Baby Care: Glimpses from my book

Artificial Feeding: An Indian Perspective

In the seventies and eighties, bottle – feeding finally became a fashion, and even healthy mothers with adequate breast milk began to “take” to it in an attempt to look “modern”. U.S.A., Britain, Australia, and many other developed countries “switched” from breast to bottle. Female emancipation ruled the day, and the babies were damned to artificial nourishment, often at the hands of a maid or some other care - taker. The winds of change arrived at the shores of developing nations such as ours, and urban mothers began to emulate their counterparts in affluent countries. Soon, disaster struck, as child after child fell ill with pneumonia, otitis media, diarrhoea, dental caries, malnutrition, and so on. Bottle feeding, a method designed to free women from the yoke of breast feeding, was now a curse, as it took lives of innocent children.

Times have changed. The wheel has turned a full circle. Doctors are extolling the virtues of the breast as never before. As more and more research findings are uncovered, it is becoming clear that breast milk is a miracle feed, and nothing else can come even close to it.

And yet, we see many mothers beginning a bottle feed on their babies for no more a reason than that “we are doing it only so that the baby does not go hungry”. This is an appalling state of affairs. No reasons, save the direst ones, can actually justify the penchant of some mothers to introduce a feeding bottle in their babies.

The Need for Artificial Feeding:

As we have seen in Chapter 7, almost all mothers can raise their babies exclusively on breast milk for the first six months. There are, however, cases where the mother or care – taker has to start the baby on top feeds, that is, milk other than breast milk. This may mean introducing dairy milks available in plastic pouches or Tetra packs ®, loose milk sold by milk sellers and powdered formula made for babies.

These are the various reasons where such feeds need to be given:

1. Where the mother is seriously ill
2. Where the mother really has insufficient milk
3. Where the mother is on anti – cancer medicines or she has AIDS
4. Where there are social constraints to successful breast feeding
5. Where the mother has borne twins, triplets or more babies
6. Where breast feeding has been stopped because of breast abscesses on both sides
7. Where the mother has to go to work and crèche facilities are available
8. For a baby whose mother dies

Which Milk to give?

As explained above, any milk that is readily available and economically affordable may be used. Most mothers have a false notion that “outside” milk needs to be diluted before giving to the baby, as otherwise, the baby is liable to be constipated, or have colic. Nothing can be more wrong.

The milk of cows, buffaloes, goats or (as in desert areas) even camels can be used. The milk so procured must be boiled first. At least two teaspoons of sugar should be added per 250 ml of the milk. The milk must then be allowed to cool to room temperature. Then, if possible, it should be transferred to the refrigerator and allowed to stay inside for at least 4 hours. The milk is now suitable for giving to the baby without further dilution. This process is also called humanising animal milk, because with these steps, the composition of the milk loosely resembles that of human breast milk.

If formula milk is used, the instructions on the container should be followed to get liquid milk of the right composition. Generally, one flat measuring spoon obtained from the container is added to about 30 ml of pre – boiled warm water.

The milk obtained from cows and buffaloes is a little different from human breast milk. The former contains more cream, less sugars and a different, more difficult to digest protein (casein) as compared to human milk which is a bit thinner, has less cream, is sweeter and has an easy to digest protein (lactalbumin). Hence, some authorities recommend adding water to animal milk in the first few months; however, I feel that is unnecessary once you have humanised the milk.

How much milk to give?

In contrast to a baby that breast feeds naturally, the top fed baby’s needs need to be worked out so that the baby does not end up being under – fed or over – fed. Generally, in the first month, the baby will consume 30 – 45 ml of milk at each feed; thereafter, the quantity can be increased by 30 ml per feed each month. In this manner, the baby should be drinking 150 – 180 ml per feed by six months. Around this time, one can begin to introduce complementary feeds (see Chapter 9). The frequency of top feeding will then begin to decline. By nine to twelve months of age, the baby should be taking 3 – 4feeds of 210 – 240 ml or so. In addition, she would be eating most home foods.

