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Practice comment

"Clinicians must not bottle out of advising on formula feeds"

There is a need to look at how information on formula feeds can be made available to health professionals

“Breast is best” is something all health professionals would agree with, and there is no question that breastfeeding should be encouraged and women supported to do it. But what about mothers who choose not to breastfeed, whether for personal or medical reasons - what support is available to them?
Women with a baby well-established on a formula feed have decided not to breastfeed. Yet their access to advice and support is limited as many health professionals are discouraged from obtaining up-to-date information on formula feeds. How can you offer mothers appropriate advice and information if you don’t know what that is, and where is the evidence-based care?
I did my midwifery training back in the dark ages when mothers were in hospital for at least three to five days - long enough for new mums to be shown how to make up feeds and sterilise bottles. As a student midwife, I was expected to know about the full range of formula feeds, how they differed and to advise mothers accordingly. Nowadays, because hospital stays are shorter, there is no time to spend with the mother to go through bottle-feeding and apparently staff are not allowed to do so.
Yet there is clear guidance from the World Health Organization (1981) on infant feeding. While breastfeeding must be promoted, when this is not possible, mothers must be given appropriate information.
Gastric problems, such as constipation, are not uncommon in formula-fed babies (Infante et al, 2011). To address this before it becomes chronic - when laxatives may be required - it seems prudent to know about different types of formula feeds so that mothers can be advised.
In 2010, Unicef produced a leaflet for health professionals and parents, which gives advice on what to do if a bottle-fed infant develops constipation. And the NHS Choices web site suggests parents who think one brand of formula disagrees with their baby should try another - and advises them to contact their GP or health visitor for advice. Yet, if health visitors are discouraged from attending study days and meetings attended by representatives from formula feed companies, how will they provide accurate, up-to-date information?
In 1981, the WHO agreed to information on formula feeds being provided as long as it was “restricted to scientific and factual matters”. There is a need to look at how such information can be made available to health professionals, which will then enable them to advise and support those mothers who do breast bottle feed. Otherwise, we are at risk of throwing the baby out with the bathwater.

June Rogers MBE is team director, PromoCon, part of the Disabled Living charity, Manchester

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Readers' comments (5)

  • As a health visitor and an advocate for breastfeeding, sometimes this information needs to be available. What about children that have been adopted and also where the mother has died in labour (I know of a few cases) then aren't these individuals entitled to know what is available? I dislike the advertising on tv for formula (they drive me mad!) I thought that they were supposed to be being banned!! At least then parents can access information that will enable them to make an informed decision regarding which formula is for their child. I think a number of GP's need updating on this matter aswell as there are a few out there who still think soya is a solution at the drop of a hat, and tell parents to water down feeds!! mis-information does not just come from nurses

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  • As a mother who has bottle fed all 3 of my kids purely through personal choice i would welcome a more open and supportive attitude from all healthcare professionals on this subject. I am sick of the demonisation of formula feeding. Asking for help or information about the different formulas is often met with a sniffy refusal.

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  • As a nurse advisor for the NHS Direct I am shocked the number of calls received from parents of babies as young as a few days old requesting information about constipation. What is more shocking are the number of babies being prescribed laxatives by GPs. Unfortunately Health Visitors seem to be altogether absent or unable to provide appropriate support. Like June Rogers I was trained as a midwife and Health Visitor in the dark days when we had knowledge about breast feeding and formula feeds. I say role back the carpet and bring back the old fashioned training for all nurses, midwives and Health Visitors.

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  • Every mother has the right to choose and be given support to make the choice that is right for her.

    Although an advocate of breast feeding, I will not judge anyone who chooses a different method.

    Information, choice and a non-judgemental approach would be welcomed by many I am sure.

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  • I agree with you as an health visitor, breast feeding should be a choice and bottle feeding as well , mothers need health professioners who are there for them at the point of their need often by the time we get to see them mothers are at their tetters and would go for their most covenient options and as we are now no that common sense this days have been thrown out of the window, I will be starting my private HV service to give parents more choices and a personalised service regards thei infants nutrition, we can no longer depend on the government's draconian rule. Independent nurses and self employed nurses keep the flag flying . Florence Nightingale started as an independent entrepreneur why should nurses of today be so depedent to be dragged left right and centre by so called draconian employers at the setriments of our patients.

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