Breastfed and/or infant formula fed alone

Aim

To identify patients who are receiving exclusive breastfeeding and/or infant formula, without any solid foods. No food is to be given.

Characteristics

No food offered. Fluids consist of breast milk and/or formula and may include water.

Indications

For infants under 6 months of age who have not yet started solids, or patients where solid food is contra-indicated (e.g. dysphagia). May be combined with a thickened fluid diet order.

Nutritional adequacy

Nutritionally adequate. Breast milk and/or infant formula provide complete nutrient requirements if age appropriate.

Precautions

Breastfeeding is the best source of nutrition for infants in their first year of life. WHO recommendations are for exclusive breastfeeding for 6 months and for continuation of breastfeeding until the age of 2 years or beyond. To optimise effective breastfeeding during hospital admission, an environment conducive to breastfeeding needs to be provided. Facilities for expressing and access to a lactation consultant may be of benefit.

Permission should be sought from a parent/guardian before giving infant formula, particularly for breastfed infants or infants fed expressed breast milk. Infants need to be supported while feeding and supervised at all times. Prop feeding with a bottle can contribute to choking and dental caries.

Water is not required, but if offered must be boiled and cooled. To ensure safety and hygiene, formula must be prepared using sterile/cool, boiled water and sterilised equipment and bottles in a dedicated formula preparation room if possible according to Food Safety Standards.

Requires regular monitoring to ensure solids are introduced at an appropriate time.

Infants may be given fruit puree/gel if required as a mode of administering medications as prescribed by a physician, where that medication cannot be modified or given in a liquid form.

Note: Preterm infants should not be given thickener.

Specific menu planning guidelines

	Allowed	Not allowed
Hot main dishes	None	All
Sauces, gravies	None	All
Starchy vegetables/pasta/rice	None	All
Vegetables	None	All
Soups	None	All
Sandwiches	None	All
Salads, dressings	None	All
Breads, cereals	None	All
Spreads	None	All
Hot breakfast choices	None	All
Fruit	None	All
Yoghurt	None	All
Desserts	None	All
Milk and cheese	None	All
Beverages	Breastmilk, infant formula and cooled boiled water only	All others
Biscuits	None	All
Miscellaneous	Starch based, locust bean (carob bean) gum and guar gum thickeners for thickening EBM or formula for term infants only No others	All others Xanthan gum based thickeners for thickening EBM or formula

References

1. Agency for Clinical Innovation. Nutrition standards for paediatric inpatients in NSW hospitals. Sydney 2011.
2. Agency for Clinical Innovation. Nutrition standards for adult inpatients in NSW hospitals. Sydney 2011.
3. Dietitians Association of Australia. 2009. Nutrition Manual 8th ed. Canberra: DAA.
4. American Dietetic Association. Paediatric Nutrition Care Manual. Chicago: ADA.
5. NHMRC 2003 Dietary Guidelines for Children and Adolescents in Australia.
6. WHO Guidelines for Infant Formula Preparation.
7. Sydney Children’s Hospital Network factsheets on Breastfeeding, Breastfeeding – Is it for me? and Preparation of Infant Formula
8. Australian Breastfeeding Association.
9. National Health and Medical Research Council. Infant Feeding Guidelines for Health Workers.
10. WHO/UNICEF. Protecting, Promoting and Supporting Breastfeeding: The special role of maternity services. A joint World Health Organisation/UNICEF statement. 1989. Geneva, Switzerland.
11. Shaw V and Lawson M. Clinical Paediatric Dietetics. 3rd Edition. 2007. Blackwell Publishing.
12. NSW Ministry of Health. Breastfeeding in NSW: Promotion, protection and support. 2011.
13. Abrams S.A. American Academy of Pediatrics Jun 3, 2011; DOI: 10.1542/aapnews.20110603-1. Be cautious in using thickening agents for preemies.
14. Food Standards Code FSANZ.