PNPG POST
A publication of the Pediatric Nutrition Practice Group
Volume 20, Number 3
SPRING 2010
Featured Story
RD Coaching:
Making Big Strides with Small Steps
By Katie Brown, EdD, RD, LD
National Nutrition Education Director
RD Coach Project
American Dietitic Association Foundation
Inside...
Healthy Schools Partnership RD
Coach A Closer Look . . . . . . . . . . 3
May 2009 Board Certifications 3
“I only eat half the bag of chips now, and save the rest for later” is just one of many
small steps Kansas City, Missouri, “tweens” are taking thanks to RD Coaching. You will
not find a definition of RD Coaching in Wikipedia, but it could be described as being a
mini-counseling session with individuals or small groups of students that is fun, interactive, and performed during physical education (PE) class, while the students are being
physically active!
In 2007 the American Dietetic Association Foundation and a group of professionals
ready to think “outside the box” formed a coalition to design the blueprint for RD
Nutrition Coaches in schools. When they partnered with the American Council for
Fitness and Nutrition Foundation (ACFN) and PE4Life, the Healthy Schools
Partnership (HSP) was born. The HSP program is funded through a grant by ACFN as
part of the Healthy Weight Commitment Foundation (HWCF). Katie Brown, EdD, RD, LD,
became the first Head RD Nutrition Coach and formed a team of six RD Coaches interested in helping with this innovative project. This small RD Coach team developed a
comprehensive curriculum with over 70 lessons focusing on energy balance that spans
seven grade levels. The lessons include RD Coaching during PE class while kids are
being active, classroom presentations, PE games, cafeteria promotions, posters, morning announcements, school newsletter articles, and family fun nights.
The Healthy Schools Partnership piloted its first project with over 800 students in the
Fall semester of 2007 in Kansas City schools, including two elementary schools, one
middle school, and one high school. In just the first two years, over 2,000 students were
reached.
Within the first week of the original interventions students were forming bonds with
the RD Coaches, starting to ask questions, and reporting impressive behavior changes.
One student said she ate pizza every day for lunch; after comparing her diet to the
USDA’s MyPyramid, she said she needed to eat more fruits and vegetables. She then
planned to stop by the salad bar after getting her pizza to add baby carrots and fruit to
complete her meal. Although she didn’t say she wanted to stop eating pizza every day,
this small step of adding more fruits and vegetables to her diet was encouraging after
just one week of interventions. By week five students were reporting significant behavior changes and attitudes towards healthy eating. A seventh grader told her RD Coach
that she was having her mom buy more fruits and vegetables to make sure she has
healthy snacks available when she gets home from school.
Evaluation
To evaluate the project’s effectiveness at achieving behavior change in fourth- to
sixth-grade students through the Healthy Schools Partnership, ADAF consulted the
University of California, Berkeley premier team of researchers (Pat Crawford, PhD, RD,
and Dana Gerstein, MS, RD). For the 2008-2009 school year, four new elementary
schools and two control schools were selected. Students completed surveys prior to
beginning the intervention and again at the end of the 14-week intervention which
asked questions regarding nutrition, knowledge of energy balance, and behavior.
continued on page 2
Chair’s Corner . . . . . . . . . . . . . . . . .4
Webinar Review . . . . . . . . . . . . . . 4
Member Spotlight . . . . . . . . . . . . 5
Calorically Dense Infant
Formulas Using Household
Measurements . . . . . . . . . . . . . . . 6
Next Submission Deadline
Summer 2010 .................. April 16, 2010
Editorial Staff
Editor
Monica Nagle, RD, CNSD, LDN
Co-Editor
Holly Van Poots, RD, CSP, LDN
Communications Chair
Carolyn Silzle, MS, MBA, RD, LD
Communications Co-Chair
Liesje Nieman, RD, CNSD, LDN
Page 2
continued from page 1
Photos were taken of student’s lunch trays
both before and after meal consumption at
pretest and post-test.
Did the RD Coach make a difference in
what children know, believe, and do
regarding energy intake?
Yes, students’ nutrition knowledge
increased significantly compared to the control group. The most promising finding was
that students participating in HSP significantly increased their consumption of vegetables
to a level nearly twice as much as the control
group (30% intervention group, 17% control
group). Students reported eating more vegetables, which was impressive, but they actually did eat more vegetables at lunch, as photos of their lunch trays were examined and
proved consistent with students’ reported
behavior.
Showing behavior change is a challenge
with nutrition education programs and the
ADAF was extremely pleased to unveil that
the intervention by the RD Nutrition Coaches
in the HSP program led to increased nutrition
knowledge and attitudes which resulted in
participants eating more fruits and vegetables. The HSP program is now entering a two
and a half year study to follow fourth- to
sixth-grade students to evaluate long-term
effects the program has on their knowledge,
beliefs, energy intake and energy output.
RD Coaching
The RD Nutrition Coaching in the HSP program is provided in a variety of settings.
Sometimes an RD Coach will talk with a few
students at a time while they are exercising
on weight machines, running on treadmills,
or moving through a lesson-specific activity.
RD Coaching consists of short activities and
conversations that reinforce the theme of the
week, usually accompanied with some personal goal-setting. For example, during
“Snacks & Beverages” week in the spring
semester, students measure out sugar cubes
that represent the amount of sugar in beverages and then discuss what changes they
want to work on in this area.
Classroom Presentations
Short ten-minute presentations were created to teach the overall concepts of the
week. There are in-class activities that reinforce the nutrition messages, handouts to
take home to share with families, a corresponding homework assignment, or a contest such as a “Breakfast Poster Contest.” Each
PNPG POST
grade level of the classroom presentations
has its own set of objectives, presentation,
and coaching outlines, and each year progresses and builds on the previous one so
that the program stays fresh for the students.
Nutrition Games
Games are a good way to reinforce the
HSP key messages. Students have to think
fast and work as a team all while they are participating in physical activity. Each semester
the RD Coaches are adapting or developing
new games. Often this occurs in collaboration
with the PE teachers.
Cafeteria Promotions
As the Healthy Schools Partnership, leaving out the education opportunities that
abound in the schools’ cafeterias would have
been a mistake. “Power Pick” (i.e. nutrient
dense) choices are highlighted using an
exclusive logo created to symbolize the
Healthy Schools Partnership focus on Power
Foods. RD Coaches help reinforce “Power
Pick” choices, acknowledging students who
have a “Power Pick” lunch tray by taking his or
her picture to place on the “I Power Picked
My Plate” banner displayed prominently in
the school’s cafeteria.
