Best Practices For Infant/Toddler Food Formula: Preparation, Heating, And Storage

Preparation of formula for bottle feeding

Bottles of infant/toddler food formula are to be prepared and heated in a careful manner. The food is given to the toddler and infants with the aim of prevention of illness. The following steps are to be followed while preparing and heating formula for bottle feeding.

Preparation of formula for bottle feeding-

1. Wash hands with an effective disinfectant
2. Ensure that the work surfaces, feeding bottles and equipment are cleaned.
3. Follow the instructions provided by the manufacturer for the respective feeding formula.
4. Store the prepared formula in refrigerator or in frozen condition.. all bottles are to be labeled with the date of preparation of the bottle.

Heating of formula for bottle feeding-

1. Place the bottle in a big container with hot water and hold for maximum 15minutes
2. Check the temperature of the formula by enabling a drop of the formula drop onto the inside of the wrist. It must feel comfortable- neither too hot nor too cold.
3. Warm the formula once and discard unused formula.

Note: Check the date of manufacturing of the formula before preparing it. Never refreeze thawed formulation and heat bottles only once. Never allow a bottle to cool and then reheat it as germs might grow (Staying Healthy: Preventing infectious diseases in early childhood education and care services 2013).

It is considered to be the best practice to label and store bottles in a dedicated refrigerator so that one can understand the child’s name for the corresponding formulation, and the date of bottle preparation by the parent. It is to be noted that formulations prepared on a considerable earlier date might promote to growth of bacteria.

Element 2.2.1 the NQS focuses on the promotion of healthy eating, and believes in the principle that food and drinks that the service provides must be nutritious and suitable for each child being care for. The element aims to achieve good nutrition for all children as a necessity for healthy living since healthy living can allow children to take up an active role in playtime and leisure. Further, care settings and education settings must provide multiple opportunities to the children for experiencing a range of healthy foods, and learning about food choices from educators and other children (acecqa.gov.au 2017).

The National Education and Care Services Regulation’ requirements in relation to children services who provide food and beverages for children are as follows-

• The provider must safeguard that the food and beverage provided to the children is adequate in quantity and nutritious
• The provider must confirm that the food and beverage provided to the children is chosen as per the dietary requirements of individual children taking into account (i) the growth and developmental needs of a child, and (ii) religious, health and cultural requirements of a child (classic.austlii.edu.au 2017).

The Regulations requirement in relation to a weekly menu is as follows-

The approved provider must ensure that the weekly menu-

• is as per the Australian Dietary Guidelines
• is displayed at an appropriate place of the service premises that parents of the children being cared for can access
• describes the food and beverages that the service provides each day

Dietary fats provided by breast milk or infant formula are particularly important for children less than 2 years since the fat is responsible for supplying the child with energy benefits. Since the child is not able to consume large amount of food, dietary fat is crucial for the maintenance of energy and enabling proper growth. Fat encourages brain and nervous system development, and helps in wound healing (Prince et al. 2014).

Recommendations have been outlined that solids are to be introduced to children strictly after the age of four months since the immune system of the child is immature till then. Ideally, six months age is the appropriate time for introducing solids.

Heating of formula for bottle feeding

Solids are to be introduced one food at a time, and it is recommended that one should start with small portions of solids. Children are to be given a gap of several days between the introduction of new food item for the child to identify the taste and the parents to assess food sensitivity/ allergies (health.gov.au 2011).

Age	Types of food and consistency	Examples of foods that can be consumed
8-12 months	Mashed or chopped foods and finger foods (no salt, sugar, fat or other flavours added)	Breastmilk. Infant formula (if partially or no longer breast feeding). Infant cereals. Well-cooked and mashed or minced fish, minced liver and minced or finely shredded meat, chicken and egg. Variety or mashed or soft cooked vegetables, including beans lentils and broccoli. Mashed and cooked fruit. Chopped soft raw fruit such as melon and banana. Cereals such as rice, wheat, oats, bread, pasta and noddles.
12 months +	Family Foods	Breastmilk and/or plain pasteurised full cream milk. Variety of foods from all food groups, with varying textures and flavours. (Caution must be taken with hard foods, as choking is still a risk)
9-12 months	Mashed or chopped foods and finger foods (no salt, sugar, fat or other flavours added)	In addition to foods for 8 – 12 months; Cheese, custards and yoghurt.
Birth-around 6 months	Liquids	Breastmilk. Infant formula (if partially or no longer breastfeeding) (health.gov.au 2011)

