5.3.12

Bottle Feeding/Introduction to Solid Foods (EHS)

Types of Formulas Offered and Procedures for the Use of Alternative Formulas

• Shasta Head Start provides, at no charge, Ready-to-Feed Enfamil PREMIUM with iron, Enfamil Genleaseor ProSobee LIPIL (a soy-based formula.).
• Parents/Guardians that choose to use a formula other than those offered must be informed of the following Shasta Head Start procedures:
  • Parent’s/Guardian’s Form for Declining a Provider’s Formula must be completed for requests for alternative infant formulas.
  • Parents may be required to provide an “alternative” infant formula. Formula provided by parents or by the center shall come in a factory-sealed, unopened container and labeled with the infant’s name. The “use by” date must be current.  Formula with an expired date will not be accepted or will be discarded.

• Scan the completed Parent’s Form for Declining a Providers Formula to the Nutrition Clerk.  The Dietitian will review the form.
• The child cannot attend center until a Cook’s Diet Order is completed for the alternative formula.
• If the parent requests a formula not on the list of approved formulas:

• The Nutrition Clerk will inform the center staff that a doctor’s Medical Statement is necessary and then consult with the Registered Dietitian.
• The center staff will inform the parents that the child will not be able to attend the center until a Medical Statement is signed by the child’s health care provider and returned to the Dietitian. Parents may decide to approve of the use of center-provided formulas or change to a formula on the approved formula list.

• Cooks must receive training from the Dietitian or Food Service Manager, and in turn, train center staff in the formula preparation. The Site Supervisor is responsible to make sure that this training occurs:
• How to correctly mix formula
• How to correctly store formula
• The importance of labeling formula with the infant’s name and ensuring only that infant receives the formula
• Infants receiving only a parent-provided formula should not be claimed for meals (e.g., the infant is not yet consuming solid foods)

Preparation and Handling of Bottle Feeding 

• Only cleaned and sanitized bottles and nipples shall be used.
• All filled containers of human milk shall be identified with a label, which will not come off in water, bearing the date of collection, time the bottle was warmed to room temperature, initials of the preparer, and child’s full name.
• The filled, labeled containers of human milk shall be kept frozen or refrigerated, and iron-fortified formula shall be refrigerated until immediately before feeding.
• Any contents remaining after a feeding shall be discarded.
• Prepared bottles of formula from powder or concentrate or ready-to-feed formula shall be labeled with the child’s name, date and time of preparation, and initials of the preparer. They will be kept refrigerated and shall be discarded after 48 hours if not used.
• Formula will be prepared according to the instructions on the container. Use bottled distilled or sterilized water and measure with a sanitized measuring cup.
• When preparing formula, as per above, add measured formula to water to ensure correct concentration.
• Supervisory staff must request and document line staff training on the preparation and handling of bottle feeding (infant formula and breast milk).
• An open container of ready-to-feed or concentrated formula shall be covered, refrigerated, and discarded after 48 hours if not used.
• Unused expressed human milk shall be discarded after 72 hours if refrigerated, or by three months if frozen, and stored in a deep freezer at 0 degrees F.
• Unused frozen human milk, which has been thawed in the refrigerator, shall be used within 24 hours.
• Frozen human milk shall be thawed under running cold water or in the refrigerator.
• Human milk from a mother shall be used only with that mother’s own child.
• A bottle that has been fed over a period that exceeds an hour from the beginning of the feeding or has been unrefrigerated an hour or more shall not be served to an infant.
• Formula mixed with cereal, fruit juice, or any other foods shall not be served unless the child’s source of health care provides written documentation that the child has a medical reason for this type of feeding.
• Formula provided by parents or by the center shall come in a factory-sealed container.

Warming Bottles and Infant Foods 

• Bottles and infant foods shall be warmed under running warm tap water or by placing them in a container of water that is no warmer than 120 degrees F.
• Bottles shall not be left in a pot of water to warm for more than 5 minutes.
• Bottles and infant foods shall NOT be warmed in a microwave oven.
• After warming, bottles shall be mixed gently and the temperature of the milk tested before feeding. Infant foods shall be stirred carefully to distribute the heat evenly.
• If a slow-cooking device, is used for warming infant formula, human milk, or infant food, it shall contain water at a temperature that does not exceed 120 degrees F. and shall be emptied, sanitized, and refilled with fresh water daily.

Cleaning and Sanitizing Equipment Used for Bottle-feeding 

• Bottles, bottle caps, nipples and other equipment used for bottle feeding shall not be reused without first being cleaned and sanitized by washing in a dishwasher or by washing, rinsing and boiling for one minute. Ready-to-feed and disposable nipples will be disposed (e.g., NOT reused).

Note: Excessive boiling of latex bottle nipples will damage them.

Feeding Human Milk 

• If a parent chooses to provide expressed human milk for their infant, have the parent sign the Parental Agreement for Releasing Breast Milk form and go over the Parent Sheet for Breastfeeding Mothers before accepting human milk at the center.
• Expressed human milk shall be placed in a clean/sanitary bottle appropriate for transport and dated with time of expression. Frozen breast milk will be in appropriate breast milk bag, labeled, dated and not to exceed 4oz per bag, excess milk will not be refrozen; thawed milk will be used or discarded.
• Center staff will ensure that the bottle is properly labeled and immediately refrigerated upon arrival.
• Prior to feeding, staff will record the time the bottle was warmed to room temperature, initials of the preparer, and child’s full name.
• Unused human milk shall be discarded after 72 hours if refrigerated, or by three months if frozen, and stored in a deep freezer at 0 degrees F. Unused frozen human milk, which has been thawed, in the refrigerator shall be used within 24 hours.
• Frozen human milk shall be thawed under running cold water or in the refrigerator.
• Human milk from a mother shall be used only with that mother’s own child.
• Expressed human milk shall be discarded if it presents a threat to a baby such as:

