raw animal milk is fed in some tribes but that is a dangerous practice with almost guaranteed transmission of infection and difficulty in digestion. Evaporated cow-milk available in tetra-packs has the advantage of prolonged storage and is easier to digest than whole milk. Condensed milk (with too much of sugar) and skimmed milk (with too much of proteins/minerals and too less of fats/ calories) are not good choices nutritionally and are not advisable for most babies.
The popularly called ‘Formula milks’ have a base of cow-milk and are humanized i.e. modified to match human milk as closely as possible. In addition, vitamins and minerals are added to improve their nutritional value. Both, powder and liquid (ready-to-feed) types of formulae are available.
Specialised formulae are made by modifying the contents of routine cow-milk based formula and sometimes substituting cow-milk protein with soy- protein (derived from soya-bean). These are useful in certain situations like some metabolic disorders, lactose intolerance, gastro-esophageal reflux, colics and cow-milk allergy. They should only be used on your doctor’s prescription.
Fresh V/s Formula milk:
The choice between fresh and formula milk is made more in accordance with the economic and educational status of country. In developing countries, it is much preferable to start with fresh milk as there milk-formulae tend to be expensive, hygienically unreliable and are more likely to be given too diluted or too concentrated to be nutritionally effective.
In a developed country (like UAE) where the relative economic and educational status is higher, formula milk is a preferred choice as it is nutritionally superior to fresh milk and avoids problems like iron deficiency anemia and occult blood loss through stools associated with fresh cow milk.
Choice of formula:
Despite tall claims and counter-claims, between different reputed brands of formula milk there is practically no difference and one can safely choose any one according to his budget and liking. If the baby is feeding comfortably and gaining weight normally, then it doesn’t make any sense to change from one brand to another.
Nowadays, most of leading brands have come up with No.1 (from 0- 6 months), No.2 (from 6-12 months) and No.3 (from 1-4 years) formulae which are supposed to be catering to particular growth patterns and nutritional needs.
Bottle V/s Bowl and spoon:
If it is possible, then spoon-feeding milk from a bowl is a much more hygienic method than using a bottle as sterilisation of a bowl and a spoon is easier and more likely to be fool-proof. But spoon-feeding is time-consuming and requires a high degree of self-motivation. So bottle remains the most popular way of milk-feeding.
Still it is always preferable to do away with bottle and switch over to cup as soon as the baby is ready to drink from it.
Preparing milk for feeding:
As compared to human milk, cow- milk has higher concentration of heavy protein (casein) and a lower concentration of sugar (lactose). Buffalo milk, in addition to these differences, also has more fat. Hence these milks need ‘Humanization’ before consumption.
· For fresh whole cow-milk, humanization includes boiling it for 10 minutes (to break down casein into softer curds) and adding sugar (1 teaspoonful every 75 ml). For fresh whole buffalo milk, in addition we have to remove the cream (to reduce fat). After humanization both these milks should be given undiluted.
· To make 30 ml of formula milk, usually that much boiled water is added to a measureful of powdered formula using the supplied measure.
Cleaning and sterilization of bottle/nipple:
This is the most important precaution to avoid infections. Follow these steps.
1. Wash the used bottles and nipples thoroughly with mild detergent in warm water.
2. Clean the sticky interior of the bottle with detergent-water and brush. Then rinse it in running water to remove traces of soap.
3. Clean the nipple with little cooking salt and then rinse it in running water.
4. Place the bottles in a wide container of water. Cover the container. Boil for at least 20 minutes.
5. Nipples and plastic caps should be added to the container for the last 5 minutes of boiling process.
6. Remove the sterilized equipment by tongs. Immediately prepare the feed in the bottle- by either pouring humanized whole milk or requisite amount of boiled water before adding measured amount of formula powder.
The commonest mistake is drying the bottle and nipple inside out with some cloth after they are out of the boiling container. This ‘cleaning’ only serves to introduce germs and wastes all the earlier sterilization process!
· Preferably mother should be bottle-feeding, holding the baby in the crook of her arm. This promotes the emotional bonding.
· Don’t bottle-feed to a baby who is lying down on its back on bed as there is a risk of choking and ear infection.
· Burp well after feeding.
· Check temperature of milk by dropping it on the inside of your wrist or back of hand. Milk should be fed at body temperature.
· Check nipple-hole size by seeing that milk comes out in slow drops. Too small nipple-hole causes underfeeding and tires the baby. You can enlarge its size by piercing with a red-hot needle. Too large a hole can lead to overfeeding, obesity and even choking.
· Check the integrity of formula packing and its expiry date.
Bottle-feeding might have been portrayed as a big bad wolf by pediatricians all over and not without a ton of justification, but the fact remains that it is a well-entrenched tradition and is there to stay. Providing correct know-how about bottle-feeding that would limit the potential drawbacks and offer maximum benefits is the only way of taming this wolf!
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Right Parenting.Com is a site dedicated to offer compassionate scientific guidance on various parenting and child-health issues. It is managed by Dr. Mandar V. Bichu, a Sharjah-based paediatrician with the help of experts in various fields.
Right ParentingDr. Mandar V. Bichu