Here at Grafton Childcare we have been working very hard behind the scenes using an evidence based approach to effective practice to develop a shared ethos for the use of bottles, cups and dummies here at Grafton Childcare.
We would like to thank the multi-agency team from Devon's health and education services including speech and language therapists, the Devon Lead oral health promotion dentist, an infant feeding coordinator and many others who have been working very hard to develop practical evidence based advice.
The impact of poor practice around the use of bottles, sports cups and dummies can have an ongoing impact on children's development, particularly communication and language development and no matter what our personal views and experiences are, it is our role at Grafton Childcare to ensure that we are offering the best provision and advice relating to using bottles, cups and dummies.
We understand that the subject can be emotive and illicit strong responses both positive and negative from staff and parents alike. We hope that this researched based information will ensure that we are using best practices for all children who attend Grafton Childcare. We hope that the following information will help staff and parents come to a shared understanding of how bottles, cups and dummies are used here at Grafton Childcare and how the guidance and good advice we can offer parents is designed to support positive conversations and offers practical advice based on only the most recent research.
We would like to thank the multi-agency team from Devon's health and education services including speech and language therapists, the Devon Lead oral health promotion dentist, an infant feeding coordinator and many others who have been working very hard to develop practical evidence based advice.
The impact of poor practice around the use of bottles, sports cups and dummies can have an ongoing impact on children's development, particularly communication and language development and no matter what our personal views and experiences are, it is our role at Grafton Childcare to ensure that we are offering the best provision and advice relating to using bottles, cups and dummies.
We understand that the subject can be emotive and illicit strong responses both positive and negative from staff and parents alike. We hope that this researched based information will ensure that we are using best practices for all children who attend Grafton Childcare. We hope that the following information will help staff and parents come to a shared understanding of how bottles, cups and dummies are used here at Grafton Childcare and how the guidance and good advice we can offer parents is designed to support positive conversations and offers practical advice based on only the most recent research.
Recommended – Ages and Stages
|
Ages
Birth-6 months 6-12 months 12 months+ |
Bottles
Breastfeeding is the recommended way to feed a baby of this age. However, some parents may make an informed choice to bottlefeed and these choices should be supported During this time babies begin the weaning process so bottle use should naturally be reduced From this age onwards bottle use should be reduced and discontinued as soon as possible |
Cups
Not applicable During this time babies begin the weaning process Open cups are recommended by health professionals If using lidded cups they must be non-valved From this age onwards open cups are more appropriate to ensure that healthy oral development can take place |
Dummies
Babies have a natural sucking reflex and dummies can help soothe or calm a baby Dummy use at sleep/nap times may reduce the incidence of cot death for babies already using dummies regularly at these times. This potential benefit ceases at six months Dummies may still be used to calm or soothe babies when they are upset Dummies, if used, should now be restricted to times when babies are upset or to help them settle to sleep From this age onwards dummy use develops into a habit and can be difficult to give up Dummy use now begins to have a negative impact on oral development and speech |
Facts about Bottles
Regardless of whether a baby has been breast or bottle-fed it is possible that, if starting at a setting before the age of 12 months, they may be bottle-fed at some point during the day. This opportunity for close, intimate contact with a familiar adult supports relationship building as part of a daily routine.
The sucking action used in bottle-feeding is different to that of breast feeding and involves fewer mouth muscles. Children who use bottles regularly past the recommended time have fewer opportunities to develop strong mouth muscles and this could result in difficulties with producing speech sounds.
Prolonged exposure to milk and sweet, sugary drinks (including fruit juice/squash) from a bottle can cause tooth decay. Often, as children get older, bottles are used more as pacifiers, which increases the time that the teeth are exposed to liquids that may cause decay. Babies that are given a bottle to go to bed can become reliant on a bottle at sleeptime and do not learn to ‘self settle’ to sleep. Giving a child a bottle to help them settle to sleep is another example of prolonged exposure to milk/liquids that could cause decay.
Research shows an association between prolonged bottle feeding and excessive cow’s milk consumption. This can lead to iron deficiency anaemia and obesity. Iron levels can also be affected by children drinking tea from bottles as the tannin in the tea reduces iron absorption.