Some babies drink more and some drink less milk. If the baby’s weight gain is all right, one shouldn’t worry about absolute quantities of milk intake. If you have offered, say, 150 ml of milk at one time, and the baby stops drinking milk and leaves a small quantity behind, do not worry. Either discard that milk, or have another family member drink it up. The fact that the baby stopped on her own is sufficient evidence that she has got enough in that feed.

What method to use?

The traditional way to give top milk is by using a cup and a spoon. This method is also less cumbersome, more hygienic and less time consuming. The plus points of this method also include a fairly easy process of just washing the steel or glass utensils in detergent and water. There is no need to sterilise by boiling or pressure cooking them. The minus point of this method is that a very hungry baby sometimes gets so frustrated awaiting the next spoon that she begins to cry, or to fret so much that the milk gets spilt from the spoon. This is a real drawback, no doubt, but it can be easily eliminated if you begin the feed before the baby begins to wail for the milk. Catch her when she is just waking up for the feed, and you will find that she will take spoon feeds without much ado. It also helps if you immobilise the baby by holding her arms with your free hand and “gripping” her legs between your crossed legs. The other minus point is that one cannot spoon feed the baby while travelling in a bus, or while being outdoors, say, on a picnic. It is true that this does become an inconvenience, but if you plan your outings properly, you should be able to get around the problem quite nicely. If the baby is suckling at your breast, you can discreetly feed her on the breast when outside; if not, you can offer her a glucose biscuit dipped in warm water to tide the crisis. If absolutely necessary, you might want to keep a feeding bottle with you for emergency use.

Another way to deal with the first minus point above is to use a bondla or a palada. This is a diyaa shaped stainless steel spoon with a long snout. It can hold 10 or 15 ml of milk depending upon its size. If your baby gets too fretful with a normal spoon, then this is the right method for her. You can trickle the milk down her throat by gently pouring it down the snout between the gums and the cheeks. She will sense “satisfaction” as there is a lot more milk for her to swallow as compared to the 3 – 5 ml available in the spoon. You can get this very useful “device” from any utensil vendor!

The third, and by far the most “popular” method of feeding among parents is bottle feeding. I say popular because in spite of the repeated admonitions by health care workers, nurses, doctors, pediatricians etc to NOT use it, it continues to be used by parents from all socio – economic strata.

We do not advocate bottle feeding at all because it brings with it a whole lot of problems. Some of these problems are listed in the next section. In spite of this, if one wants to use a feeding bottle, I can only pray that the baby is not the victim of her mother’s folly (or the father’s or the grandmother’s … it does not matter).

Technique: The bottle should first be filled with pre – boiled warm water up to the needed mark on it. Next, milk powder should be added to it. The bottle top should be closed by using the flat lid provided with the bottle, and the contents shaken till the powder dissolves in the liquid. Check the flow of the milk through the teat. There should be an initial stream of milk, after which, milk should flow in drops and NOT as a stream. Allow some drops to fall on the back of your hand so that you can check the temperature of the milk. If it’s too hot, or cool to the touch, modify this by waiting/heating for some time. Next, you can feed the baby. Tilt the bottle sufficiently so that the teat remains full of milk at all times, and there is no danger of swallowing air. You should pay full attention, always keeping the baby’s head high, checking the milk flow intermittently, till the milk is over, or till the baby leaves the teat.

Remember to never “prop up” the bottle on pillows and leave the baby to suck on her own from it. The risks include the risk of the baby swallowing a lot of air and the possibility of the milk being aspirated into the baby’s lungs (choking).


Disadvantages of bottle feeding:

1. If proper hygienic precautions are not taken, bottle feeding can lead to all sorts of infections. Diarrhoea, vomiting and dysentery are the consequences of G.I. infection. They occur because of inadequate sterilisation of the bottles and teats. Many a times, such infection can lead to hospitalization or even death.

2. The Eustachian tube connects the back portion of the mouth to the middle ear, and its function is to help hearing. It also equalises the pressure of air on both sides of the delicate ear drum. A small lump of tonsil surrounds its internal opening. When you bottle feed the baby, the thin jet of milk hits this tonsillar tissue and effectively causes germs to grow on it. Over time, the tonsillar tissue grows in size and blocks the opening of the Eustachian tube. The result is accumulation of fluid and pus in the middle ear, and eventual perforation of the ear drum. (Perforation = hole). This can lead to permanent hearing loss in the affected ear.

