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Blog Archive

Safe Preparation and Storage of Breast Milk Substitutes

June 2020

Guideline 5.3 of The Baby-Friendly Hospital Initiative Interim Guidelines and Evaluation Criteria for Facilities Seeking and Sustaining Baby-Friendly Designation (2019) states “Mothers who feed formula should receive written instruction, not specific to a particular brand, and verbal information about safe preparation, handling, storage, and feeding of infant formula.  Staff should document completion of formula preparation instruction and safe feeding in the medical record.  This information should be given on an individual basis only to women who are feeding formula or mixed feeding their infants,” (1).

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These are the teachings to include:

  • Appropriate hand hygiene
  • Cleaning infant feeding items (bottles, nipples, rings, caps, syringes, cups, spoons, etc.)
  • Cleaning workspace surfaces
  • Appropriate and safe reconstitution of concentrated and powdered infant formulas
  • Accuracy of measurement of ingredients
  • Safe handling of formula
  • Proper storage of formula
  • Appropriate feeding methods which may include feeding on cue, frequent low volume feeds, paced bottle techniques, eye-to-eye contact, and holding the infant closely
  • A reminder that powdered infant formula is not sterile and may contain pathogens that can cause serious illness in infants younger than 3 months

One US-based hospital developed their own teaching kit for this step, contained in a portable plastic file box. Inside were cans of concentrate and powdered infant formulas with all brand names hidden; measuring cups; bottle and nipple/teat; disinfectant wipes; WHO handouts on safe preparation and storage of formula; handouts on infant cues for hunger and satiety; handouts on paced bottle feeding; handouts on safe and comfortable milk suppression; a model breast for teaching hand expression (to avoid engorgement); a teaching script; and contact information for the IBCLCs at the hospital and in the local community. This teaching box was taken to the room of any family that made an informed decision to feed formula for any reason, and the script with a demonstration of each step was covered with every family member who might be preparing infant feeds or bottle-feeding the infant. All staff members were instructed on the use of this teaching box and were able to provide instructions to such families on a one-to-one basis as needed, avoiding the undue necessity for the IBCLC to provide all the teaching.

How does your facility teach Step 5.3? Did you develop a teaching kit of your own? Let me know your unique ideas for teaching by emailing me at the address below. 

Stay safe and keep up the great work toward your BFHI designation.


Kathy Parkes, MSN-Ed, RN, IBCLC, FILCA CHC

Professional Development Educator

This email address is being protected from spambots. You need JavaScript enabled to view it.




1. Baby-friendly USA. (2019). Interim guidelines and evaluation criteria for facilities seeking and sustaining Baby-Friendly Designation. Albany, NY: Baby-Friendly USA.


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