Nutrition Posters
Each week several nutrition posters that
relate to the week’s theme are hung throughout the school in hallways, cafeterias, and
locker rooms. This nutrition information seeping into the school environment begins to
affect the school staff positively as well.
Several of the school staff ask for RD
Coaching programming for the adults.
Morning Announcements
Every day a Healthy Schools Partnership
announcement is read over the intercom,
once again to help reinforce the weekly message. “Be a Power Pick Champion every day.
Brighten up your lunch tray with fruits and
vegetables. Swap those fries or chips for a
salad and a piece of fresh fruit” is one example of announcements students hear.
School Newsletter Articles
To help take the message home to parents, short nutrition articles are provided to
the schools to be incorporated into parent
newsletters, giving tips such as choosing
healthier foods when dining out or selecting
better beverage choices for kids, which are
SPRING 2010
common concerns that many parents have.
Family Fun Nights
Family Fun Nights are an important way to
teach the whole family about nutrition. With
a “Walk Through the Pyramid” activity, parents and their children participate in activities
in each of the five food groups and collect
items to make a trail mix to take home.
Where to Next?
The Healthy Schools Partnership is taking
big steps in the spring semester of 2010 by
expanding to 11 schools in Kansas City and
into four schools in Des Moines, Iowa, closely
followed by Washington, D.C., and Chicago,
Illinois. Keep an eye out for more news about
the effective ways that RD Coaches in PE class
help to change children’s eating behaviors.
For more information about the Healthy
Schools Partnership project, contact ADAF’s
National Nutrition Education Director Katie
Brown, Ed.D, RD, LD, at [email protected]
19th National Conference
on Advances in Perinatal
& Pediatric Nutrition
Stanford University, Stanford
California
The conference will tackle some of the
most interesting topics and
provocative issues that concern
nutrition practitioners today. Topics
include:
What are the roles of feedings, human
milk, and lactoferrin in the prevention of
NEC?
Who needs vitamin D, and how much?
What are important updates on the use
of human milk for the ELBW infant?
What nutritional intricacies must be
considered when treating food refusal or
selectivity in children with autism?
July 19-21, 2010
http://nutritionconference.stanford.edu
SPRING 2010
Healthy Schools
Partnership and RD
Coaching: A Closer Look
By Stephanie Howard, MPH, RD, LD
The RD Coaches working with the Healthy
Schools Partnership (HSP) will tell you that
their job is multi-faceted, high-paced, everchanging, and most importantly, rewarding.
Many registered dietitians (RD) consider
themselves “coaches” to their clients and
patients, and in the Healthy Schools
Partnership, weekly individual coaching sessions are a cornerstone to the program.
These one-on-one interactions allow RDs to
address individual barriers to change for
each student and to praise even the smallest
improvements. Positive encouragement from
the RD Coach when the students choose the
“Power Pick” foods offered in the cafeteria
also provides a unique opportunity for
coaching in the school setting.
“What I like the most about my RD
Coaching job is the fact that we meet the
kids where they are, and we can tailor nutrition messages to their level of knowledge
and readiness,” says Tammi Linnebur ,MS, RD,
LD, a second-year RD Coach. She enjoys making that personal connection with the kids
and having the ability to “build up their confidence and help them feel good about even
the smallest change they make in eating and
activity behaviors.” Even better, she says, is
the ripple effect that she has seen when one
child takes home an energy balance message
that results in positive lifestyle changes for
the entire family.
Kuda Chimanya, MPH, MS, RD, LD, one of
the original RD Coaches, says, “Being an RD
Coach is a great opportunity to touch the
lives of students, in a fun and interactive way,
that empowers them to make small steps
towards overall health and wellness. I love
being an RD Coach because each week, I am
able to coach the students and see them
progress in their nutrition behaviors as well
as develop friendships where they begin to
look at me as their personal nutrition expert.”
Not only do the Kansas City RD Coaches
“meet kids where they are” figuratively speaking, they literally bring a rare health care
expertise to many schools and neighborhoods with lower socioeconomic status.
Many of the students and school staff
members have never had the opportunity to
visit with a registered dietitian prior to their
involvement with the HSP program. With this
connection to neighborhoods plagued by
health disparities, the Kansas City RD
PNPG POST
Page 3
Congratulations to the November 2009 Board
Certified Specialists in Pediatric Nutrition
Arkansas
Christy Banks
Megan Green
Renita Snow
Arizona
Lisa Kandell Kotler
Heather Ottenbacher
California
Erin Feldman
Jennifer Jordan
Emily LaRose
Jennifer Murray
Kimberly Olson
Colorado
Jacqueline Keller
Connecticut
Eileen Tichy
Florida
Laura Heare
Pamela Legoski
Sonia Motolongo
Georgia
Jennifer Davis
Aruna Navathe
Alyssa Withee
Idaho
Joanna Bork
Linda Diamond
Indiana
Mary Engelland
Jean Wyss
Kentucky
Amy Sapsford
Maryland
Angela Eshleman
Cheryl Issa
Amy Toscano
Michigan
Catherine Larrman
New Jersey
Michele Colin
Coaches are motivated by the knowledge
that their investment today will lead to big
returns in the future, thereby reducing the
prevalence of obesity and its co-morbidities.
In fact, the program received a “Promising
Practice Award” this year from the American
Diabetes Association for its strong focus on
serving low-income and minority populations. Chimanya believes this is an important
aspect of the program and stated, “We are
making a difference by changing the lives of
kids who have lower access to healthcare and
addressing obesity to prevent its co-morbidities over a lifetime.”
