Performance Checklist for bottle feeding

Student Name:……………………….. Group No……………

Done Not Done Comment

Items done incompletely
Assessment
1 Assess need for feeding, infant’s condition. check vital
signs.
2 Check doctor’s orders and any precautions.
3 Check infant’s identification.
Planning
4 Gather the equipments (graded feeding bottle, nipple,
bottle caps , kettle , large pan , small pan , measuring cup
, measuring spoon , bib , tissue , cloth , sterile formula &
funnel).
5 Wash all equipment in soapy warm water then rinse in
clean running water.
6 Test the nipple hole (not too wide or blocked).
7 Remove the sterilized feeding devices from the sterilizer
8 Clean the work surface where you are going to prepare
feeds with a damp clean cloth and then dry it with a
hygienic paper towel.
9 Wash hands thoroughly with soap and water and dry
with a clean cloth.
Implementation
10 Place the empty bottle on a flat clean surface.
11 Pour the needed amount of hot water of no less than 70ºC
12 Measure the required amount of powder milk by the
measuring spoon and level it with the sterilized straight –
edged back of the plastic knife then Add it to the warm
water.
13 Attach the bottle, the teat and the cap, and then shake the
bottle until the powder is dissolved.
14 Place the bottom half of the bottle under running water
to cool down the milk to a temperature suitable for
feeding.
15 check the temperature of formula by testing it on inner
aspect of the wrist.
16 Put a towel or tissue under infant's chin.
17 Hold infant's head up and support him in semi setting
position.
18 Tilt bottle to keep the nipple full at all time to prevent air
entry.
19 Stimulate rooting reflex by rubbing nipple along lower
lip or cheek. Place nipple on top of tongue.
20 In the middle of feeding hold the child to burp (at least
once during the feeding).
21 Continue the feeding and make infant burp when
finished.
22 cover your finger with gauze pad and gently wipe the
baby's teeth and/or gums (with sterile water/NS)
23 Put the infant on right side or on prone position with
head on side.
24 Discard any remaining milk in the bottle after feeding.
25 Wash the bottle and nipple thoroughly with soap and
water, rinse well.
26 Remove the equipment.
27 Wash your hands.
Evaluation
28 Document feeding time and amount consumed on the
Daily Infant Activity Record.
29 Record and report any problems or abnormality.
Total Score

Demonstrator signature ………………… Student signature………….