Most babies progress to using cups from bottles or the breast. Long-term bottle use delays the ability to adapt from sucking to sipping and could make this progression more difficult.
Recommendations
1. Babies who are bottle-fed should be held and have warm physical contact with a key person while being fed. This key person should feed them whenever possible
2. Babies should never be left propped up with bottles, as this is both dangerous and does not meet their emotional needs
3. It is important that bottles only contain milk or water
4. It is recommended that babies and young children do not ‘feed to sleep’ (use a bottle to settle them down to sleep)
5.It is recommended that from 12 months bottle use is reduced with the aim of making a complete withdrawal as soon as possible after this
What liquids are more likely to cause tooth decay?
Sugary drinks, including milk. It is important for young children to have milk but drinking from an open cup rather than a bottle lessens the time the sugar is in contact with the teeth.
What are the only liquids which should be given in a bottle at Grafton Childcare and ideally at home as well?
Milk or water. This is an NHS recommendation supported by dieticians, dentists and our whole staff team at Grafton Childcare.
At Grafton Childcare babies are fed by the same key person or their buddy at each feed whenever possible.
The closeness of feeding helps to develop a bond between the baby and key worker or buddy. Close relationships help the baby to feel more secure with us here at Grafton Childcare. Babies with close early relationships go on to develop other relationships more easily.
When should bottle use be stopped?
Bottle use should be reduced from 12 months and completely stopped as soon as possible after this. This is to avoid developing a more established habit which may be hard to break and to ensure good oral development.
Regardless of whether a baby has been breast or bottle-fed it is possible that, if starting at a setting before the age of 12 months, they may be bottle-fed at some point during the day. This opportunity for close, intimate contact with a familiar adult supports relationship building as part of a daily routine.
The sucking action used in bottle-feeding is different to that of breast feeding and involves fewer mouth muscles. Children who use bottles regularly past the recommended time have fewer opportunities to develop strong mouth muscles and this could result in difficulties with producing speech sounds.
Prolonged exposure to milk and sweet, sugary drinks (including fruit juice/squash) from a bottle can cause tooth decay. Often, as children get older, bottles are used more as pacifiers, which increases the time that the teeth are exposed to liquids that may cause decay. Babies that are given a bottle to go to bed can become reliant on a bottle at sleeptime and do not learn to ‘self settle’ to sleep. Giving a child a bottle to help them settle to sleep is another example of prolonged exposure to milk/liquids that could cause decay.
Research shows an association between prolonged bottle feeding and excessive cow’s milk consumption. This can lead to iron deficiency anaemia and obesity. Iron levels can also be affected by children drinking tea from bottles as the tannin in the tea reduces iron absorption.
Most babies progress to using cups from bottles or the breast. Long-term bottle use delays the ability to adapt from sucking to sipping and could make this progression more difficult.
Recommendations
1. Babies who are bottle-fed should be held and have warm physical contact with a key person while being fed. This key person should feed them whenever possible
2. Babies should never be left propped up with bottles, as this is both dangerous and does not meet their emotional needs
3. It is important that bottles only contain milk or water
4. It is recommended that babies and young children do not ‘feed to sleep’ (use a bottle to settle them down to sleep)
5.It is recommended that from 12 months bottle use is reduced with the aim of making a complete withdrawal as soon as possible after this
What liquids are more likely to cause tooth decay?
Sugary drinks, including milk. It is important for young children to have milk but drinking from an open cup rather than a bottle lessens the time the sugar is in contact with the teeth.
What are the only liquids which should be given in a bottle at Grafton Childcare and ideally at home as well?
Milk or water. This is an NHS recommendation supported by dieticians, dentists and our whole staff team at Grafton Childcare.
At Grafton Childcare babies are fed by the same key person or their buddy at each feed whenever possible.
The closeness of feeding helps to develop a bond between the baby and key worker or buddy. Close relationships help the baby to feel more secure with us here at Grafton Childcare. Babies with close early relationships go on to develop other relationships more easily.
When should bottle use be stopped?
Bottle use should be reduced from 12 months and completely stopped as soon as possible after this. This is to avoid developing a more established habit which may be hard to break and to ensure good oral development.