For Linnebur, another favorite aspect of
her job is witnessing a student having an
“aha” moment during a one-on-one weekly
RD Coaching session. A recent example of
one such moment happened during an RD
Coaching session with a fourth-grade student
after Thanksgiving break. This wise fourth
grader shared that cherry pie was being
offered for dessert, and she remembered that
it was a “noodle-arm” food (a lower-power
food) not a “strong-arm” food (power food),
so she chose to have a smaller piece of pie
and made sure she went outside to play later
in the day. The student hadn’t remembered
the terms “power” food or “low-power” food,
but she clearly understood the fun illustration used by the RD Coach who demonstrated the strong muscle arm pose or the “noodle-arm.” More importantly, the student had
the ability to apply the energy balance mes-
New Mexico
Susan Jones
Ana Llinas
New York
Nancy Garrison
North Carolina
Arlecia Phillips
Sharon Wallace
Ohio
Katherine Dart
Oklahoma
Laura Cooper
Oregon
Lori Brizee
Julie Stahl
Pennsylvania
Liesje Carney
Elizabeth Paul
Ancy Thomas
South Dakota
Melissa Kruce
Tennessee
Kimberly Ann Baxter
Kristy Gibbons
Texas
Diane Anderson
Kimberly Bilger
Rachel Davis
Cynthia Floyd
Katherine Green
Amy Kapich
Elisabeth Lee
Jill Rockwell
Brittany Szarek
Utah
Ellen Lechtenberg
Catherine McDonald
Virginia
Ashleigh Sellman
West Virginia
Amy Spadafora
Wisconsin
Jessica Balliet
sage to her own life. Similar success stories
about behavior change related to energy balance can be found throughout all of the participating schools. But as any RD Coach will
tell you, there is an enormous amount of time
and energy involved in achieving those positive results.
An RD Coach with Healthy Schools
Partnership wears many hats during the
course of a day. Coordinating schedules with
busy teachers and coaches, providing classroom sessions, hauling food and all the equipment needed for taste-testings, and memorizing the names of all the students is just a start.
An RD Coach may begin the day teaching a
hands-on cooking class to a group of hungry
second graders, then run to the gym to lead a
nutrition game as part of the physical education class, take “power pick” photos in the cafeteria, and then provide some one-on-one
coaching sessions. Following that, she might
stop by the principal’s office to provide a program update to the school leadership team
and contribute information for the school
newsletter. Many of the RD Coaches will visit at
least two and sometimes three schools per
day to achieve all their weekly goals at each
assigned location.
To accomplish all of those tasks effectively, the job requires some special attributes
from the RD Coaches, including patience,
flexibility, passion for educating others about
the importance of nutrition and physical
activity, and most important of all, a “strong
continued on page 5
PNPG POST
Page 4
SPRING 2010
Chair’s Corner
Just as you manage
your professional and
personal lives, PNPG
plans for the future as
we work in the present. We are hard at
work on our many
PNPG activities this
spring and planning
the new PNPG year!
The Program of Work (POW) for the
coming year – June 2010 through May
2011 – has been approved by the PNPG
Executive Committee and sent on to ADA
for their approval. The POW, developed by
Chair-Elect Beverly Henry, PhD, RD and
Treasurer Linda Heller, MS, RD, CSP, CLE, is
based on the PNPG Strategic Plan. This
plan focuses on meeting the needs of the
PNPG membership and aligns with the
American Dietetic Association Strategic
Plan. As you see, PNPG and ADA work
together to support the professional needs
of our members. An exciting addition to
the POW is the return of the PNPG
Pediatric Nutrition Symposium in spring
2011. We also plan an increase in support
for a number of pediatric nutrition projects
through the ADA Foundation. More about
these plans in the near future! We will continue to offer our highly valued member
benefits: our publications, the Building
Block for Life and the PNPG Post; our rapidly developing website, www.pnpg.org;
our webinars for CEUs; awards and scholarships; and so much more!
Working in the present to support our
PNPG members, the following projects are
in progress:
• An invitation to participate in the PNPG
Member Survey, from our Member
Support Committee led by Chair Mimi
Kaufman, MPH, RD, LD, will have
arrived by eblast notice. We are hoping
you have taken this opportunity to
express your views on how PNPG
leadership can best support your
pediatric nutrition professional
development and what you truly value
in your membership. Member
responses will be used on Strategic
Plan revision.
• The PNPG Strategic Plan will be revised
in a workshop as part of the PNPG
Spring Meeting at the end of April.
Information gathered from the Member
Survey will be used to help us
shape our strategic direction for the
next three years. Your opinions, stated
through our survey, make PNPG your
dietetic practice group.
• Please “drop in” to the PNPG website,
www.pnpg.org, for up-to-date
information on many topics including
CEU opportunities and news about
pediatric nutrition. Our wonderful
Forum remains available to post your
pediatric nutrition questions as well as
serve as a support for your colleagues
by responding to posted Forum
questions. Check out information from
the many committees in PNPG by
visiting our Officer’s Page, when you
log in as a member.
Many thanks to all of you have taken
the NCP Survey. The information provided
to our NCP Ad Hoc Committee, led by
Sandy Spann, MS, RD, LD, will help this
group develop a plan to support our member needs in this important area of practice.
As always, PNPG is thankful to all of our
devoted and active volunteers who give of
their time and talents to make this a great
dietetic practice group! And we thank all
of you for your membership in PNPG!
Please contact me at
[email protected] if you have questions or comments about your PNPG!
Sue Konek, MA, RD, CSP, CNSD, LDN
Chair – PNPG
Webinar Review: “Balancing the Nutritional Needs of VLBW Infants
with the Protective Properties of Human Milk”
By Amy Brandes, RD, LD, CNSD, IBCLC
Manager of Neonatal Nutrition & Lactation Services
Steton Family of Hospitals
[email protected]
On November 10, 2009, PNPG hosted a
webinar titled “Balancing the Nutritional
Needs of VLBW Infants with the Protective
Properties of Human Milk,” presented by Dr.
Paula “Polly” Sisk, PhD, RD, IBCLC. Dr. Sisk has
over 23 years experience as a neonatal dietitian and 20 years as a lactation consultant.
Paula currently works in the Neonatal
Intensive Care Unit (NICU) at Forsyth Medical
Center in Winston-Salem, North Carolina. In
addition to clinical work, Paula is a research
instructor in the Department of Pediatrics at
Wake Forest University School of Medicine.
Her research and publications focus on the
nutritional needs of the premature infant,
human lactation, and specifically the health
outcomes of premature infants receiving
human milk.
Dr. Sisk initially explained the benefits of
human milk in the NICU population and the
challenges of using it. She then raised the
importance of communication with mothers
of infants in the NICU about the many benefits of human milk. This communication may
help alleviate the anxiety that new mothers
feel, and less anxiety may contribute to
increased milk supply for the mother. Dr. Sisk
also reviewed strategies for using human
milk in the NICU to ensure nutrient requirements are provided.
If you missed this wonderful piece of education in November, don’t worry! You can still
see the webinar and receive two continuing
education hours. To view the webinar, go to
www.pnpg.org and log in as a member. Then
click on “My Courses” on the upper left hand
side of the website. From there, scroll down
to the bottom of the page and look under
“Webinar” for “VLBW Infants and Human
Milk,” Click there to download the handouts,
view the webinar, and take the quiz that
must be passed to receive your continuing
education credits. Please note that it may
take several minutes for the handouts and
the webinar to load.