• Human milk that is in an unsanitary bottle
• Human milk that has been unrefrigerated for an hour or more

Feeding Human Milk to Another Mother’s Child 

If a child has been fed another child’s bottle of expressed human milk, this shall be treated as an accidental exposure to a potential HIV-containing body fluid. Staff shall:  

• Inform the parents of the child who was given the wrong bottle that:

• Their child was given another child’s bottle of expressed human milk;
• The risk of transmission of HIV is very small;
• They should notify the child’s physician of the exposure;
• The child should have a baseline test for HIV and a follow-up test six months later;
• The mother of the child should have an HIV test immediately and a follow-up test six months later.
• If the parent chooses to seek medical treatment for their child, an Unusual Incident Report should be completed.

• Inform the mother who expressed the human milk of the accidental bottle switch and ask:
• If she has ever had an HIV test and, if so, if she would be willing to share the results with the parents of the exposed child;
• If she does not know if she has ever had an HIV test, if she would be willing to contact her obstetrician and find out, and if she has, share the results with the parents;
• If she has never had an HIV test, if she would be willing to have one immediately and a follow-up test six months later and share results with the parents;
• If the mother has had a previous test more than six months prior to the incident, if she would be willing to have a test immediately and a follow-up test six months later and share results with the parents;
• When the human milk was expressed and how it was handled before being brought to the facility.

Parent and Staff Tips for Weaning Infants from Bottle

Weaning a child from a bottle may be a challenge and is usually a gradual process. Consistency is essential and all caregivers should be aware that the child is transitioning from the bottle to the cup.

Review the questions below with the parent to help answer their questions about weaning infants off the bottle and introducing them to a cup.

When is my child ready to be weaned? 

• Children can try a cup at 6 months and be weaned off the bottle around 12 months.
• Children are ready to be weaned when they:
  • Can sit up by themselves
  • Can eat from a spoon
  • Show more interest in solid foods
  • Have an established mealtime routine

How do I wean my child off the bottle and introduce a cup? 

• Start teaching your baby to use a cup around 6 months. They can play with an empty cup earlier.
• Initially hold the cup for the infant and help guide it. Start with a small amount of liquid to minimize spills. Using a cup with a broad base and two handles will also result in fewer spills. (Avoid using a sippy cup unless necessary, the idea is to help infants learn to drink from an open cup)
• At 8 to 10 months, start cutting down on the number of bottles the child gets each day. Use the cup instead.  Start with using a cup at just one bottle feeding per day and gradually move to two bottle feedings per day.
• If morning and bedtime bottles are hard to give up, start weaning with the daytime bottles.  If a bedtime bottle is used, fill with plain water to prevent tooth decay.
• Cups can be filled with water, breast milk, or formula.  Discourage juice as it is not needed.  If parent insists on juice, offer no more than 2 ounces mixed with 2 ounces of water per day.
• Spend extra time comforting the child during the weaning process.

When should I offer cow’s milk and how do I transition to it? 

• In Head Start EHS centers, children are offered fluid, whole cow’s milk at 12 months.  Plan ahead to help the baby learn to drink from a cup and learn the flavor of cow’s milk.
• Cow’s milk is more likely to be accepted if offered gradually.  At home, parents can mix whole cow’s milk with part formula, gradually increasing the amount of cow’s milk. Start with 1-2 ounces whole milk for every 6-7 ounces formula and gradually increase over a 1-2-week period.  Breastfed infants can be offered whole cow’s milk from a cup during mealtimes.
• Head Start staff should remind parents when their child is 10 months of age that transition to an open cup with cow’s milk will take place at 12 months.  Not all children are the same, if a child requires a longer transition period Head Start staff are to contact the Nutrition Consultant and discuss planning strategies and reason for changes.

Introduction to Solid Foods

The introduction to solid foods is an important milestone in a child’s life. The Solid Food Introduction and Skills Progression checklists are used to help manage the introduction to solid foods.

Solid Food Introduction Checklist

The Solid Food Introduction checklist is used to ensure that infants receive solid foods in an organized manner to avoid and monitor possible allergic reactions to foods. It is completed by the Primary Caregiver when new foods are introduced.

Mark the box next to the new food and the dates it was given to the infant.  If food was offered by a staff member, mark it under “S” column, if offered by a parent, use the “P” column.  Staff are encouraged to offer bold foods first, as they occur more frequently on the cycle menu.

The checklist should be filed in the infant’s feeding chart at the center.

Checklist for Skills Progression

This checklist is used to help plan and encourage appropriate feeding skill development for infants. It is completed by the Primary Care Giver when the infant is 6 months of age to document the infant’s progression with cup, finger foods, and spoon.

Mark the box next to the appropriate skill used for the corresponding food and the date each time the infant practices that skill.  Mark the “Introduced by Staff” column when infant is practicing with staff, and the “Introduced by Parent” column when infant practices with parent.

The checklist should be filed in the infant’s feeding chart at the center.

Important Notes: If the Primary Caregiver has concerns about an infant’s skill progression, please notify the Health Department for additional assessment of infant.

References

• Checklist for Solid Food Introduction – Formster | Checklist | Spanish
• Checklist for Skills Progression – Formster | Checklist 
• Parental Agreement for Releasing Breast Milk – Formster | Form 
• Parent/Guardian’s Form for Declining a Provider’s Formula – Formster | Form 
• Parent Sheet for Breastfeeding Mothers – Storing and Transporting Human Milk