Tube feeding - Your Child’s Tube Feeding Formula

Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

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The types of formula

Formulas can be ‘ready-to-use’ liquids or powders that you mix with water.

The type of formula prescribed for your child has been carefully chosen by your dietitian.

  • Infants (less than 12 months of age) will usually have expressed breast milk or infant formula.
  • Children (12 months and over) will usually have a formula that is designed for the needs of their age group.
  • Some children may require special formula that is only available on prescription through your doctor.

Ordering the formula 

There are many companies that make and supply formulas for infants and children.

Your dietitian will assist you by comparing providers and find the best supplier for you, considering:

  • the type of formula your child needs,
  • the cost per tin / can / pack,
  • where you live (as some formula can be home delivered), and your other needs i.e. a feeding pump.

Storing ‘ready-to-use’ liquids or powders

Unopened formula should be stored in a cool, dry place away from sunlight. As you buy new formula you should rotate your supply to ensure you are using the oldest products first.  Check expiry dates on bottles / tins / cans / packs and do not use if expired. Do not use any dented, rusted or damaged tins; contact the supplier if you receive any products that are damaged.

Tins of powdered formula should be used within one month from opening. It is recommended that you write the date you open the tin of formula on the tin, to help you know when you should discard and replace it.  Once opened, tins should be covered and stored in a cool, dry place.

Preparation of powders

Follow your Dietitian’s recipe carefully.

  1. Wash your hands thoroughly with soap before you start.
  2. Ensure the work space / bench and equipment you need is clean. This will reduce the risk of bacterial contamination.

You will need: a mixing bottle / jar for the made-up formula, fork / mixing utensil, knife / leveling devise, the powder and water (cooled boiled water for infants under 12 months of age)

  1. Carefully check the recipe provided by the dietitian. Particularly, note if you are to add the water to the powder or the powder to the water.
  2. To measure the powder, ALWAYS use the scoop that belongs to the can of formula. Fill the scoop and level it off with a knife / leveling devise, do not use the side of the can.
  3. Measure water carefully.
  4. Put the lid on and shake the bottle / mix the container well until the powder is completely dissolved.

A volume of formula can be made in advance and stored in the back refrigerator for up to 24 hours. The temperature of the refrigerator should be less than 4°C.

Preparation of liquids

  1. Check the expiry date on the bottle/can/pack. Discard if it has expired.
  2. Shake the bottle / can / pack well before opening.
  3. Wipe the tops of cans with a clean damp cloth before opening.

 After opening a can of ready-to-use formula, it should be covered, stored in the fridge and used within 24 hours.

Hang Times

Formula produced in bottles, known as ‘ready-to-hang’ or closed system (accessed by a spike set) can be hung for a maximum of 24 hours.

Formulas that are:

  • prepared from powders or
  • ready to use liquid that are then decanted into feeding containers or bags

should hang for no longer than 4 hours.

If the formula is left at room temperature for more than 4 hours, bacteria could grow and may make your child unwell.

If you need to hang formula for longer than 4 hours, seek advice from your health professional to see if you can do this safely.

Remember

  • Store and prepare your formula correctly and carefully. 
  • Ensure the work space / bench and equipment you need is clean, to reduce the risk of bacterial contamination.
  • Discard any made up / opened formula after 24 hours.  

References:

Academy of Breastfeeding Medicine Protocol Committee, 2010 ‘ABM Clinical Protocol #8: Human Milk Storage - Information for Home Use for Full-Term Infants’, Breastfeeding Medicine, Vol. 5, No. 3, pp. 127-130

American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), March/ April 2009 ‘A.S.P.E.N. Enteral Nutrition Practice Recommendations’ Journal of Parenteral and Enteral Nutrition, Vol. 33 No. 2, pp. 122-167. 

European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition, October 2004 ‘Preparation and Handling of Powdered Infant Formula: A Commentary by the ESPGHAN Committee on Nutrition’ Journal of Pediatric Gastroenterology and Nutrition. Vol. 39, pp. 320–322.

World Health Organization (WHO) 2007, Safe preparation, storage and handling of powdered infant formula guidelines, viewed 27 September 2012, http://www.who.int/foodsafety/publications/micro/pif_guidelines.pdf

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The Children's Hospital at Westmead
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Sydney Children's Hospital, Randwick
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Hunter New England Kids Health
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