PNPG would like to give a special thanks
to Medela for sponsoring this webinar.
Medela develops innovative and high-quality breastfeeding and phototherapy products
and supports mothers and health care professionals to successfully provide human
milk to all newborns for as long as possible.
SPRING 2010
continued from page 3
muscle arm” attitude. Although the HSP RD
Coaches receive financial compensation for
their hard work, the common motivation is
the personal reward earned every day they
step into a school and give students a better
chance for health and success.
An Interview with First-Year Healthy Schools
Partnership RD Coach Stephanie Howard, MPH,
RD, LD
Interviewer: What is the most rewarding
aspect of your RD Coaching position?
Stephanie Howard: To be able to gain the
trust of a student and see that the knowledge
and encouragement I provided led to a positive behavior change that will hopefully be
long-lasting. I have always believed that it is so
much easier and more effective to spend time
shaping a young person’s behaviors than to
try to change behaviors later in life when there
are already existing health problems.
Interviewer: Why did you want to be a part
of the Healthy Schools Partnership?
SH: I worked in school health programs
almost a decade ago, and since then have
been passionate about the need for using
schools as the stronghold to address the
health problems plaguing our nation. After
learning about the partnership with the
ADAF, ACFN, and PE4life, the energy balance
message, and the ability to connect with students one-on-one in the school setting, I
wanted to be a part of the effort. For years,
we have known about the rising number of
children who are overweight, and it is exciting to be a part of a national effort that is taking action to address it with evidence-based
methods.
Interviewer: What part of your experience
has been the most challenging?
SH: Learning how to best connect with the
middle school-age students. They are in such
a flux with their own self-development, and
so influenced by their peers and the media, it
can sometimes be challenging to guide them
toward making better nutrition and physical
activity choices. On the other hand, they
have more freedom to make their own food
and activity choices than a second- or thirdgrade student, so when they do make the
decision to move toward a healthier lifestyle,
they have a greater ability to sustain it.
Interviewer: Tell me about the most fun
you’ve had as an RD Coach.
SH: Last semester we taught a lesson on
“power beverages” and part of the seventhgrade coaching sessions included students
working in groups to create a skit, song, rap,
or public service announcement related to
“power picking” their beverages. I had the
best time watching them create fun, educa-
PNPG POST
tional messages and performing their creations for their peers. Keeping the lessons fun
and exciting for the kids is always an important aspect of our program, but this day was
extra special for the kids.
Interviewer: What sets HSP apart from
other school-based nutrition programs?
SH: We only work in schools that have a
pre-existing partnership with PE4life, which
means the school already understands the
benefit of having health-related initiatives as
a part of their curriculum. It also means we
have an existing ally, the PE Coach, in each
school. We also have the ability to provide
one-on-one interactions with the kids while
they are being physically active, and that is a
rare component to any school-based health
or nutrition program. Being able to provide
incentives that reinforce the messages, food
tastings, and other resources to schools is
also a beneficial aspect of the program.
Interviewer: Why do you think this program
has been so successful?
SH: There are many reasons for the program’s success: visionary creators, good funding, essential partnerships with other organizations fighting childhood obesity, but most
important of all is the dedicated team of RD
Coaches who started HSP here in Kansas City,
Missouri, and continue to build and develop
the program. We are fortunate to have a
director who has a doctorate degree in education, and a high-energy team of RD
Coaches from a variety of backgrounds who
devote their talent, energy and passion for
the profession toward the overall success of
the program. The level of expertise and commitment demonstrated by each and every
team member toward a common goal has
been unmatched in my career as a dietitian.
For more information on the Healthy
Schools Partnership program, please contact
Abby Manger at [email protected].
Please also visit the Coach’s Corner blog
found on the ADA website www.eatright.org.
First, sign in as a member using your ADA
number and password, then type in “RD
Coach Blog” in the search box in the upper
right corner of the webpage. Once on the
blog homepage, scroll down until you see a
box on the right side of the page that says
“RD Coaches Corner”. In that box, click on
“Blog Home”, where you can read the latest
entries.
Page 5
Member Spotlight:
Sabrina Candelaria
Sabrina Candelaria,
MPH, RD was chosen
earlier this year to
participate in the
American Dietetic
Association’s (ADA)
new Diversity
Leadership program.
The primary goal of
this program is to advance the leadership
skills of underrepresented groups within the
Association and dietetics profession. This
new program is part of the ADA’s Strategic
Plan to provide service to a changing demographic group of Registered Dietitians.
Sabrina was one of four RDs chosen. She is
of Puerto Rican heritage. The other RDs chosen were Indian, African American, and male.
Sabrina currently works in a public health
setting through the University of Miami
Miller School of Medicine as a pediatric clinical dietitian. She also is the first registered
dietitian from the Miller School to participate in a long-term nutrition “Tele-Medicine”
clinic servicing children with special health
care needs and their families living in rural,
medically underserved areas in St. Lucie
County, Florida. Her past experience includes
pediatric renal transplant, critical care pediatrics, maternity, wellness, and sports nutrition. She has served as a consultant dietitian
for the University of Miami’s medical school
wellness center for the past few years. Until
January 2010 she was a nutrition columnist
for two local parenting publications. A lifelong learner, Sabrina is now in an executive
MBA program in Health Sector Management
and Policy at the University of Miami. She
has a BS in nutrition from Cornell University
and a MPH from New York University.
As a Diversity Leadership participant,
Sabrina attended the Food & Nutrition
Conference & Expo in Denver this fall and will
be participating in other ADA-sponsored
events later this year including a visit to ADA
headquarters in Chicago, Illinois for the
Diversity Committee meeting. She is currently serving on the Florida Dietetic Association’s
first Diversity Task Force. Along with her
membership in PNPG, she is a member of the
Dietitians in Functional Medicine (DIFM) and
Sports, Cardiovascular and Wellness Nutrition
(SCAN) DPGs. She is also a member of the
MIG- Latinos and Hispanics in Dietetics and
Nutrition (LAHIDAN).
