Shaken Baby Syndrome

A large number of child deaths are reported in South Africa each year. A lot of deaths relate to neglect, abuse or murder. Despite this, there's a knowledge gap in relation to understanding the issue....

Amniotic fluid problems

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Choosing a pre-school

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Newborn reflexes

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Pelvic floor exercises

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Antenatal Classes

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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Bottle Feeding

Although breast milk is the best food for a baby, it is sometimes not an option and the baby needs to be formula fed. Whatever the reason for not breastfeeding (and it could simply be that you don’t want to), this is your choice as a parent. Infant formula is an acceptable and nutritious alternative to breast milk, providing all of the nutrients the baby needs.


Formula feeding

Breastfeeding is not an option when:

1.       An infant is diagnosed with galactosaemia, a genetic disorder

2.       The infant’s mother

·         Has been infected with the human immunodeficiency virus (HIV)

·         Is taking antiretroviral medications

·         Has untreated, active tuberculosis

·         Is infected with human T-cell lymphotropic virus type I or type II

·         Is using or is dependent upon an illicit drug

·        Is taking prescribed cancer chemotherapy agents that interfere with DNA replication and cell division or is undergoing radiation therapies


For mothers who are unable to breastfeed or who decide not to, infant formula is a good alternative. Some women feel guilty if they don’t breastfeed. But if you feed your baby with a commercially prepared formula, be assured that your baby’s nutritional needs will be met. And you’ll still bond with your baby. After all, whether with breast milk or formula, feeding is an important time of connection between mother and baby.


Enough formula must be on hand at all times and bottles must be prepared. The powdered and condensed formulas must be prepared with sterile water (which needs to be boiled until the baby is at least 6 months old). Bottles and nipples need to be sterilised before the first use and then washed after every use (this is also true for breastfeeding women who give their babies bottles of pumped breast milk).


Bottles left out of the refrigerator longer than 1 hour and any formula that a baby doesn’t finish must be thrown out. And prepared bottles of formula should be stored in the refrigerator for no longer than 24 to 48 hours (check the formula’s label for complete information).


Some parents warm bottles up before feeding the baby. The microwave should never be used to warm a baby’s bottle because it can create dangerous ‘hot spots’. The best way to warm a bottle is to place it in a container of boiling hot water. Be sure to shake the bottle and test the temperature on the inner wrist to ensure that the bottle is not too hot or cold.


Formula-fed babies tend to have more gas and firmer bowel movements than breastfed babies. The bacteria in their intestinal tracts are strikingly different. Those in the tracts of breastfed babies consist largely of Lactobacillus bifidus, a beneficial organism that prevents the growth of certain harmful bacteria and that’s present in only small numbers in the stools of bottle-fed babies. Lysozyme, another substance found only in the stools of breastfed infants, also protects against harmful microorganisms. The ratio of vitamins in their systems is different. Human milk contains more cholesterol than does formula, and animal studies suggest that exposure to cholesterol early in life may help programme the individual to metabolise cholesterol more efficiently in adulthood, offering some protection against heart disease. Breastfed infants have higher cholesterol levels at first than do bottle-fed babies, but this difference disappears after weaning.


Choosing a formula

When deciding on an appropriate formula for your baby, you will find there are 3 basic types: cow’s milk-based, soy-based and specialised formulations.


Cow’s milk-based formula:  Though cow’s milk forms the base of these formulas, the milk has been changed dramatically to make it safe for babies. It is treated by heating and other methods to make the protein more digestible and less potentially allergenic. More milk sugar (lactose) is added to make the concentration equal to that of breast milk and the fat is removed and replaced with vegetable oils and other animal fats that are more easily digestible. It is also fortified with extra minerals and vitamins.


Whey-based milks: Normally marketed for babies from birth. The protein content has more whey in it than casein, which reflects breast milk’s balance of these ingredients.


Casein-based milk: Suitable for babies from birth, though usually marketed as being for ‘hungrier’ babies as the casein is less easily digestible, and is supposed to keep the baby feeling fuller for longer.


Soya formula: This is based on soy protein and contains a different carbohydrate (sucrose) from milk-based formula. It is recommended most commonly for babies unable to digest lactose or who have an allergy to milk protein. Unfortunately, as many as half the infants who have milk allergy also have soy protein sensitivity and they must be given a specialised formula.


Specialised formula milks: These include formulas for pre-term babies and formulas for babies who are not breastfed and who are unable to tolerate regular cow’s milk formula. The protein in these formulas is hydrolysed, which means it’s partially broken down, and this makes them easier to digest.