Facts about Cups
Whether breast or bottle-fed, babies need to progress to drinking from a cup, usually alongside breast/bottle during weaning. There are so many different cups on the market that claim to make the transition easy for children – it can be confusing for parents and us! Here are the main categories of cups:
Open Cups – these are cups without lids.
Unvalved/sippy cups/beakers – these are cups that have lids and usually have a spout with holes in - if they are held upside down the liquid should drip freely from the holes.
Valved cups – these are lidded cups which have valves inside to stop the liquid pouring/leaking out. They need to be bitten or sucked hard to access the drink inside – if they are held upside down no liquid will drip from them.
Sports Caps – these need to be pulled open and then sucked to access the drink. Children who drink mainly from valved cups and sports cap cups are at risk of damage to their developing mouth shape as well as of dental decay. Valved cup spouts are designed to be non-spill. They are usually made of hard plastic and need to be bitten or sucked hard to release liquid which is not good for growing teeth and mouths as it affects how a child learns to sip. This may result in the tongue coming further forward than it should, the back of the tongue becoming stronger than it should and the lips becoming weaker than they should be, causing dribbling. Drinking from these cups may also concentrate the flow of liquid onto the teeth - any liquid other than water can cause decay if concentrated onto the teeth in this way. In 2008, 31% of 5-year-olds showed obvious signs of dental decay.
Often, parents choose valved cups for convenience and cleanliness. In many ways they are no different to bottles, so moving from bottles to valved cups is not a recommended step.
Children who mainly drink from non-valved lidded cups do not need to suck as hard to release liquid; however, the spouts are often hard. Open cups are recommended as they allow children’s delicate, developing mouths and teeth to grow as they should.
Recommendations
1. Babies should be given the chance to drink from a cup from weaning at six months (or when they can sit up unsupported and hold something on their own)
2. They can be weaned immediately to an open cup with small amounts of liquid to reduce the risk of spills as well as plenty of help and patience from the adults around them
3. Give babies empty cups to play with so that they get used to holding them
4. Mop up any spills calmly and patiently
5. Give heaps of praise for drinking from open cups
When should a baby be introduced to an open cup?
We will introduce an open cup at Grafton Childcare at weaning, around six months, or when the baby is old enough to sit up unsupported and hold something on their own. This is recommended by dieticians, dentists and speech and language therapists.
How can you tell if a lidded cup is valved or not?
Hold the cup upside down – if the liquid runs freely there is no valve. If the cup has a valve no liquid will leak out. If you try drinking from a valved cup you can see just how hard babies need to suck to drink the liquid.
Some helpful tips for successful weaning onto open cups.
Only place a small amount of liquid in the cup. Small amounts are more manageable and mean there is less mess to clean up if spilled.
Mop up spills calmly – be prepared with cloths close at hand. A calm, stress-free experience for baby and adults will mean they are more likely to achieve success and want to use an open cup.
Give heaps of praise. Give the baby an empty cup to play with. Playing with cups helps the baby learn how to hold and control them.
How can valved cups affect a baby’s oral development?
Children who use mainly valved cups are at risk of damage to their developing mouth shape. When used with any liquid other than water, children are also at increased risk of dental decay, as the flow of liquid is concentrated onto the teeth.
Valved cup spouts need to be bitten or sucked hard to release liquid. This may result in the tongue coming further forward than it should, the back of the tongue becoming stronger than it should and the lips becoming weaker than they should be, causing dribbling and preventing children from learning how to sip.
Whether breast or bottle-fed, babies need to progress to drinking from a cup, usually alongside breast/bottle during weaning. There are so many different cups on the market that claim to make the transition easy for children – it can be confusing for parents and us! Here are the main categories of cups:
Open Cups – these are cups without lids.
Unvalved/sippy cups/beakers – these are cups that have lids and usually have a spout with holes in - if they are held upside down the liquid should drip freely from the holes.
Valved cups – these are lidded cups which have valves inside to stop the liquid pouring/leaking out. They need to be bitten or sucked hard to access the drink inside – if they are held upside down no liquid will drip from them.