PNPG POST
Page 6
SPRING 2010
Calorically Dense Infant Formula Recipes Using Household Measurments
By Deb Hustler MS, RD, LD
Akron Children’s Hospital, Akron, OH
Liesje Neiman Carney RD, CSP, LDN
The Children’s Hospital of Philadelphia
Within the article below, the authors make reference to “formula recipe tables”. Due to the length
of the document, these tables will be available on
the PNPG website www.pnpg.org. From the home
page, log in using your last name and ADA membership number. Click on the "Post" link in the column titled "Members" (on the right-hand side of
the page). In the PNPG Post table of contents, click
on the link to this article: Calorically Dense Infant
Formula Recipes Using Household Measurements.
Click on the link within the article to download the
PDF file of these tables.
Please contact Liesje Nieman Carney with any
questions or concerns: [email protected]
These recipes were designed for home use
by families and caregivers. The intention is to
use these recipes when an infant formula
greater than 20 calories per ounce is indicated, and when a larger volume or daily supply
of formula is to be made using measuring
cups (rather than using scoops provided in
the product can). If it is essential that a child
receive very precise amounts of certain nutrients, as in some metabolic conditions, a
recipe using weighed amounts should be
used instead. Household measures will have
some variance due to the degree of packing
of the powder in the measuring cup or
spoon. Standard measuring cups must be
used, not a coffee cup, soup spoon, etc. When
instructing caregiver(s) about preparation of
the formula, it is imperative to ascertain
whether they have standard measuring
equipment for the required amounts in the
recipe. In some circumstances providing
measuring cups or spoons to the caregiver(s)
may be necessary to ensure that the formula
recipe will be prepared as instructed. A level
measurement should be used, not a rounded
one. Also the cup should not be packed (with
the exception of Nutramigen and Pregestimil,
for which the manufacturer recommends
packed measurements).
Powdered infant formula products are not
sterile; however, these products are the most
popular for home use due to their convenience and cost savings. Because powder formula is not sterile, it should not be fed to
infants with a compromised immune system
unless approved by the child’s physician.
Formula prepared from powder should be
kept in the refrigerator for no more than 24
hours and at room temperature for no more
than two hours. Prepared formula in a bottle
that has been fed should be discarded within
one hour after the feeding begins.
The following topics are beyond the scope
of this article and thus have not been
addressed: formula handling/preparation in
the acute-care setting, administering tube
feedings, and feeding considerations for the
immune-compromised infant and child.
Detailed information on these issues can be
found in the following resource: Robbins ST,
Beker LT. Infant Feedings: Guidelines for
Preparation of Formula and Breastmilk in
Health Care Facilities. Chicago, IL: American
Dietetic Association; 2004. Please note that
an updated edition of this book is anticipated
in November 2010.
Methods Used in Creating Formula
Recipes
Calculations were based on each manufacturer’s product information at the time of
publication, included the following: grams of
powder per cup or scoop, calories per gram,
and volume displaced per gram of powdered
formula. The volume of water added to the
powder was designed to provide the volume
TABLE 1
Formula Preparation Guidelines
Child’s Name: ____________________________________________ Today’s Date: ________________
Formula: ________________________________________________ Calories per ounce: __________
Before mixing the formula:
1. Wash all equipment you will use to make the formula (container to mix in, measuring spoons and
cups, mixing spoon or wire whisk) and the bottles, nipples, caps, etc. you will be using in a dish
washer or with clean warm soapy water. Rinse in hot water and dry with a clean cloth or allow to
air dry on a clean towel.
2. Wash off the counter surface where you will be preparing the formula with soapy water or an
antibacterial spray, rinse with clean water, and dry with a clean towel.
3. Have all of the needed ingredients ready.
4. Wash your hands with soap and water just before starting formula preparation.
5. Talk to your health care provider to determine if you need to use sterile water. Water may be
sterilized by boiling for two minutes, then being allowed to cool to room temperature or
refrigerated in a clean container for later use. Bottled water is not sterile unless specifically stated
on the label.
To make an individual bottle of formula:
Use the scoop from the can. Place the scoop back in the can with the handle facing up. Date the can
when opening and throw away after one month. Mix ____ scoops of formula powder with ____
ounces of water. Formula powder is added to the measured water and will make a larger amount.
Refrigerate prepared formula until use.
To make a larger batch:
Use standard measuring cups and mix _______ cup(s) formula powder with _____ ounces of water.
The total volume will be more than the water added. Mix well with a spoon or wire whisk. Store in a
large covered container or pour into individual bottles with caps/covers. Refrigerate until use.
1. Follow mixing and cleaning instructions carefully so that your child receives the right amount and
does not become sick from an improperly mixed or contaminated formula.
2. Shake or mix formula before pouring into bottles if storing in a larger container and also before
feeding. Throw out any unused mixed formula after 24 hours.
3. Warm formula in a container of warm water, under warm running water, or in an approved bottle
warmer, not in a microwave as hot spots may result.
4. Throw out any formula that is still in the bottle one hour after your child has started the feeding,
do not refrigerate and reuse partial bottles.
5. If you will be traveling, use ice packs to keep the formula chilled.
If you have any questions about preparing the special formula, contact your dietitian. If your baby is
having less than 6 wet diapers daily, vomiting, having multiple loose/watery stools, or feeding poorly,
contact your child’s doctor or clinic.
Dietitian: __________________________________________ Phone Number: __________________
PNPG POST
SPRING 2010
closest to the total volume for the desired caloric density (i.e.,
kcals/oz) using ½-ounce increments; these calculations did factor in
volume displacement of the powdered formula. The goal was less
than a 0.5 kcal/oz variance. This is easier to achieve in most cases
with larger volumes.
These recipes are all calorically dense formulas created by using formula exclusively, which results in products with a higher renal solute
load and osmolality as compared to when that same formula is mixed
to standard concentration (i.e., 20 kcal/oz). Depending on the amount
of protein and other vitamins/minerals needed, use of a modular may
be more appropriate. Infants with restricted fluid intake must be carefully evaluated to ensure nutritional needs are being met. Whenever a
modified formula is used, the clinician must evaluate the impact on
meeting individual nutrient needs and tolerance.
How to Utilize the Tables
When using the recipes provided in the tables, first decide on the
caloric density and final volume needed. Identify these on the corresponding formula table, and then look horizontally to the left-hand
column for the amount of formula powder to add.
To provide reinforcement of your verbal instruction, it is recommended to use a standardized form to provide written formula
preparation instructions to caregiver(s)—refer to Table 1 for an
example. Notably, if the recipe calls for a ½-ounce measurement,
write out instructions as the full ounces, then add 1 tablespoon for
the ½-ounce (e.g., 4 ½ oz of water would be 4 ounces and 1 tablespoon).
