Artificial feeding-
The WHO International Code of Marketing of breastmilk
Substitutes-
The WHO International Code of Marketing of breastmilk
Substitutes was adopted by the World Health Assembly
and UNICEF in 1981. The International Code was written in
response to the aggressive marketing activities of a
number of companies, which efforts in terms of
advertising, provision of free samples to mothers and
hospitals, were undermining breastfeeding women.
The Code is a marketing code that aims to protect
breastfeeding, to protect all mothers and babies (whether
breastfeeding, formula-feeding or combination feeding)
and to prevent aggressive marketing practices that often
prevent mothers from meeting their own breastfeeding
goals.
UK Infant Formula and Follow-on Formula Regulations-
Representatives from the UK involved in the formulation of
the WHO Code, at the World Health Assembly in 1991
voted to adopt the Code. Despite this, the UK Laws
implemented in 1995, incorporated some but not all of the
code. One main difference is echoed in the title of the
regulation; Infant Formula and Follow-on Formula, hence
the law is specific to these breastmilk substitutes only.
Advertising of formula is mainly restricted to those milk
feed to infants from birth to 12 months.
The following table illustrates the differences between the
WHO Code and the UK Law.
The main issue with the UK law, is it allows the advertising
of Follow -on formula and advertising of formula through
the health care system. Continuing to allow the formula
companies to advertise their Follow-on formula milks, have
given them the opportunity to exploit the law, by
advertising both their infant and follow-on formula through
Brand placement of their follow-on formula. The WHO and
the Government Scientific Advisory Committee on Nutrition
(SACN) state that Follow-on formula has NO nutritional
advantage over standard first infant formula milks. Follow-
on milks are promoted in a way that makes them difficult to
distinguish from normal infant formula. Many parents are
often under the impression they have seen advertisements
of infant formula, despite the adverts only feature follow-on
milk. Hence, loopholes appear; these include:
Loophole 1: Promoting follow-on milks in a way that makes
them difficult to distinguish from normal infant formula.
Loophole 2: Deliberately confusing
the company name and logo with
the formula milk brand name. Companies can advertise their
product range through the promotion of “Care lines” &
brand loyalties through the promotion of " Mums Cubs".
Groups-
Two influential groups Baby Milk Action and The Baby
Feeding Law Group work actively to stop misleading
marketing by the baby feeding industry.
 The Baby Feeding Law Group UK was founded by
Baby Milk Action in 1997 and has been working for
over 20 years to strengthen UK baby feeding laws
in line with UN recommendations
 Baby Milk Action, as part of a global network, acts
to stop misleading marketing by the baby feeding
industry. We protect breastfeeding and babies fed
on formula to prevent unnecessary death and
suffering.
 Baby Milk Action is not anti-baby milk. Our work
protects all mothers and infants from irresponsible
marketing. Formed in 1979.
NHS Guide to bottle feeding-
A step-by-step guide to preparing a powdered formula feed
1. Fill the kettle with at least 1 litre of fresh tap water from
the cold tap (don’t use water that has been boiled before).
2. Boil the water. Then leave the water to cool in the kettle
for no more than 30 minutes so that it remains at a
temperature of at least 70°C.
3. Clean and disinfect the surface you are going to use.
4. It’s really important that you WASH YOUR HANDS.
5. If you are using a cold-water steriliser, shake off any
excess solution from the bottle and the teat, or rinse the
bottle with cooled boiled water from the kettle (not the
tap).
6. Stand the bottle on a clean surface.
7. Keep the teat and cap on the upturned lid of the steriliser.
Avoid putting them on the work surface.
8. Follow the manufacturer’s instructions and pour the
correct amount of water into the bottle. Double check that
the water level is correct.
9. Loosely fill the scoop with formula – according to the
manufacturer’s instructions – and level it off using either the
flat edge of a clean, dry knife or the leveller provided.
Artificial feeding-
10. Holding the edge of the teat, put it on the bottle. Then screw
the retaining ring onto the bottle.
11. Cover the teat with the cap and shake the bottle until the
powder is dissolved.