Food Group Name	Food Group Description
Vegetables and legumes	Provides vitamins including C and folate.
Milk, yoghurt cheese and/or alternatives, mostly reduced fat	Provides calcium, protein, riboflavin and vitamin B12.
Lean meats and poultry, fish, eggs, tofu, nuts and seeds and legumes/beans	Provides protein, iron, zinc, niacin, and vitamin B12.
Grain foods	Provides carbohydrates, protein, fibre and a wide range of vitamins and minerals like folate, thia min, riboflavin, niacin, and iron.
Fruits	Provides vitamins, minerals, dietary fibre and carbohydrate (eatforhealth.gov.au 2015)

Educators must be actively taking up initiatives to ensure that the children meet their daily nutritional requirements. Children are to be encouraged to enjoy different variety of foods, especially vegetables and fruits. Further, it is recommended to make the children understand the importance of these foods in relation to the growth and development. Encouragement can be given by praising the children and providing positive motivation. Lastly, children are to be encouraged to enjoy their mealtimes and focus on positive aspects of the food (Mahan and Raymond 2016).

In regards to daily nutritional requirements, care should be taken to

• Ensure that the calorie intake is adequate for supporting growth and development of the child
• Ensure that food is low in saturated fat, trans fat, cholesterol and added sugar
• Select a variety of food for getting adequate carbohydrates, protein and other nutrients

Recommended Servings Per Day
Food group	4-7years
Breads and cereals	5-7
Vegetables	2
Fruit	1
Milk and dairy products	2
Lean meats, fish, poultry, nuts and legumes	½
Food Group	Food Example of Serving Size
Breads and cereals	2 slices of bread
Starchy vegetables	1 medium potato
Dark green leafy vegetable	½ cup cabbage, spinach, broccoli
Fruit	1 cup diced pieces or canned fruit
Milk and dairy products	½  cup evaporated milk
Lean meats, fish, poultry, nuts and legumes	80- 120 gm cooked fish fillet  (Foodfor health 2005)

• Adequate health and hygiene practices
• Safe practices for handling, preparing and storing food
• The service must also ensure that monitoring and surveillance systems are in place about these practices

Services must take into account the developmental growth needs of the children. A weekly menu has to be displayed at the approved service’s premises. Further, Policies and procedures about nutrition, food and beverages, and dietary requirements are to strictly regulated by the service (uws.edu.au 2012).

The two ways in which Educators can assist children to develop healthy attitudes towards food are as follows

• Children are to be provided with a positive and calm social environment during mealtimes. They are not being forced to eat any food at any given point of time.
• Opportunities are to be created to make the children learn about the nutritional foods and the optional foods. They are to be encouraged to eat new foods items through making them understand the differences in textures, tastes and colors (Marotz 2014). 

• Since Max is able to climb, the educator must ensure that he is fastened to the high chair in a safe manner. This would make sure that he is not able to reach out to anything else other than food, as he has the tendency to put everything he can reach up to in his mouth.
• Hand hygiene is to be maintained through washing hands before mealtime.  This would ensure that Max does not get infected with any germs.