Disclaimer
Product information may change. Please refer to the product
label or contact the manufacturer for the most current nutrition
information and mixing/storage instructions. The RD is encouraged
to double check each recipe before providing it to caregiver(s) for
home use. Depending on the caregiver’s ability to demonstrate formula preparation techniques, the RD may choose to adjust a given
recipe. The Pediatric Nutrition Practice Group and the American
Dietetic Association do not take responsibility for any harm caused
to an infant due to improper use of these recipes.
Page 7
Submission Deadlines
Editor’s Notes
Submission Deadlines
Summer 2010
April 16, 2010
Fall 2010
June 21, 2010
Winter 2010
October 4, 2010
Editorial Staff
Editor
Monica Nagle, RD, CNSD, LDN
Phone: (215) 590-3967;
Fax: (215) 590-4460
Email: [email protected]
Co-Editor
Holly Van Poots, RD, CSP LDN
Phone: (336) 832-8172; Fax: (336) 832-8083
Email: [email protected]
Communications Chair
Carolyn Silzle, MS, MBA, RD, LD
Phone: (404) 785-7763; Fax: (404) 785-7157
Email: [email protected]
Communications Co-Chair
Liesje Nieman Carney, RD, CNSD, LDN
Phone: (267) 426-5347; Fax: (215) 590-4460
Email: [email protected]
PNPG Post is a quarterly newsletter which keeps members up to date on
continuing education opportunities, educational resources, legislative issues,
publications, and communications regarding the various PNPG activities and
member benefits. The PNPG Post also provides members with Practice Points.
For information, contact the editor.
Publication of an advertisement in the PNPG Post should not be construed as
endorsement of the advertisement, of the advertiser or of the product by the
Acknowledgments
We would like to take this opportunity to thank everyone else
who contributed to the creation and revision of these tables—Aida
Miles, Sandy Robbins, Nikki Sanner and Nancy Wooldridge. We also
would like to thank the following hospitals for sharing their education materials with us: Inova Fairfax Hospital for Children (Va),
Children’s Hospital Boston, Denver Children’s Hospital, Akron
Children’s Hospital, and The Children’s Hospital of Philadelphia. It’s
been a lot of work, but we’re thrilled to see it finally published!
TABLE 2: Manufacturer Contact Information
Abbot Nutrition
www.abbotnutrition.com
Mead Johnson
Nutrition
www.mjn.com/professional
Nestle Infant Nutrition
www.medical.gerber.com
Nutrica Advanced
Medical Nutrition
www.nutrica-na.com
American Dietetic Association and/or the Pediatric Nutrition Practice Group.
The content of the newsletter does not imply endorsement by the Pediatric
Nutrition Practice Group of the American Dietetic Association © 2010. Copyright
by the Pediatric Nutrition Practice Group of the American Dietetic Association.
All rights reserved.
Monica Nagle, RD, CNSD, LDN
Children’s Hospital of Philadelphia
Department of Clinical Nutrition
34th Street and Civic Center Boulevard, Room 9NW82
Philadelphia PA 19104
This publication is supported by a professional
grant from the Nestlé Nutrition Institute
Stephanie Howard, MPH, RD, LD, CNSD
127 East 46th St., Apt. #7
Kansas City, MO 64112
This publication is supported by a professional grant from
the Nestlé Nutrition Institute.
PRSRT STD
U.S. Postage
PAID
Little Rock, AR
Permit No. 307
The American Dietetic Association is the world’s largest
organization of food and nutrition professionals.
ADA is committed to improving the nation’s health and
advancing the profession of dietetics through research,
education, and advocacy.
PNPG POST
Page 8
PNPG M
!!
S
R
E
B
M
E
SPRING 2010
You are invited to register now for the PNPG and Weight
Management DPG Live Webcast: “Pediatric Weight Management:
Nutrition Assessment and Intervention Strategies” on April 20,
2010, Noon-2 p.m. CDT, with two hours of CEUs available.
Speakers:
Paula Mrowczynski-Hernandez, RD, LDN
and
Shelley Kirk, PhD, RD, LD
Session Objectives:
1. Differentiate among assessment tools used for the underweight, healthy weight and obese child.
2. Identify key factors to consider in nutrition assessment and intervention for the overweight and obese child.
3. Learn communication strategies that incorporate parent participation/education during
weight management interventions.
4. Implement two new age-appropriate weight management tools during parent/family counseling.
The cost for registration for PNPG and WMDPG members
is $25 per person and $15 for students. The registration
fee for non-members is $35 per person.
To register for this event please go to www.wmdpg.org
For PNPG member questions please contact Lisa Grentz
at [email protected]
For WMDPG member questions please contact Kim
Gorman at [email protected]
Product Information was obtained from the Manufacturers listed below. Added water is in
full oz unless the resulting cal/oz were not within 0.5 cals/oz for the designated cal/oz
level, then ½ oz were used.
