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Bottle feeding and giving a baby breastmilk substitutes such as infant formula or animal milk can threaten the baby's health and survival. If a woman cannot breastfeed her infant, the baby can be fed expressed breastmilk or, if necessary, a quality breastmilk substitute from an ordinary clean cup.
Babies who do not receive breastmilk do not receive protection from illnesses provided by the mother's antibodies and other components that come in her milk. These babies are more likely to get diarrhoea and respiratory and ear infections. Diarrhoea and respiratory infections, such as pneumonia, can be deadly in babies and young children.
Feeding the baby breastmilk substitutes can cause poor growth or illness if (1) too much or too little water is added, (2) the water is not from a safe source and/or (3) the bottles and teats are not cleaned properly. Powdered breastmilk substitutes may contain harmful bacteria that can cause illness. Studies suggest that children fed breastmilk substitutes, as compared to breastfed children, are at greater risk of childhood obesity and some chronic illnesses, such as heart disease, later in life.
Feeding the baby breastmilk substitutes can be expensive and particularly risky if parents cannot afford to buy enough of a quality breastmilk substitute. For example, to feed one baby for the first six months requires 20 kilograms (about 40 tins) of infant formula. Trained health workers should inform all parents considering the use of breastmilk substitutes about the costs.
If it is necessary to feed the baby with formula, it is important to boil clean drinking water first and then add the hot water to the powdered formula. The water should not be added after it has cooled down. The directions for mixing should be carefully followed. This ensures that the right amounts of formula and safe water are mixed and that the process is hygienic. Before giving the formula to the baby, the mother, father or other caregiver must make sure it is not too hot.
Animal milk and infant formula go bad if left at room temperature (around 20–25 degrees Celsius) for more than two hours. Breastmilk can be stored for up to eight hours at room temperature without going bad. Of course, it is better to safely store all types of milk in a clean, covered container, preferably in a refrigerator.
Cup feeding is safer than bottle feeding because the cup can be easily cleaned with soap and water. Cup feeding also provides some of the contact and stimulation the baby needs, since the person has to hold the baby. Feeding with a cup does not cause problems with suckling at the breast.
The best food for a baby who cannot be breastfed directly is milk expressed from the mother's breast, given from a clean, open cup. Even newborn babies can be fed with an open cup. If it is necessary to feed a baby with a nutritionally adequate breastmilk substitute, it should be fed to the baby by cup.