Artificial Feeding

Artificial Feeding:

Artificial feeding is the term used when a preparation other than human milk is used to feed a baby. Artificial feeding is frequently referred to as "bottle feeding" since it is frequently accompanied by the use of a bottle. However, a feeding can be induced artificially.

Indication:

The following are the indication of artificial feeding:

• Contraindication of breastfeeding either temporary or permanent
• Inadequate quantity of breast milk.
• Death of the mother.
• Changing lifestyle of woman or pressurized under changed socio economic conditions.

Principles of artificial feeding:

• The milk must be clean and free from organism.
• The milk should be modify to meet the infant’s requirement for growth.
• The baby is to be held in comfortable position during feeding.
• The amount should be satisfy the baby’s need without giving excessive amount of water.
• Milk should be free from microorganism, it should be easily digestible.
• The hole of the teat should be of such size so that 20-30 drops of milk may be suckled by the baby per minutes.
• Burping of the baby should be done in the middle and at the end of each feed.
• Not more than 20 minutes should be spent for each feed.
• All utensil including the bottle and teat are to be cleaned before and after each feed and to be sterilized by boiling.

Food used for artificial feeding

There is no perfect substitute for breast milk. In general, boiled diluted milk , various dried milk formulas are commonly used as artificial feeds. In some countries, goat’s milk, buffalo’s milk is used.

• Cow milk: It is impossible to change the composition of the cows milk to that of human milk, no matter how the amounts of protein, fat, carbohydrate and minerals altered.
• Qualitative changes in the constituents can be done by dilutation followed by addition- one part of milk is added to one part of milk is added to one part of water. This reduces the protein content of half white fat and sugar contents are reduced drastically. To being about readjustment, about 4% of sugar and 2% of fat are to added to diluted cow’s milk. The sugar can be added cane sugar or glucose on the proportion of a quarter of teaspoonful to each once of food. The fat is added as cream 30-60%.
• The qualitative alternation is principally directed to change in the caseinogens to make it easily digestible. Any one of the methods is employed.
  • By boiling
  • By alkalinization: adding 1gm of sodium citrate
  • By acidification: 3 ml of lactic acid is added to half liter of milk

Preparation of a feed:

Every time before feeding, a feed should be prepared. The universal formula is as follows. The amount to be fed in ounces is calculated by multiplying the infant's weight in pounds by 2, 1.5 of which should be water and the rest cow's milk. Cane sugar, one teaspoon worth, should be added. The mixture to be boiled in clean pan followed by cooling before the baby is fed.

Dried milk

A variety of dried milk is commercially available mainly in three forms:

• Full cream dried milk
• Half cream dried milk
• Humanized dried milk

Preparation: if full strength is used, one level scoop measure added to 30 ml of water gives the same composition and calorie value as that of cow’s milk. When half strength is required, one level scoop measure is to be added to 60 ml.

Container of feeding: babies may be fed either by spoon from the bowl or by feeding bottle. It is easy to clean the former. The feeding bottle and teat should be cleaned prior to and after each feeding. The rubber teat and the bottle should be boiled.

Complementary feeds

Following a breastfeed, complementary feeding are offered. This custom apparently started around the turn of the century, when it was suggested that the length of the first feeding be severely limited and that the infant be given additional cow's milk feeds until his or her ability to breastfeed the child.

Supplementary feeds

In place of a breastfeed, supplementary feeds are administered. Because each breastfeed the infant receives will interfere with the formation of lactation and undermine the mother's confidence, there can be no justification for their use other than in extreme situations (such as serious illness or unconsciousness).

Preparation of equipment

A mother artificially feeding her baby would need the following equipmemt:

• Fork spoon for mixing dried milk
• Knife for leveling dried milk powder
• Desert spoon for mixing evaporated milk.
• Teaspoon for sugar
• Small covered bowl for teats and bottle caps
• Bottle brush
• For boiling a saucepan between feeds.
• For sterilization by immersion a glass or plastic container, similarly with lid and of large enough size.

Strength of milk

If an emergency artificial feed has to be prepared from liquid pasteurized milk. It should be made as follows:

• 2/3 full cream milk
• 1/3 water
• 1 level teaspoon of sugar

Before adding the previously heated water and the sugar, the milk should be cooked for 2 minutes to prevent it from becoming overly concentrated. You can check the temperature of the feed by letting some milk drip into the palm of your hand. The feed should be between 36.5°C and 37.5°C. Warm but not hot should be how you sense it.

Methods of artificial feeding

Spoon feeding

Spoon feeding is one method of artificial feeding and is applied over those babies who are contraindicated fir breastfeeding and those to whom mother’s milk is insufficient. From the spoon, liquid food e.g. cow’s milk, goat’s milk, buffaloes milk, powder milk etc are given.

Equipmemts:

• Milk: expressed breast milk, cow’s, goat’s, buffaloes, powdered milk
• Spoon
• Boiled water
• Bowel or glass

Principles:

• The milk should be boiled and the temperature of the milk should be of baby’s temperature.
• The baby should be kept at proper position by elevation of head slightly to avoid chocking and milk to water into the nose or ear.
• The spoon or milk container as well as surrounding should be cleaned.
• Milk should be introduced at timely i.e. feeding interval 2-4 hours should be maintained.
• A large amount should not be given at a time because over feeding results vomiting and abdominal discomforts to the baby.

Bottle feeding

It is method of milk feeding to the baby by bottle when mother cannot fulfill the baby’s desire or get so busy.

Equipment:

• Bottle cleaned with boiled water
• Milk – expressed breast milk, cow’s, goat’s, buffalo’s or powder milk.
• Boiled milk
• Spoon
• Glass
• Measuring jug

Principles:

• The baby is to be held in comfortable position during feeding.
• The hole of the teat (nipple) should be such size so that 20-30 drops of milk may be sucked by the baby per minutes.
• Breaking the wind off the baby should be done in the middle and at the end of the feed.
• Not more than 20 minutes should be spent to each food.
• All utensils including bottle and teat are to be cleaned before and after each feeding and to be sterilized by boiling at least once daily.
• The temperature of the feed should be 36.5°C to 37.5°C and can be tested by allowing the milk to drop into the back of the hand. It should feel warm but not hot.

Tube feeding

Tube feeding is indicated when food or adequate nutrient can not be taken by mother but the GI system functions remains intact.

Equipment:

• Inserted naso gastric tube.
• Tray
• 20-50 cc syringe
• Milk
• Sterile bowl
• Measuring jug
• Gauze piece
• Towel
• Water
• EBM or formula as prescribed
• Extension tubing

Indication:

• Weak, premature
• Contraindication for breast sucking

Maintenance of tube feeding:

• Change hard plastic tubes every 3-5 days, use alternative nostrils.
• Soft tubes may remain in place for long periods, may be removed, rinsed, inspected and reinserted periodically.
• Alternate position of tube on the skin.
• Rinse the tube with sterile water or saline after intermittent feeding and modification.
• Tape all the connection of tubing separately