POWDERED INFANT FORMULA DISCHARGE RECIPES
Preparing a single bottle or up to a 24 hour supply daily is suggested
Amount of
Ounces of Water to Add = Ounces Final Volume
Formula
Powder
Cal/oz: 20
22
24
27 Kcals/g
g/cup ml/g disp
To Add:
Enfamil AR, RestFull (unpacked) Max conc=24 cal/oz
5.0
97
0.73
n/a
½C
11=12
10=11
9=10
n/a
¾C
16.5=18 15=16.5 13.5=15
n/a
1C
22=24
20=22
18=20
n/a
1½C
33=36.5
30=33
27=30
Enfamil EnfaCare (unpacked)
4.9
114
0.73
½C
12.5=14 11.5=13 10.5=12
9=10.5
¾C
19=21
17=19 15.5=17.5 13.5=15.5
1C
25.5=28 23=25.5 20.5=23 18=20.5
1½C
38=42
34=38
31=35
27=31
Enfamil PREMIUM and Gentlease (unpacked)
5.1
111
0.76
½C
13=14.5 11.5=13 10.5=12
9=10.5
¾C
19=21
17=19 15.5=17.5 13.5=15.5
1C
26=29
23=26
21=24
18=21
1½C
38=42
34=38
31=35
27=31
Enfagrow PREMIUM Next Step (unpacked)
5.1
95
0.76
½C
11=12
10=11
9=10
8=9
¾C
16=18 14.5=16.5 13.5=15.5 11.5=13.5
1C
22=24.5 19.5=22 18=20.5 15.5=18
1½C
32=35.5 29=32.5 27 =30.5 23=26.5
Enfagrow Soy Next Step (unpacked)
4.8
101
0.71
½C
11=12
10=11
9=10
8=9
¾C
16=18
15=17 13.5=15.5 11.5=13.5
1C
22=24.5 19.5=22 18=20.5 15.5=18
1½C
32=35.5 29=32.5 27=30.5 23=26.5
Enfagrow Gentlease Next Step (unpacked)
5.0
108
0.76
½C
12=13.5 11=12.5 10=11.5
8.5=10
¾C
18=20 16.5=18.5
15=17
13=15
1C
24=26.5 22=24.5 20=22.5 17=19.5
1½C
36=40
33=37
30=34
26=30
Nutramigen with Enflora LGG (packed)
5.0
97
072
½C
11=12
10=11
9=10
8=9
¾C
16.5=18 15=16.5 13.5=15 11.5=13
1C
22=24.5 20=22.5 18=20.5 15.5=18
1½C
33=36.5 30=33.5 27=30.5 23.5=27
Enfamil Nutramigen AA (unpacked)
5.1
115
0.76
½C
13=14.5 12=13.5 10.5=12
9.5=11
¾C
20=22
18=20
16=18
14=16
1C
26=29
24=27
21=24
19=22
1½C
40=44.5 36=40.5 32=36.5 28=32.5
Pregestimil (packed)
5.0
128
0.79
½C
14.5=16 13=14.5 11.5=13 10=11.5
¾C
21.5=24 19.5=22 17.5=20 15.5=18
1C
29=32.5 26=29.5 23=26.5 20=23.5
1½C
43=48
39=44
35=40
31=36
Formula information from manufacturers was current as of January 10, 2010.
Information from Nestle is consistent with March, 2010 Product Guide.
POWDERED INFANT FORMULA DISCHARGE RECIPES
Preparing a single bottle or up to a 24 hour supply daily is suggested
Amount
Ounces of Water to Add = Ounces Final Volume
of
Formula Cal/oz:20
22
24
27
Kcals/g
g/cup ml/g disp
Powder
To Add:
Enfamil ProSobee (unpacked)
5.0
128
0.69
½C
14.5=16 13=14.5 12=13.5 10.5=12
¾C
22=24
20=22
18=20 15.5=17.5
1C
29=32
26=29
24=27
21=24
1½C
44=48.5 39=43.5 36=40.5 31=35.5
Neocate Infant SHS Nutricia (unpacked)
4.21
114
0.7
½C
10.5=12
9.5=11
8.5=10
7.5=9
¾C
16=18 14.5=16.5
13=15 11.5=13.5
1C
21=23.5 19=21.5 17=19.5 15=17.5
1½C
32=36
29=33
26=30
23=27
Gerber Good Start Protect PLUS (unpacked)
5.12
103
0.76
½C
12=13.5 11=12.5
9.5=11
8.5=10
¾C
18=20
16=18 14.5=16.5 12.5=14.5
1C
24=26.5 21.5=24 19.5=22 17=19.5
1½C
36=40
32=36
29=33
25=29
Gerber Good Start Gentle PLUS (unpacked)
5.01
105
0.75
½C
12=13.5 10.5=12
9.5=11
8.5=10
¾C
18=20
16=18 14.5=16.5 12.5=14.5
1C
23.5=26 21=23.5 19=21.5 17=19.5
1½C
36=40
32=36
29=33
25=29
Gerber Good Start 2 Gentle PLUS (unpacked)
4.92
105
0.75
½C
11.5=13 10.5=12
9.5=11
8=9.5
¾C
17=19 15.5=17.5
14=16 12.5=14.5
1C
23=25.5 21=23.5 19=21.5 16.5=19
1½C
35=39
31=35
28=32
25=29
Gerber Good Start 2 Protect PLUS (unpacked)
5.03
105
0.75
½C
12=13.5 11=12.5 10=11.5
8.5=10
¾C
18=20
16=18 14.5=16.5 12.5=14.5
1C
24=26.5 21=23.5 19=21.5 17=19.5
1½ C
36=40
32=36
29=33
25=29
Gerber Good Start Soy PLUS (unpacked)
5.01
105
0.75
½C
12=13.5 10.5=12
9.5=11
8.5=10
¾C
18=20
16=18 14.5=16.5 12.5=14.5
1C
23.5=26 21=23.5 19=21.5 17=19.5
1½C
36=40
32=36
29=33
25=29
Gerber Good Start 2 Soy PLUS (unpacked)
5.01
105
0.75
½C
12=13.5 10.5=12
9.5=11
8.5=10
¾C
18=20
16=18 14.5=16.5 12.5=14.5
1C
23.5=26 21=23.5 19=21.5 17=19.5
1½C
36=40
32=36
29=33
25=29
Formula information from manufacturers was current as of January 10, 2010.
Information from Nestle is consistent with March, 2010 Product Guide.
