Infant Feeding Policies and Practices

POLICY: Infants less than 1 year of age will be fed either human milk or a commercial, iron-fortified, infant formula as their primary source of nutrition while in childcare. 

Human milk and formula will be stored, prepared, and served safely.

PURPOSE: To ensure safe and nutritious feeding of all infants for optimal growth and development. Improper or inadequate feeding during this vulnerable age can harm an infant’s health and brain development. 

PROCEDURE:

1. Infants will be bottle fed human milk or formula at least every 4 hours or more frequently anytime they are showing hunger cues or as written in the plan.
2. Infants shall always be held when fed a bottle.  At no time will a child have a propped bottle, walk with a bottle, nor be put to bed with a bottle.
3. Solid foods shall always be fed with the infant sitting upright in a high-chair or seated at a table.
4. Bottles shall never be microwaved for warming, neither human milk nor formula.
5. Place the bottle in hot water to warm up or use a bottle warmer device.
   1. Human milk should never be shaken, instead, swirl the bottle to mix it.  Shaking human milk can destroy the living white blood cells and immunological components of human milk. 
   2. Formula is okay to shake. In fact, shaking powdered formula helps it to mix better with the water.
   3. Test the temperature with a few drops on your wrist. 
   4. Both human milk and formula can be served cold, room temperature, or warm. 
6. For infants who spit up often after bottle-feeding:
   1. Try keeping them in an upright position for about 20 minutes after feeding. Avoid laying them flat or doing tummy time immediately after a bottle (sleeping infants will still need to be laid down flat). 
   2. Practice “responsive feeding” to reduce spit up (see L-12 and L-13)
   3. Minimize swallowing air in the bottle. Remember to burp the infant.
   4. If spit up is significant and frequent, the parent/legal guardian should be notified and advised to see their health care provider. 

BREASTMILK/HUMAN MILK FEEDING

1. See section L-10 for important detailed information.
2. All human milk shall be labeled with the child’s name and the date it was pumped.
3. Freshly pumped human milk can be stored:
   1. At room temperature for 4 hours (if pumped fresh that morning)
   2. In a cooler bag with ice packs for 24 hours
   3. In the refrigerator for up to 4 days
   4. In the freezer for up to 1 year
4. Thawed human milk that was previously frozen can be stored:
   1. At room temperature for 2 hours once thawed
   2. In the refrigerator for 24 hours once thawed
   3. Can be thawed in the fridge or by placing the bag/bottle in hot water
   4. Thawed milk should never be re-frozen
5. If an infant has drank out of a bottle but does not finish it, the milk must be thrown out after 2 hours (versus 1 hour for formula) 

FORMULA FEEDING

1. See section L11 for important detailed information.
2. The center shall provide only commercially prepared formulas or accept commercially prepared formulas. Homemade formulas shall not be made and shall not be accepted.
3. Formulas shall be stored and prepared in accordance with label directions.  
   1. For MOST formulas, this is usually 1 level scoop of powdered formula for every 2 ounces of water. For an accurate water amount, water should be poured into the bottle before the powder. Only use half scoops if the scoop has a line to indicate a half scoop. Do not eyeball/estimate half scoops.
   2. Incorrect ratios of formula powder to water can cause inadequate growth and malnutrition, dehydration, stomach discomfort, or constipation.
   3. Powdered formula can be mixed with water and stored in the fridge for up to 24 hours. 
   4. If an infant has drank out of a bottle but does not finish it, the formula must be thrown out after 1 hour (versus 2 hours for human milk).
4. Infants who are under 3 months old, were born prematurely, or who are immunocompromised may need extra safety precautions for formula preparation such as boiling water to kill bacteria that could be present in powdered formula. Powdered formula is not sterile. For more information, see: Cronobacter Infection Linked to Infant Formula - CDC
5. Healthy infants over 1 year old do not require infant formula or “toddler formula” unless prescribed by their healthcare provider. The plan for transitioning out the formula after age 1 should be discussed with the parents/legal guardian.