Sports Caps – these need to be pulled open and then sucked to access the drink. Children who drink mainly from valved cups and sports cap cups are at risk of damage to their developing mouth shape as well as of dental decay. Valved cup spouts are designed to be non-spill. They are usually made of hard plastic and need to be bitten or sucked hard to release liquid which is not good for growing teeth and mouths as it affects how a child learns to sip. This may result in the tongue coming further forward than it should, the back of the tongue becoming stronger than it should and the lips becoming weaker than they should be, causing dribbling. Drinking from these cups may also concentrate the flow of liquid onto the teeth - any liquid other than water can cause decay if concentrated onto the teeth in this way. In 2008, 31% of 5-year-olds showed obvious signs of dental decay.
Often, parents choose valved cups for convenience and cleanliness. In many ways they are no different to bottles, so moving from bottles to valved cups is not a recommended step.
Children who mainly drink from non-valved lidded cups do not need to suck as hard to release liquid; however, the spouts are often hard. Open cups are recommended as they allow children’s delicate, developing mouths and teeth to grow as they should.
Recommendations
1. Babies should be given the chance to drink from a cup from weaning at six months (or when they can sit up unsupported and hold something on their own)
2. They can be weaned immediately to an open cup with small amounts of liquid to reduce the risk of spills as well as plenty of help and patience from the adults around them
3. Give babies empty cups to play with so that they get used to holding them
4. Mop up any spills calmly and patiently
5. Give heaps of praise for drinking from open cups
When should a baby be introduced to an open cup?
We will introduce an open cup at Grafton Childcare at weaning, around six months, or when the baby is old enough to sit up unsupported and hold something on their own. This is recommended by dieticians, dentists and speech and language therapists.
How can you tell if a lidded cup is valved or not?
Hold the cup upside down – if the liquid runs freely there is no valve. If the cup has a valve no liquid will leak out. If you try drinking from a valved cup you can see just how hard babies need to suck to drink the liquid.
Some helpful tips for successful weaning onto open cups.
Only place a small amount of liquid in the cup. Small amounts are more manageable and mean there is less mess to clean up if spilled.
Mop up spills calmly – be prepared with cloths close at hand. A calm, stress-free experience for baby and adults will mean they are more likely to achieve success and want to use an open cup.
Give heaps of praise. Give the baby an empty cup to play with. Playing with cups helps the baby learn how to hold and control them.
How can valved cups affect a baby’s oral development?
Children who use mainly valved cups are at risk of damage to their developing mouth shape. When used with any liquid other than water, children are also at increased risk of dental decay, as the flow of liquid is concentrated onto the teeth.
Valved cup spouts need to be bitten or sucked hard to release liquid. This may result in the tongue coming further forward than it should, the back of the tongue becoming stronger than it should and the lips becoming weaker than they should be, causing dribbling and preventing children from learning how to sip.
Facts about Dummies
Most babies have a natural strong sucking reflex and a dummy can help to calm or settle them. Ongoing research shows that for babies up to six months that have a dummy to go to sleep there may be a reduction in the risk of cot death. Dummies can help premature babies develop their sucking reflex.
Dummy use can have a harmful effect on children’s health, establishment of breastfeeding, physical development as well as communication, speech and language development. They can harbour bacteria which are passed into the mouth and can cause tummy upsets, ear infections that could lead to glue ear and infections leading to dental problems. If dipped into something sweet they can cause tooth decay. As the bone is still forming, dummies can change the shape of the upper jaw and tooth alignment by pushing upper teeth forward to create a space between the upper and lower teeth, potentially leading to a brace or even surgery in later life.
With the teeth out of line, some speech sounds may be more difficult. Speech could also be affected if the baby has the dummy in their mouth for long periods of time as they become less inclined to babble – a vital stage of learning how to make sounds. As they get older they may possibly talk with the dummy in their mouth preventing them from making sounds correctly and using other sounds instead to compensate.
Glue ear, which is linked to dummy use, can have a huge impact on the child’s hearing and ability to develop listening skills, which are important for learning to understand and use language.
From 12 months, dummy use can develop into a habit and can be difficult to give up for both children and carers. This becomes even more difficult as the child gets older.