Question
What foods should parents/carers pack in the lunchbox?	Fruit- it is advisable to include fresh fruits as dried fruits are sticky and high in sugar content. These can be apple, banana, and berries. Vegetable- Vegetable sticks with dips can be given, such as carrot, cucumber, cherry tomato. Milk products- Flavoured yoghurts are a healthy food option. Biscuits and cheese- Homemade versions of crackers, biscuits and non-flavoured cheese can be given Breads- bread rolls, pita bread, fruit loaf or buns, foccacias, scones, flat bread, bagels, muffins are healthy options
What foods should parents/carers not pack in the lunchbox?	Chips, cakes, pastries, chocolate, fires, canned food, pizza, white bread, candy bars, processed meat, processed cheese
What drinks should parents/carers provide for their children?	Fresh fruit juice, homemade electrolyte drinks, herbal teas, low-fat milk
How much food is adequate for parents/carers to send each day	Wholegrain cereal foods-2 serves Fruit- 1 serve Salad vegetables- 2 serves Dairy foods- 1 serve Lean meat, chicken, fish, egg- ¾ serve (healthykids.nsw.gov.au 2014)
What information is particularly important for parents to read on food labels?	Food labels outline the ingredients contained in the food, and the value of vitamins, fibre, sugar, salt, energy and protein content in it. Parents are also to read food additives present and the food allergy information provided. Further, the health claims are to be checked apart from the ‘Use by’ or ‘Best before’ dates.
Why is it important to read labels?	Reading label ensures that a child is not provided with a food that is harmful for his health. In addition, nutritional information and information about food storage instructions can be seen from the label.
What are the recommended levels for Salt, Fat, Sugar Intake?	1500 milligrams each day 500 calories each day 100 calories each day
Why is it important for parent to notify the service of any special dietary requirements relating to medical conditions?	Parents must notify about the special dietary requirement to help the educator ensure safe practices in relation to providing food to the child, and to help him develop management plans for the child’s condition. Menu planning is also easier if the parents notify the concerns (Marotz 2014).

Meal Times and Food Service	Safe Food Practices
	Hand hygiene is maintained as gloves have been worn Cooking is done with the help of utensils and not by hand
	The food is covered appropriately in order to avoid contamination Hygiene is maintained as protective equipment in the form of apron has been worn (Koletzko et al. 2015)

The responsibility for menu planning at a center lies mostly with the chef/cook. In certain cases the director or the coordinator is accountable for the menu planning. Parents seldom play a role in menu planning (heas.health.vic.gov.au 2018).

As per the clause 54 of the Children (Education and Care Services) Supplementary Provisions Regulation 2004, the center is to employ a qualified cook for preparing and providing the children with food on a daily basis. A person is qualified if he has a certificate of Australian Qualification Framework (AQF) competencies considering menu planning, nutrition, and safe food handling. The courses meeting these requirements include a Certificate III in Hospitality (Commercial Cookery) and a Statement of Attainment in NSW TAFE 3599 – Cookery in Children’s Service (det.nsw.edu.au 2015).

Meals for children with food allergies or special diets managed at a Centre through strategies implemented by the professionals in a proactive manner. Necessary information about food allergy or special diet requirements are taken from the respective parents prior to commencing with the services. The children are taught not to eat from other children’s food. The children are supported with allergies and they are only given food prepared for them distinctly. They are also educated about the food allergy they are having, and encouraged to wash hands before eating to prevent allergic reactions (ncac.acecqa.gov.au 2009).

Recommended daily nutritional requirements for children

The Meal Times policy has the objective of providing a suitable meal time environment promoting culturally suitable communication, social and self-help skills. The rationale of the policy is multifaceted. Meal times are known to offer children with the opportunity to develop their social skills and understand the art of conversation in a clam environment. In addition, mealtimes create an environment in which children can practice their self-help skills in addition to making meaningful choices. Educators have the opportunity to promote meal time behaviors that are socially acceptable through setting rules and role modeling. Further, they can model positive attitudes towards food and guide children to try out new food choices (Meal Times Routine Policy 2011). 

Educators must determine the seating arrangement for taking advantage of peer role modeling.

Children are to be arranged in small groups of 4-6 for creating an opportunity for the children to socialize and engage in effective communication with each other.

Educators must encourage children to sit in the same place so the children can be habituated to the meal time routine. Further they can develop meal time behaviours that are socially acceptable (Meal Times Routine Policy 2011). 

The four distinct forms of self-help skills are self-feeding, independent grooming, hygiene and toileting, and participating in daily chores. The children’s service can promote self-help skills in different ways. The best strategy to promote independent feeding skills is to encourage the children feeding themselves after understanding the normal developmental skills at different stages. Independent grooming can be taught by providing minimal assistance while they dress themselves. Hygiene and toileting skills can be taught by encouraging them to follow hygiene routines and use toilet independently. Participation in daily chores can be taught by teaching them activities such as cleaning plates, placing napkins and so on (Garvis and Manning 2017).