12. It is important to cool the formula so it is not too hot to drink.
Do this by holding the bottom half of the bottle under cold running
water. Move the bottle about under the tap to ensure even
cooling. Make sure that the water does not touch the cap covering
the teat.
13. Test the temperature of the infant formula on the inside of
your wrist before giving it to your baby. It should be body
temperature, which means it should feel warm or cool, but not
hot.
14. If there is any made-up infant formula left after a feed, throw it
away.
https://www.unicef.org.uk/babyfriendly/wp-
content/uploads/sites/2/2008/02/start4life_guide_to_bottle_-
feeding.pdf
Responsive bottle feeding
https://www.unicef.org.uk/babyfriendly/wp-
content/uploads/sites/2/2019/04/Infant-formula-and-responsive-
bottle-feeding.pdf
1. Feed your baby when they show signs of being hungry:
look out for cues (moving head and mouth around,
sucking on fingers). Crying is the last sign of wanting to
feed, so try and feed your baby before they cry.
2. Hold baby close in a semi-upright position so you can see
their face and reassure them by looking into their eyes
and talking to them during the feed. Try and alternate the
side you hold baby.
3. Begin by inviting baby to open their mouth: softly rub the
teat against their top lip. Gently insert the teat into baby’s
mouth, keeping the bottle in a horizontal position (just
slightly tipped) to prevent milk from flowing too fast.
4. Watch your baby and follow the cues for when they need
a break; these signs will be different from one baby to the
next, they may splay their fingers and toes, spill milk out
of their mouth, stop sucking, turn their head away or push
the bottle away. Gently remove the teat or bring the
bottle downwards to cut off the flow of milk.
5. Your baby will know how much milk they need. Forcing
your baby to finish a feed will be distressing, and can
mean your baby is overfed.
6. What infant formula should I use? It doesn’t matter which
brand you use; they are all very similar. It doesn’t matter
if you choose cows’ or goats’ milk-based formula, but talk
to your midwife or health visitor before choosing a soya-
based formula
7. What about all the other milks that claim to help hungry
babies, prevent colic, wind, reflux or allergies? There is no
evidence that most of these “special” milks do any good,
and they might not be safe for your baby. Ask your
midwife or health visitor if you think your baby might
need a different milk.
8. Should I move on to follow-on formula when my baby is
six months old? There is no need for follow-on formula.
Stick to a first infant formula throughout the first year.
9. How long do I need to use infant formula for? When your
baby is one year old, they will be getting more of their
energy, vitamins and minerals from food, and full fat
cows’ milk can be their main milk drink. If you have any
concerns, or want to know about other milks, ask your
health visitor.
UNICEF BFI Bottle-feeding Assessment Tool-
How parents and midwives/health visitors can
recognise that bottle feeding is going well:
What to look for/ask about:
General health and wellbeing of the baby:
 Around six heavy, wet nappies a day by day
five
 At least one soft stool a day
 Appropriate weight gain/growth
 Is generally calm and relaxed when feeding and
is content after most feeds
 Has a normal skin colour and is alert and
waking for feeds?
Feed preparation:
 Equipment washed and sterilised appropriately
 Parents know how to make up feeds as per
manufacturer’s guidelines
Responsive bottle feeding:
 Parents are giving most of the feeds and
limiting the number of caregivers
 Parents recognise early feeding cues
 Parents hold their baby close and semi-upright
and maintain eye contact
Pacing the feed:
 Bottle held horizontally allowing just enough
milk to cover the teat
 Baby invited to take the teat
 Baby observed for signs of needing a break and
teat removed or bottle lowered to cut off flow
Finishing the feed:
 Parents recognise signs when baby has had
enough milk (turning away, splaying hands,
spitting out milk)
 Baby not encouraged to finish a feed
inappropriately
Expressed breastmilk:
 Mother is expressing her breastmilk effectively
and storing it safely
 Mother is maximising her breastmilk if that is
her goal
Infant formula:
 First stage milk is used
 Leftover milk is discarded after two hours
https://www.unicef.org.uk/babyfriendly/wp-
content/uploads/sites/2/2020/04/Unicef-UK-Baby-
Friendly-Initiative-Bottle-Feeding-Assessment-Tool-
1.pdf