POWDERED INFANT FORMULA DISCHARGE RECIPES
Preparing a single bottle or up to a 24 hour supply daily is suggested
Amount
Ounces of Water to Add = Ounces Final Volume
of
Formula Cal/oz:20
22
24
27 Kcals/g
g/cup ml/g disp
Powder
To Add:
Similac Organic
5.2
100
0.77
and Go and Grow Milk-Based (unpacked)
½C
12=13 10.5=11.5 9.5=10.5 8.5=9.5
¾C
18=20
16=18
14=16 12.5=14.5
1C
23=25.5 21=23.5 19=21.5 17=19.5
1½C
35=39
32=36
29=33
25=29
Similac Advance Early Shield (unpacked)
½C
11.5=12.5 10.5=11.5 9.5=10.5
8=9
¾C
17=19 15.5=17.5
14=16
12=14
1C
23=25.5 21=23.5 19=21.5 16.5=19
1½C
34=38
31=35
28=32 24.5=28.5
Elecare (unpacked)
½C
14=15.5 12.5=14 11.5=13 10=11.5
¾C
21=23.5 19=21.5 17=19.5 15=17.5
1C
28=31
25=28
23=26
20=23
1½C
41=46
37=42
34=39
30=35
5.12
4.75
Similac Isomil Advance- includes
Go and Grow Soy-Based (unpacked)
½C
11.5=13 10.5=12
9.5=11
8=9.5
¾C
17=19 15.5=17.5
14=16 12.5=14.5
1C
23=25.5 21=23.5 19=21.5 16.5=19
1½C
35=39
31=35
28=32
25=29
Similac Neosure (unpacked)
½C
11.5=13 10.5=12
9.5=11
8=9.5
¾C
17.5=19.5 15.5=17.5
14=16 12.5=14.5
1C
23=25.5 21=23.5 19=21.5 16.5=19
1½C
35=39
31=35
28=32
25=29
Similac Sensitive (Lactose Free) (unpacked)
½C
11.5=13 10.5=12
9.5=11
8=9.5
¾C
17=19 15.5=17.5
14=16 12.5=14.5
1C
23=25.5 21=23.5 19=21.5 16.5=19
1½C
35=39
31=35
28=32
25=29
Similac PM 60/40 (unpacked)
½C
11.5=13 10.5=12
9.5=11
8=9.5
¾C
17=19 15.5=17.5
14=16
12=14
1C
23=25.5 21=23.5 19=21.5 16.5=19
1½C
34=38
31=35
28=32
25=29
5.14
Similac Alimentum (unpacked)
½C
13.5=15 12=13.5 11=12.5
9.5=11
¾C
20=22
18=20 16.5=18.5 14.5=16.5
1C
27=30
24=27
22=25
19=22
1½C
40=44.5 36=40.5 33=37.5 29=33.5
5.09
100
0.77
130
0.74
100
0.78
5.13
100
0.76
5.14
100
0.78
5.14
100
118
0.79
0.76
Formula information from manufacturers was current as of January 10, 2010.
Information from Nestle is consistent with March, 2010 Product Guide.
To Make a Single Bottle For All Formulas
(EXCEPT NEOCATE, Neosure, EnfaCare and Elecare)
2 scoops=89 kcals and displaces 13-14 ml
Cal/oz:
20
22
24
27
Scoops
2
2
3
3
Added
Water
3 ½ oz 5 oz
4 oz +1 ½ tsp
4 oz
or 120 ml or 105 ml or 150 ml or 127 ml
Approximate 4 ½ oz
Final Volume
4 oz
5 ½ oz
5 oz
To Make a Single Bottle For EnfaCare/Neosure
2 scoops=96/99 kcals and displaces 12-15 ml
Cal/oz
20
22
24
27
Scoops
2
2
3
5
Added
4 1/2 oz or 4 oz or 5 ½ oz or 8 oz or
Water
135 ml
120 ml 165 ml 240 ml
Approximate 5 oz
4 1/2 oz 6 oz
9 oz
Final Volume
To Make a Single Bottle For Elecare
2 scoops =89 kcals and displaces 14 ml
Cal/oz
20
22
24
Scoops
2
2
5
Added
4 oz or
3 1/2 oz or 8 oz or
Water
120 ml
105 ml
240 ml
Approximate 4 1/2 oz 4 oz
9 oz
Final Volume
27
5
7 oz or
210 ml
8 oz
30
4
5 oz or
150 ml
6 oz
To Make a Single Bottle For Neocate Infant
1 scoop= 20 kcal and displaces 3.3 ml
Cal/oz
20
22
24
27
Scoops
4
4
3
4
To
2.5 oz or
2 oz or
Added
3 oz or
make
60 ml
Water
90 ml
75 ml
final
volume
Approximate 4 oz or 3 ½ oz
70 ml
3 oz
Final
120 ml
Volume
Formula information from manufacturers was current as of January 10, 2010.
Information from Nestle is consistent with March, 2010 Product Guide.
MAKING FORMULA FROM CONCENTRATED LIQUID
WIC provides concentrated liquid formulas, if specified.
Formulas available in concentrated liquid:
Enfamil PREMIUM, Lactofree, Generic Store Brand, Generic Store Brand Soy,
Good Start Gentle PLUS, Protect PLUS and Soy PLUS, Isomil Advance,
Nutramigen, Prosobee, Similac Advance Early Shield, Similac Sensitive
Concentrated liquid formula is sterile and less vulnerable to preparation error and
bacterial contamination.
Amount of
Liquid
Concentrate
Cal/oz
Amount of
Sterile Water
Added
To Make
Final Volume
20
13 oz=390 ml
22
13 oz=390 ml
11 oz=330 ml
24 oz=720 ml
24
13 oz=390 ml
9 oz=270 ml
22 oz=660 ml
27
13 oz=390 ml
6 oz=180 ml
19 oz=570 ml
13 oz=390 ml
26 oz=780 ml
*All Concentrated Liquid Formulas come ONLY in 13 oz cans
Concentrated Liquid Formulas: 40 cal/oz or 1.33 cal/ml
30 ml = 1 oz
13 oz can = 390 ml
Enfaport
Cal/Oz
Ready-to-Use Enfaport (oz)
Water (oz)
20
8
4
22
8
2.9
24
8
2
27
8
0.9
Formula information from manufacturers was current as of January 10, 2010.
Information from Nestle is consistent with March, 2010 Product Guide.
RECIPES FOR ADDING POWDERED INFANT FORMULA TO BREAST MILK
These recipes are designed for discharge instructions
Health care facilities should use commercially sterile forms of formula when available; any
powdered formulas used should be measured by weight
Powdered Infant Formulas
This chart was developed based on the following data:
1 tsp formula = approximately 13 cal
1 scoop formula = approximately 44 cal
Always use the scoop that comes with the can of powder formula.
Ensure family has liquid measuring containers (such as an accurate baby bottle) to measure liquids.
Babies ready for discharge do not require the accurate formula calculations that are used in the hospital.
*USE THE FOLLOWING RECIPES FOR ALL POWDERED INFANT FORMULAS (except Neocate) TO BE
MIXED WITH BREAST MILK:
Home Preparation Instructions:
To make 24 cal/oz Breast Milk:
1 tsp formula + 3 oz Breast Milk or
1 scoop formula + 11 oz Breast Milk
To make 26-27 cal/oz Breast Milk:
1 tsp formula + 2 oz Breast Milk or
1 scoop formula + 7 oz Breast milk
It is best to prepare recipes for single feeding volumes to minimize risk of bacterial contamination.
*Recipes for single feeding volumes are recommended for stability of the mixture and infection control purposes.
Manufacturer websites for further information:
www.AbbottNutrition.com
www.mjn.com/professional
www.nestleinfantnutrition.com
www.Nutricia-NA.com
Formula information from manufacturers was current as of January 10, 2010.
Information from Nestle is consistent with March, 2010 Product Guide.