Formula feeding

Preterm infants have specific nutritional needs. Based on their weight and stage of development, they receive specialized formula that contains higher levels of calories, proteins, vitamins, and minerals than standard infant formula. This enriched formula is specifically designed to optimally support growth, brain development, and bone formation during the early stages of life.

Once the baby has grown sufficiently, feeding is transitioned to starter formula or first‑stage formula. This type of formula is suitable for infants up to around 6 months of age and provides a complete source of nutrients.

Preparation

1. Wash hands thoroughly beforehand.

2. Prepare each bottle only at the moment it is needed.

3. Use still mineral water that is labeled as suitable for babies. Never use unboiled tap water and avoid bottles of mineral water that have been open for more than 3 days.

4. Check the packaging to see how many scoops/ml of water are required (usually 1 scoop per 30 ml).

5. Measure the required amount of water into the feeding bottle.

6. Add the scoops of formula powder to the bottle. Fill the provided scoop completely and level it off whith the flat side of a knife.

7. Roll the bottle between the hands until the powder is fully disolved and mixed.

Warming the formula

Formula can safely be prepared and given at room temperature. If warming is preferred, several methods can be used:

Au bain marie: place the bottle in a bowl of warm water.
Bottle warmer: a safe and convenient way to warm milk evenly.

The microwave is not recommended, as it can heat the milk unevenly and create hot spots.
If the microwave is used, follow these steps:

Warm the bottle without the nipple, for only a few seconds at the lowest setting (maximum 350 W).
Roll the bottle between the hands during and after warming to distribute the heat evenly.
Place the nipple onto the bottle without touching the inside to avoid contamination.

Before feeding, always check the temperature of the milk. Test by letting a few drops fall on the inside of the wrist, the milk should feel lukewarm, not hot.

Early Feeding Skills

Early Feeding Skills a feeding scale designed to support and assess the bottle‑feeding abilities of premature babies. The aim of the EFS method is to help parents and healthcare professionals recognize the baby’s cues and adapt the feeding process to the baby’s individual needs.

One of the most important conditions when applying the EFS method is determining whether the baby is ready to be fed.

A baby who is ready to feed:

is sufficiently alert and shows a stimulated rooting reflex
maintains a flexed body posture with hands/arms toward the midline
has stable vital signs (heart rate/oxygen saturation/respiratory rate)
has adequate energy

Only when these signals are present the bottle can be offered.

* The rooting reflex can be stimulated by gently stroking the baby’s cheek or the corner of the mouth with a finger or the nipple.

The feeding process can be assessed by asking three key questions:

1. Does the baby stop sucking independently to breathe?

A premature baby is not yet capable of breathing between sucking and swallowing, which means regular pauses are necessary to allow the baby to breathe safely. Premature infants often prioritize sucking over breathing, which may lead to alarms or choking. To support safe breathing, pacing can be used. This involves tilting the bottle downward so that no milk remains in the nipple, allowing the baby to take a few final sucks before beginning to breathe. If the baby continues to suck without pausing, the bottle can be gently removed and held at the corner of the mouth to encourage a break. The duration of this breathing pause is determined by the baby. Once the baby resumes sucking, the bottle is tilted upward again so the milk flows back into the nipple.

2. Is the milk flow not too fast?

If milk spills from the baby’s mouth, if coughing occurs, or if multiple consecutive swallows appear, the milk flow is too rapid. The flow can be slowed by positioning the baby in side‑lying so the milk does not flow directly toward the throat, by holding the bottle more horizontally to reduce pressure on the nipple, or by using a low‑flow nipple that releases milk more slowly.

3. Does the baby become tired during feeding?

When fatigue sets in, muscle tone decreases and the baby’s arms may fall loosely beside the body. Adequate muscle tone is essential for safe bottle feeding, as it supports proper coordination of the upper airways. To support muscle tone and reduce energy loss, the baby can be loosely swaddled with the arms positioned toward the face, placed in a supported side‑lying position, and positioned so that the torso is well supported, for example with a breastfeeding pillow or another suitable aid. The head and torso should always remain aligned.

Bottles and nipples

There are many different types of bottles and nipples available. It is advisable to seek guidance from a nurse, midwife, lactation consultant, or speech and language therapist when choosing the most suitable option. In some situations, a low‑flow nipple may be recommended; the smaller opening ensures a slower milk flow, which supports safer and more regulated feeding.

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