Educators and children must wash their hands before handling food, after handling food, after handling dirty napkins, after wiping nose, after coughing or sneezing, and after touching body fluids such as saliva (Staying Healthy: Preventing infectious diseases in early childhood education and care services 2013).

The minimum qualification of the person is a successful completion of Australian Qualification Framework (AQF) competencies through a registered training organization, in menu planning,   nutrition and safe food handling from an AQF hospitality or health course (nsw.edu.au 2015)).

Regular cleaning is to be undertaken in the kitchen on a daily basis and when dirt is visible. This ensures prevention of introduction of harmful and infectious agents into the food being prepared.

Assisting children in developing healthy attitudes towards food

All fresh and frozen foods are to be immediately stored safely in a freezer. Appropriate preservatives are to be used wherever necessary to avoid spoilage. Expired or spoiled food is to be removed from the freezer to avoid spoilage of other food present. Growth of mold is to be prevented in the freezer as they spoil food faster. Lastly, different forms of food, such as solids and liquids, are to be stored in different parts of the freezer (Staying Healthy: Preventing infectious diseases in early childhood education and care services 2013).

Statement
Tongs and serving spoons should always be used to serve food.	True
Food prepared but not served from the kitchen can be covered, refrigerated and served later.	True
It is safe to reheat food more than once.		False
It is OK for children to share bowls or utensils, or eat from each other’s plate or cup.		False
Leftover food served to the table or individual plates should always be thrown away.	True
High risk foods include milk, meat, fish, rice and dishes containing them.	True
Food that is leftover on a platter that has been served to the children can be covered refrigerated and served later.		False

Water is essential for life and deficiency of water intake is life-threatening. Water helps in absorption of nutrients from the food consumed and also helps in removing waste products form the body. In addition, water in the form of perspiration controls body temperature. Consumption of drinking water replaces the fluid lost from the body and in hotter parts of Australia this is of more importance as the body becomes dehydrated. Children are at more risk of suffering from dehydration. This might lead to mental tiredness and physical exhaustion (Hanna-Attisha et al. 2016).

Food Group	Day Menu	Recommended servings per day
Wholegrain cereals (includes bread, rice, pasta and noodles)	Example: Wholemeal Bread Sandwiches Served at: o Morning Tea   o Lunch   þAfternoon Tea	5-7 servings
Vegetables and legumes	Example: Bioled vegetables with mayonnaise dip Served at: o Morning Tea   o Lunch   o Afternoon Tea	2-3 serving
Fruit	Example: Fruit juice Served at: o Morning Tea   o Lunch   o Afternoon Tea	1 serving
Milk and dairy products	Example: Frozen youghurt Served at: o Morning Tea   o Lunch   o Afternoon Tea	1-2 serving
Red meats, fish, poultry, eggs, nuts and legumes	Example: Grilled fish fillet Served at: o Morning Tea   o Lunch   o Afternoon Tea	4-5 servings

Statement
Childhood Obesity is having an excessive amount of body fat.	True
Inadequate physical activity is not a contributor to obesity.		False
Family background (inherited genes) does not influence the likelihood of becoming overweight.		False
Obesity can affect a child’s emotional and social competence.	True
Obesity can have serious health consequences e.g. Diabetes; Cardiovascular disease.	True
Excess fat in children “Puppy Fat” is normal and will disappear as the child grows.	True
Limiting ‘sometimes foods’ and encouraging ‘everyday healthy foods’ is a way to prevent obesity.	True
Poor diet can lead to tooth decay, deficiencies, poor concentration and out of character behavior.	True

Religion Chosen

Cultural/Religious Food/Drink Practices

o Christianity

Food has been accepted as a valuable element of religious rituals and observance for many faiths including Christianity. The role of food in cultural practices and beliefs in religious context is multifaceted. The several faiths in Christianity include Roman Orthodox, Catholic and Protestant.  These guidelines leading food habits tend to vary among the different faiths. A section of the Christian population observes many feasts and fast during the year. Most Protestants observe Easter and Christmas as the only feast days. The ritual of communion is common among many Christians. Self-denial of food is related to spiritual discipline. Christians have the tradition of blessing any food before eating it accompanied by a mealtime prayer, and they consider them as a sign of thanking the almighty for the meal they have (Atkins and Bowler 2016).