It is best to discuss the choice of formula with your clinic nurse or paediatrician to find the one that will best meet your baby’s needs. It may also be necessary to try a few different formulas to find one that is best suited to your baby. Always try one for at least 48 hours before changing to a different one.


Is there any milk my baby can’t drink?

Ordinary cow’s milk, goat’s milk, condensed milk, dried milk, evaporated milk or any other type of milk should never be given to a baby under 12 months old.


Preparing formula feeds

Always follow the manufacturers’ instructions and always use the scoop provided in the tin to measure the formula.


Preparing formula is like preparing any other meal in your home. Gather all the equipment together and make sure your hands and your work surface are clean. Pour warm, previously boiled, water in the bottles, add the formula (level the scoop with the back of a clean knife), cap bottle closed and gently shake to mix.


Formula can be prepared in advance and kept in the fridge but only for 24 hours, after which it should be discarded. Bottles of boiled water can also be kept in the fridge and then warmed a bit before adding the formula. Most formulas mix better in warmer water.


Formula that has been kept in the fridge should be brought to room or body temperature before giving to the baby. Warm the formula in a jug of warm water. Avoid warming the formula in the microwave as this could result in cooked formula or ‘hot spots’ that could scald your baby’s mouth.


When mixing formula it is important to follow the directions. Adding a little extra formula per bottle in the hope of keeping baby satisfied for longer, or less so that she doesn’t get too fat, will be detrimental to the baby’s nutritional needs.


How to bottle feed

As with breast feeding, you should ensure you are sitting comfortably on a chair or sofa before bottle feeding and that your arms are well supported.

Hold your baby half-sitting with her head in the crook of your elbow and her back along your forearm; this will allow her to swallow safely and easily. If your baby is lying back too far she may find it difficult to swallow. As you feed her, keep your face close to hers and talk to her frequently.

You may want to warm the milk before feeding, although it will be perfectly all right if it has simply been brought to room temperature. Many babies like their bottles cold.

Before you begin bottle feeding, test the temperature of the milk by tipping a couple of drops of formula milk on your wrist. It should be lukewarm; neither hot nor cold to the touch. Once milk is heated, it should never be reheated as this very rapidly increases the bacteria levels in the milk, which is one of the main causes of upset tummies in formula-fed babies.

The hole in the nipple should allow the milk to flow in a steady stream of several drops per second when the bottle is inverted. If the hole is too large, your baby will get too much too fast and splutter; if it is too small, your baby will get tired of sucking before she is satisfied. Teats are sold with different ratings which offer an indication as to how fast the milk will flow. As your baby gets older, she will probably prefer a teat that provides a faster milk flow.

Insert the nipple carefully into your baby’s mouth. If she does not start sucking, you can try stroking her cheek to elicit her sucking reflex. Hold the bottle at an angle and keep the teat full of milk to prevent her from swallowing air with the milk.

If your baby does not appear to want to take any more formula, gently remove bottle from her mouth, sliding your little finger into the corner of her mouth if needs be in order to break the suction on the teat. You may well find that after burping her and perhaps changing arms so that she has a different view, she will take more milk.

Bottle feeding can be a close bonding experience, especially for fathers who are unable to experience breast feeding.



 If you plan on exclusively bottle feeding your baby you will need 6-8 bottles to start with. If you are going to mix-feed your baby (combine breast and bottle feeding) then 2 or 3 bottles should suffice.

There are a huge variety of bottles available and most come complete with a teat and lid. You should always check that the flow rate of the teat provided is suitable for your baby’s needs. Smaller bottles of approximately 125 ml are suitable for newborns and smaller babies. However, larger bottles of approximately 250 ml tend to be a better investment as they can be used right through until your baby is weaned.



Teats are categorised by flow rate – this specifies the speed at which the milk flows out of the bottle and is determined by the hole in the top of the teat. They are available in slow (suitable for newborns), medium (suitable for babies of 3-6 months) and fast (suitable for babies of 6 months+) flow rates.


Teats are made either of latex or silicone. Although there is no great difference between them, silicone teats have a reputation for being more durable while latex teats are said to feel more like a nipple. Teats also vary in shape and can be bell-shaped or naturally shaped to resemble a nipple. When it comes down to teat shape and feel, there is no evidence to suggest that one is better than the other so it is really a question of which one your baby prefers.


Sterilising equipment  

This is down to personal choice and how much you want to spend on sterilising equipment. You will need to sterilise all of your baby’s feeding equipment for the first 6 months and it is recommended that you continue until she is 12 months old. There are 4 main methods of sterilising your baby’s feeding equipment: steaming, boiling, using a sterilising solution and microwaving.