3. Sometimes, the angle of the bottle is not sufficient to guide the remaining milk into the baby’s mouth. Air is then swallowed by the baby. This causes stomach discomfort, leading to crying, leading to further aerophagia (swallowing air). Bottle – fed babies are therefore more fretful and irritable in the first three months of life, as they have more gas problems.

4. Bottle – feeding is very easy as compared to breast feeding. While the latter is an active process in which the baby has to “draw” the milk out of her mother’s breast (s), the former is an entirely passive process, in which the baby doesn’t have to “do” anything; she merely has to keep her jaws open, and the milk will flow inwards automatically.

As a result of this basic ease of feeding at the bottle, the baby slowly starts preferring the bottle to her mother’s breast. She feeds less frequently there, and when she does, she stays on the breast for a shorter time. When a top feed is given, she takes it more energetically each time; as a consequence of this, the breast milk goes on decreasing, and eventually, the breasts dry up.

Once the bottle is introduced, sooner or later, the breasts will dry up. This is the most unfortunate outcome of bottle feeding. The baby stops getting all the known and unknown benefits of breast feeding, and is liable to fall ill more often because of this.

5. Bottle – feeding becomes a hard to leave habit over a period of one year. Infants who are still feeding at the bottle at two, or even three, years are not so rare to see. They will demand their bottle at any odd hours of the day or night. They are stubborn, irritable and more often than not, fat for their age. They will take the bottle with them all over the neighbourhood. They will drop the bottle on the ground, then pick it up from the filth, and promptly put it back in their mouths.

6. Since bottle feeding is a passive act, (see above) there is a very good chance that the baby will completely empty the bottle at each feed even though she is not that hungry. This risk of overfeeding is real, and may lead to obesity in the child.

7. Babies love to feed at the bottle. As a result, many babies will ignore weaning foods presented to them. The mother gets confused as to why the baby will not eat such an attractively given plate of rice, or cream biscuit or the like. Some mothers get so frustrated about this, that they start force – feeding the baby. The result: irritability in the baby, torture to the mother, and often vomiting by the baby.

8. Sterilisation of feeding bottles and teats is a cumbersome process. The water must first reach boiling point, then the cleaned and scrubbed bottles are put inside it; the water is allowed to boil further; then the cleaned nipples are added to the boiling water. The gas is switched off after two minutes.

As can be seen from the foregoing list, the problems of bottle – feeding do not begin and end at infection alone.

Further tips on cleaning and hygiene of bottles:

It is better to purchase 3 – 4 sets of bottles and teats. Sterilise them together by putting them all in a big container filled with water and boil the lot for at least ten minutes. As an option, the bottles may be put in first, and the teats may be added after 5 – 8 minutes.

In a method known as terminal sterilisation, the bottles are all filled with the requisite amount of milk, and then capped with inverted nipples mounted under the flat covers. These are then kept upright in a large pressure cooker, and pressure cooked for 8 – 10 minutes. After some time, the cooker lid is opened and the pre – sterilised feeds are stored in the refrigerator. They can be removed about half an hour before the anticipated time for the baby’s next feed. When the baby demands the feed, the cap is opened, the nipple is “righted” and the baby is given a completely hygienic feed.

Remember that hand washing has no substitute. It should be done rigorously before preparing any artificial feed for the baby. The inner areas of the wrists, the back of the hands, the hollow of the palm and the grooves between the fingers should receive a little extra scrubbing.

On no account should the “balance” milk in the feeding bottle be kept for the baby’s next feed; it should always be either discarded or taken by an adult member.

Those who have scarcity of gas for boiling and cooking can keep the cleaned bottles and teats in Milton’s sodium hypochlorite solution for at least three to four hours. This is adequate to sterilise the equipment, but after this the bottles and teats must be washed with hot water before milk is filled inside them.

The important task of sterilising the bottles etc. must never be left for the maid to perform. You should do them on your own.

(End)



- ##Dr.Taher##



Check out:

"Medical Matters: Pediatrics and Other" 
"Invalid Item" 
"Child's Lament" 

I do not suffer from insanity. I positively enjoy every moment living it!