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Feeding - bottle feeding

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General Principles

Follow the steps below to safely establish bottle feeding.

  1. The aim of feeding is to progress feeding, as the infant is able, in a safe manner. 
  2. Do not force feeding at any stage. 
  3. Use appropriate teat for gestational age or difficulties. Follow information below on Cross-cut teats & Haberman Feeder 
  4. Infants will progress faster if offered oral feeds frequently. They may initially take smaller volumes. 
  5. Any difficulties with feeding will be reported to the FLN, Clinical Charge Nurse or medical team. An appropriate referral will then be made. Difficulties may include coughing, choking, gagging, colour change, slow to feed, drooling milk around mouth. 
  6. Do not offer bottles to breastfeeding infants unless it has been discussed with the mother first and there is a valid reason for doing so. See Preparing for breastfeeding 
  7. The primary care giver (usually the mother) should be encouraged to contribute to as much bottle feeding as possible. 
  8. Document on feeding chart infants progress and difficulties. 

Cross Cut Teats

  1. All infants:
    • born less than 32 weeks will initiate oral feeding using a cross-cut teat if a bottle feed is required
    • breastfed infants, requiring the occasional bottle feed.
  2. The majority of Infants transition to a normal teat in the community with professional help. This may occur earlier if the infant is taking full oral feeds safely after assessment by either FLN/CCN.
  3. See RBP- Disinfection/Sterilising Feeding Equipment in NICU.
  4. If infant is to be discharged home using a cross cut teat he will need a referral to the community Speech & Language Therapist in the community. Some infants will be monitored by the homecare service and may be asked by the SLT to transition if they feel fit to a standard teat.
  5. If an infant is being discharged home using a cross-cut teat, then 2 teats will be given to the family to take home. These teats are considered specialized feeding teats and cannot be bought in the community.

Haberman Feeder Use

Infants should be assessed by a speech language therapist prior to prescription of a Haberman Feeder. To enable effective and safe sucking (including but all not limited to)

  • Dysfunctional sucking 
  • Cleft lip or palate 
  • Aspiration of secretions or feed leading to respiratory infection 
  • Pierre Robin Sequence etc. 

Note: Lack of education in the correct technique could lead to the infant getting an incorrect flow i.e. too fast or too slow.
Valve in Haberman bottle can become worn and not function correctly.

Follow the steps below for use of Haberman feeder:

  1. See appendix for instructions on Haberman feeder assembly. 
  2. The teat has an opening with a slit valve in it. 
  3. The flow rate can be controlled by lining the flow mark required with the infant's nose. 
  4. External pacing may be prescribed / demonstrated in specific instances. 
  5. Observe the infant closely for signs of distress. Stop feed if infant agitated and allow time for infant to settle. Stress indicators may include sneezing, colour change etc. 
  6. It may be necessary to lift the infants jaw forward to support / enhance sucking. 
  7. When feed completed, rinse equipment in warm water and soak in sterilising solution as per unit/ward protocols. Remove from solution as soon as sterilizing is complete and store as directed by ward/unit protocols.

Use of Ready to Feed Formula (RTF)

Follow the steps below for the storage and administration of RTF

  1. All RTF formula will be stored in a storeroom. 
  2. Small amounts of RTF may be stored in clinical areas. These must be stored in a cupboard away from public view. 
  3. One bottle of RTF for an individual baby. Do not share bottles between babies. The baby's sticky label is to be placed on the bottle, covering the brand name. Please check expiry date of bottle. 
  4. Write date and time on the RTF when it was opened. 
  5. At each feed decant required amount into syringe or feeding bottle. 
  6. Once RTF has been opened it should be used within 1 hour or stored in the fridge and used within 24 hours of opening. If RTF formula has been heated and not used it will be discarded. 
  7. Empty glass bottles of RTF will be washed in warm soapy water, rinsed and placed in bucket under the sink in the clinical rooms. 
  8. Glass bottles of RTF are not to be reused. Glass bottles to be taken to rubbish room daily and placed in glass recycling bin 
  9. All mothers or families who choose to formula feed will require one to one education on reconstituting infant formula. This education should occur prior to discharge. Please refer to the NWH pamphlet 'Information About Bottle Feeding Your Baby' or MOH's 'Feeding Your Baby Infant Formula'. 
  10. Mothers or families must not be given bottles of formula or teats and bottles to take home.

References

  1. Instruction leaflet Produced by Medela Manufacturers 
  2. Communicating Quality 2 1996 (new drafts) p.105 - 108 
  3. Wolf, L.S. and Glass R.P. "Feeding and Swallowing Disorders in Infancy : Assessment and Management Tucson: Therapy Skill Builders, 1992. 
  4. RBP - Bottlefeeding - Haberman Feeder Assembly

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Document Control

  • Date last published: 03 October 2004
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Author(s): Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years