References

acecqa.gov.au. (2017). Guide to the National Quality Standard. [online] Available at: https://files.acecqa.gov.au/files/National-Quality-Framework-Resources-Kit/NQF-Resource-03-Guide-to-NQS.pdf [Accessed 20 Feb. 2018].

Atkins, P. and Bowler, I., 2016. Food in society: economy, culture, geography. Routledge.

Classic.austlii.edu.au. (2017). Education and care services national regulations – REG 79Service providing food and beverages. [online] Available at: https://classic.austlii.edu.au/au/legis/nsw/consol_reg/eacsnr422/s79.html [Accessed 20 Feb. 2018].

Det.nsw.edu.au. (2015). Cooks in education and care services – qualifications guidelines. [online] Available at: https://www.det.nsw.edu.au/media/downloads/what-we-offer/regulation-and-accreditation/early-childhood-education-care/workforce/qualifications/cooks-qualifications-27082015.pdf [Accessed 20 Feb. 2018].

Eatforhealth.gov.au. (2015). The Five Food Groups | Eat For Health. [online] Available at: https://www.eatforhealth.gov.au/food-essentials/five-food-groups [Accessed 20 Feb. 2018].

Food for health : Dietary guidelines for Australians. (2005). Australian government: National Health and Medical Research Council.

Garvis, S. and Manning, M., 2017. An Interdisciplinary Approach to Early Childhood Education and Care: Perspectives from Australia. Taylor & Francis.

Hanna-Attisha, M., LaChance, J., Sadler, R.C. and Champney Schnepp, A., 2016. Elevated blood lead levels in children associated with the Flint drinking water crisis: a spatial analysis of risk and public health response. American journal of public health, 106(2), pp.283-290.

Health.gov.au. (2011). Department of Health | Introducing solids. [online] Available at: https://www.health.gov.au/internet/publications/publishing.nsf/Content/gug-director-toc~gug-solids [Accessed 20 Feb. 2018].

Health.gov.au. (2011). Department of Health | Introducing solids. [online] Available at: https://www.health.gov.au/internet/publications/publishing.nsf/Content/gug-children-toc~gug-children-solids [Accessed 20 Feb. 2018].

Healthykids.nsw.gov.au. (2014). Lunchbox Checklist for Food Brought from Home for 2 to 5 year olds. [online] Available at: https://www.healthykids.nsw.gov.au/downloads/file/teacherschildcare/LunchboxChecklist2-5yroldsJan15WEB.pdf [Accessed 20 Feb. 2018].

Koletzko, B., Bhatia, J., Bhutta, Z.A., Cooper, P., Makrides, M., Uauy, R. and Wang, W. eds., 2015. Pediatric nutrition in practice. Karger Medical and Scientific Publishers.

Mahan, L.K. and Raymond, J.L., 2016. Krause’s Food & the Nutrition Care Process-E-Book. Elsevier Health Sciences.

Marotz, L.R., 2014. Health, safety, and nutrition for the young child. Nelson Education.

Meal Times Routine Policy. (2011). Blue Bay Early Learning Centre.

Ncac.acecqa.gov.au. (2009). https://ncac.acecqa.gov.au. [online] Available at: https://ncac.acecqa.gov.au/educator-resources/pcf-articles/Managing_anaphylaxis_Dec09.pdf [Accessed 20 Feb. 2018].

Prince, R.L., Kuk, J.L., Ambler, K.A., Dhaliwal, J. and Ball, G.D., 2014. Predictors of metabolically healthy obesity in children. Diabetes care, 37(5), pp.1462-1468.

Staying Healthy Preventing infectious diseases in early childhood education and care services. (2013). Australian Government: National Health and Medical Research Council.

Uws.edu.au. (2012). Nutrition/food/beverages/dietary requirements Policy. [online] Available at: https://www.uws.edu.au/__data/assets/pdf_file/0006/408129/CSS3517_UWSELL_Policies_Nutrition_food_beverages_dietary_requirements_Policy.pdf [Accessed 20 Feb. 2018].