a. Review the mother’s health record to verify the order.

b. Wash your hands.

c. Assemble the necessary equipment (sterile water in bottle, nipple and cap combination, tissue or cloth, and gown (if necessary)).

d. Wash your hands.

e. Put on clean gown (if not already in scrubs).

f. Approach and identify the newborn.

g. Invert the bottle and shake some water on your wrist.

(1) Test the patency of the nipple hole.

(2) Ensure that the water drips freely, but not in a stream. If the hole is too large, the newborn may aspirate water. If the hole is too small, the newborn may tire before the end of feeding.

h. Sit comfortable and cradle the newborn in a semi-reclining position in one arm. The infant’s head and back are easily supported. Air is allowed to rise to the top of the infant’s stomach where it is more easily expelled.

i. Place the nipple in the newborn’s mouth. Do not insert if far enough to stimulate a gag reflex. The newborn should begin to suck. If he doesn’t, stroke him under the chin or on the side of his cheek, or touch his lips with the nipple to stimulate a sucking reflex.

j. Tilt the bottle upward as the newborn feeds. Keep the nipple filled with water. This prevents him from swallowing air. Watch for a steady stream of bubbles in the bottle. This indicates proper venting and flow of water.

k. Reinsert the nipple if the newborn pushes the nipple out with his tongue. This is a normal reflex. It does not necessarily mean that he is finished eating.

l. Burp (bubble) the newborn after each 1/2 ounces of water. Some air will be swallowed by the newborn even when fed correctly. Positions to bubble the newborn are:

(1) Hold the newborn upright in a slightly forward position. Use one hand to support his head and cheek. Rub or gently pat his back until air is expelled.

(2) Hold the newborn upright over your shoulder or place him face down across your lap. A change in position helps bring up the bubble. Rub or gently pat his back until air is expelled.

m. Place the newborn on his stomach or right side. This prevents aspiration if he regurgitates.

n. Discard any remaining formula and properly dispose of all equipment.

o. Record the procedures and significant nursing observations in the patient’s health record. Give the same report to the Charge Nurse. This will include:

(1) Time of feeding.

(2) Amount taken.

(3) How well the newborn fed.

(4) Did neonate appear satisfied.

(5) Occurrence of any regurgitation or vomiting.