GuidelinesIMCI
Replacement Feeds
IMCI - Counsel the Mother or Caregiver on Infant and Young Child Feeding
Requirements for Safe Replacement Feeding
Safe Preparation of Replacement Feeds
Benefits of Breastfeeding
- Breastfeeding is the perfect food for the baby. It contains many antibodies and substances that fight infection, mature the gut and body, and promote optimal growth, development and health for the baby
- The risk of not breastfeeding is a much higher chance of the baby becoming ill with, or even dying from, diarrhoea, pneumonia or malnutrition
- If the mother is HIV positive, with ART prophylaxis the risk of HIV transmission is much less than in the past
Requirements for Safe Replacement Feeding
- The mother or caregiver must purchase all the formula herself, and be prepared to do this for 12 months
- She must safely prepare milk before EACH of 6 – 8 feeds a day
- Running water in the house and electricity and a kettle are advisable for safe preparation of 6 – 8 feeds a day
- She must be able to clean and sterilise the equipment after each feed
- She should use a cup to feed the baby as it is safer than a bottle
Replacement Feeds
- Ensure that the mother understands the benefits of breastfeeding and risks of not breastfeeding
- If the mother (or caregiver) nevertheless chooses not to breastfeed, ensure that she understands the requirements for safe replacement feeding and knows how to prepare replacements feeds safely
- Infants who are on replacement feeds should receive no other foods or drinks until six months of age
- Young infants require to be fed at least 8 times in 24 hours
- Prepare correct strength and amount of replacement feeds before use
- Cup feeding is safer than bottle feeding. Use a cup which can be kept clean i.e. not one with a spout
- Pasteurised full cream milk may be introduced to the non-breastfed infant’s diet from 12 months of age. Avoid coffee, tea, creamers and condensed milk
- Where infant formula is not available, children over six months may temporarily receive undiluted pasteurised full cream milk (boiled), provided that iron supplements or iron-fortified foods are consumed and the amount of fluid in the overall diet is adequate
Safe Preparation of Replacements feeds
- Wash your hands with soap and water before preparing a feed
- Boil the water. If you are boiling the water in a pot, it must boil for three minutes. Cover the pot with the lid while the water cools down. If using an automatic kettle, lift the lid of the kettle and let it boil for three minutes
- The water must still be hot when you mix the feed to kill germs that might be in the powder
- Carefully pour the amount of water that will be needed in the marked cup. Check if the water level is correct before adding the powder. Measure the powder according to the instructions on the tin using the scoop provided. Only use the scoop that was supplied with the formula
- Mix by stirring with a clean spoon
- Cool the feed to body temperature under a running tap or in a container with cold water. Pour the mixed formula into a cup to feed the baby
- Only make enough formula for one feed at a time
- Feed the baby using a cup and discard any leftover milk within two hours
Cleaning of equipment used for preparation and giving of feeds.
- If the infant is being cup fed:
- Wash all containers and utensils used for feeding and preparation thoroughly in hot soapy water. Make sure that all remaining feed is removed. Rinse with clean water, allow to dry or dry with a clean cloth and store in a clean place
- If possible, all containers and utensils should be sterilized once a day as described below - If the caregiver is using bottles to feed the infant:
- Wash all containers and utensils used for feeding and preparation thoroughly in hot soapy water. Make sure that all remaining feed is removed using a bottle brush. Rinse with clean water
- The bottles and other equipment must be sterilised after each use as described below - Sterilization should be done as follows:
- fill a large pot with water and completely submerge all washed feeding and preparation equipment, ensuring there are no trapped air bubbles
- cover the pot with a lid and bring to a rolling boil, making sure the pot does not boil dry
- keep the pot covered until the feeding and preparation equipment is needed.
Integrated Management of Childhood Illness 2022; Young Infant (Birth up to 2 months); Counsel the Mother or Caregiver on Infant and Young Child Feeding (Birth up to 2 months); Counsel the Caregiver about Giving Replacement Feeds
Last checked for updates: June 2023