Bottle brush

You will need to thoroughly clean your baby’s bottles before sterilising and a nylon-bristled bottle brush provides a convenient way to ensure all traces of milk are removed. Some bottle brushes are fitted with a teat cleaning brush on the other end.


Useful extras

  • Muslin cloths: These are relatively inexpensive and come in really handy for mopping up dribble and spilt milk. They can also be used to protect your clothes when you feed and burp your baby.
  • Bibs: These are fantastic for protecting your baby’s clothes at feeding time and also prevent spilt milk from irritating the skin around your baby’s neck. Again, they are inexpensive and available in a wide range of sizes, styles and colours. Bibs with a towelling top and waterproof backing are especially good.
  • Thermos flask: Current guidelines suggest that it is not safe to store ready-made formula milk for any length of time before a feed. For this reason a thermos flask can be incredibly useful for storing ready-boiled water to combine with formula powder when you are out and about.


Quantity and frequency of formula feeds

There is no exact science to predict how much formula milk your baby will need. Just like adults, an infant’s appetite will vary from day to day, and feed to feed.

The basics

As a rough guide, however, you can work out how much your baby is likely to need over the course of a day by allowing approximately 150 ml of formula for every kg of your baby’s body weight. For example, a 5 kg baby will consume around 750 ml of formula milk in any 24 hours. Do bear in mind though that this won’t work for low birth weight or premature babies or infants over 6 months of age.

It’s also important to remember that all babies are different, some have a larger appetite than others and provided your baby is putting on weight and your health care providers are happy with her progress there is little reason to worry.

In general, you’re likely to notice that your baby consumes less milk when she is feeling unwell and more when she’s having a growth spurt (these typically occur at around 2, 3 and 6 weeks and 3 and 6 months of age). This is completely normal.

A rough guide



In their first few weeks of life newborn babies need to feed little and often as their tummies aren’t big enough to hold large quantities of milk at a time. Most newborns will consume somewhere between 30 to 60 ml each feed, eating 8-10 times a day.

1 month old

Over the first month your baby will start to take on more milk during each feed, gradually increasing to 60-90 ml then 90-120 ml from each bottle.


It is a good idea to make up roughly 25 ml more formula milk in each bottle than you expect your baby to eat during a feed as this will ensure that a plentiful supply is available and prevent your having to mix up some afresh if she’s still hungry. Once your baby starts to finish the bottle on a regular basis (although you should never try to force your baby to drain the bottle) you’ll know that her appetite is growing.

2 months old

Once your baby reaches 2 months of age she’ll typically need to feed between 6-8 times a day, consuming 120-180 ml from each bottle.

4 months old

4-month-old babies will typically need 4-5 bottles a day, consuming between 175-200 ml each feed.

6 months old

By the time your baby reaches 6 months of age she’ll typically feed 3-4 times a day, consuming 200-220 ml from each bottle.

Once you start introducing solids into your baby’s diet the amount of milk she’ll need during the day will gradually start to decrease. However, most infants will still need approximately 600 ml of formula milk a day even when they’re established on solids, as they are unlikely to get all the nutrients they need from the small amounts of food they consume.

Many parents find that giving their baby a full bottle in the morning, a full bottle before bed and supplementing meals with a smaller drink of formula milk is a good routine; however, over time you’ll find one that works best for you and your baby.

1 year old

Once your baby reaches a year old you can begin to wean her on to full fat cow’s milk. You should aim to give her at least 350 ml a day to ensure she continues to get all the nutrients she needs.

How can I tell if my baby is hungry?

Babies do cry when they’re hungry; however, there are usually lots of signs that they want to be fed before they resort to this. Over time, you’ll tune in to your baby’s hunger cues and these will help you to feed her ‘on demand’.

Typical signs that your baby is hungry include:

  • Rooting (baby moves her mouth in the direction of something that touches her cheek)
  • Sucking fingers or hands
  • Smacking the lips
  • Opening the mouth and moving the head from side to side
  • Crying

It’s important to remember that not all cries mean that your baby is hungry, particularly if she’s recently been fed. Crying can mean that your baby is tired, wet or just wants some attention instead.

How can I tell when my baby has had enough formula milk?

Once your baby has had her fill she will begin to turn away from the bottle, appearing relaxed and contented.

If your baby has drained the bottle and is still hungry you’ll notice that she will continue to look around for more food after you take the bottle away. Try giving her another 25 ml of formula milk at a time until she appears sated.

Remember, if you ever have any concerns about whether your baby is getting enough formula milk you should speak to your doctor or health visitor as they will be in the best position to advise you.