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human breastmilk (60:40), which makes these formulae generally easier to digest, especially for new- born babies.
Hungry milks have a higher percentage of casein than standard first milk. Casein takes longer to digest so it can help babies feel fuller for longer. These milks are used to help to delay the onset of early weaning.
Bottles should be made up with water at 70oC, or about 30mins after a kettle has been boiled. The exact number of level scoops should be used according to the manufacturer’s instructions, and the feed used within two hours. If this is not practical, a number of bottles may be made up at one time and cooled down by holding it under a running tap and stored in the fridge at 5o
C. These can be
heated in warm water directly before use (never in a microwave), and used within 24 hours.
of the nipple should be near the back of the mouth for comfortable feeding. If there is no infection, an effective treatment is some breastmilk applied at the end of a feed. If there is any discharge, referral is necessary. If bacterial infection is suspected, fusidic acid 2% cream may be prescribed for use after every breastfeed for 5-7 days, and if there is a localised fungal infection, miconazole 2% cream applied after every breastfeed for 2 weeks.
Mastitis This is characterised by a red, hot swollen area usually on one breast only, often with a burning pain, especially during feeding. Unlike a blocked duct however, there are flu- like symptoms such as increased temperature and muscle aches and pains. It can come on very quickly and may be mistaken for flu. GP referral is important, as mastitis with systemic treatment requires antibiotic treatment with Flucloxacillin 500mg qid, or if penicillin allergic, erythromycin 250-500mg qid, both x 10-14 days. Ibuprofen can help, and may be prescribed, but is not licensed for OTC sale during breastfeeding. Paracetamol may be sold and will provide some relief. A hot compress will also help by encouraging milk to flow.
Thrush This may follow a course of antibiotics for either mother or baby. There is severe pain, often described as shooting or stabbing, to the point where latching on is almost unbearable. Nipples may be white after feeding and if cracked, will not heal. Without prompt diagnosis and treatment this is a condition that will almost certainly lead to premature cessation of breastfeeding due to severe pain. Mother and baby need treated simultaneously, with oral fluconazole 300mg stat and 50-100mg daily for 10-14 days for the mother, and nystatin or miconazole oral gel (if over 3 months) for the baby.
Support A useful place to signpost mums to is
breastfeeding.org, a local NI-based website. Mother and baby groups and even online forums can provide much-needed peer support for a new mum. ‘Breastfeeding in Northern Ireland’ is a very large and active local Facebook group which may also be helpful. In the pharmacy, stocking breast pads and pumps may make breastfeeding mums feel more welcome and perhaps more likely to ask for advice if they are having difficulties.
Formula feeding Bottle feeding is currently the most common method of infant feeding in NI.
Formula milks are mostly based on modified cow’s milk (although some are based on soya, or goat’s milk), with additives e.g. vegetable oils, vitamins, minerals and fatty acids. The macronutrient content (fats, carbohydrates and energy) and micronutrients (vitamins, minerals) are specified in current legislation, with a new requirement due to come into force in Feb 2020 which says that the long chain polyunsaturated fatty acid DHA (omega-3) must also be added. Most manufacturers have already implemented this.
The two main types of protein in breastmilk are whey and casein. Whey is more easily digested and is the type of protein contained in the liquid part of milk when it curdles. 60% of breastmilk protein is made up of whey protein. Casein is the type of protein in the solid part of curdled milk and makes up the remaining 40% of breastmilk. Casein protein remain in the stomach for longer, and hence are slower to digest. Cow’s milk is 80% casein and 20% whey. The whey: casein ratio in ‘first’ infant milks is more closely aligned to that of
See packs for preparation instructions as some product instructions may vary.
Follow-on milks The main difference between follow- on milks and first infant / hungry milks is that they have a higher iron content. Babies are born with a natural store of iron which begins to deplete around 6 months. As babies are usually beginning to wean at 6 months there are only taking very small amounts of food and may not be eating enough iron rich food at this stage. Parents can choose to move to a follow-on milk at 6 months which contains higher levels of iron that standard first milks.
These milks are for babies over 6 months, and as such they may be advertised direct to the public. UK law prohibits the advertising of milks intended for babies under 6 months directly to the public, and so they cannot be the subject of any promotional offer such as multibuys, money-off coupons or any sort of discount.
Cow’s Milk Protein Allergy
(CMPA) Cow’s milk protein allergy affects approx. 2-7.5% of babies2
, although
NICE states that up to 15% show symptoms of an adverse reaction to it.
> PHARMACY IN FOCUS - 23
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