Recommendations
1. It is recommended that from six months dummy use is reduced with the aim of moving on completely from 12 months
2. A dummy is not recommended until breastfeeding is well established (around 6-8 weeks)
3. Tune into the baby’s cries to understand what they need
4. Find alternative ways of soothing/distracting the baby
5. Clean and sterilise dummies for babies up to six months; beyond six months make sure they are cleaned thoroughly
6. Store dummies in clean, individual containers (not plastic bags)
Follow the ‘look, listen and think’ rule.
LOOK at your baby. Can you see something that is making them sad that you can fix?
LISTEN to their cries – you might be able to tell what they want by their different cries.
THINK about what else could help – try distracting them with a song, cuddle, favourite toy, etc.
Why can dummies soothe or calm babies?
Babies have a natural sucking reflex and many babies are happiest when they are sucking on something. Babies can also be soothed or calmed by rhythmic movements, such as rocking or being patted, or by gently talking or singing to them. Introduction of a dummy before breastfeeding is established is not recommended.
Why do dummies need to be kept clean?
To prevent bacteria causing tummy upsets and other infections, some of which could lead to dental problems or glue ear. Dummy use is linked with otitis media (glue ear). Children with hearing difficulties do not develop their listening skills to the best of their ability.
Why is it better to give up a dummy before 12 months?
It is easier to give up dummy use before 12 months before it becomes a habit. Babies only have fleeting attention so it is easier to distract them with something other than the dummy before 12 months.
In what ways could dummy use affect children’s communication, speech and language development?
Difficulty in producing sounds accurately. Ear infections/glue ear can affect a child’s ability to listen and attend. When children have a dummy in their mouth they are less inclined to talk.
This could be as a result of malformation of the teeth/jaw. Having the dummy in can prevent babbling in babies or cause incorrect speech patterns in older children. Listening and attention skills are the foundations for the development of speech and language.
Most babies have a natural strong sucking reflex and a dummy can help to calm or settle them. Ongoing research shows that for babies up to six months that have a dummy to go to sleep there may be a reduction in the risk of cot death. Dummies can help premature babies develop their sucking reflex.
Dummy use can have a harmful effect on children’s health, establishment of breastfeeding, physical development as well as communication, speech and language development. They can harbour bacteria which are passed into the mouth and can cause tummy upsets, ear infections that could lead to glue ear and infections leading to dental problems. If dipped into something sweet they can cause tooth decay. As the bone is still forming, dummies can change the shape of the upper jaw and tooth alignment by pushing upper teeth forward to create a space between the upper and lower teeth, potentially leading to a brace or even surgery in later life.
With the teeth out of line, some speech sounds may be more difficult. Speech could also be affected if the baby has the dummy in their mouth for long periods of time as they become less inclined to babble – a vital stage of learning how to make sounds. As they get older they may possibly talk with the dummy in their mouth preventing them from making sounds correctly and using other sounds instead to compensate.
Glue ear, which is linked to dummy use, can have a huge impact on the child’s hearing and ability to develop listening skills, which are important for learning to understand and use language.
From 12 months, dummy use can develop into a habit and can be difficult to give up for both children and carers. This becomes even more difficult as the child gets older.
Recommendations
1. It is recommended that from six months dummy use is reduced with the aim of moving on completely from 12 months
2. A dummy is not recommended until breastfeeding is well established (around 6-8 weeks)
3. Tune into the baby’s cries to understand what they need
4. Find alternative ways of soothing/distracting the baby
5. Clean and sterilise dummies for babies up to six months; beyond six months make sure they are cleaned thoroughly
6. Store dummies in clean, individual containers (not plastic bags)
Follow the ‘look, listen and think’ rule.
LOOK at your baby. Can you see something that is making them sad that you can fix?
LISTEN to their cries – you might be able to tell what they want by their different cries.
THINK about what else could help – try distracting them with a song, cuddle, favourite toy, etc.
Why can dummies soothe or calm babies?
Babies have a natural sucking reflex and many babies are happiest when they are sucking on something. Babies can also be soothed or calmed by rhythmic movements, such as rocking or being patted, or by gently talking or singing to them. Introduction of a dummy before breastfeeding is established is not recommended.
Why do dummies need to be kept clean?
To prevent bacteria causing tummy upsets and other infections, some of which could lead to dental problems or glue ear. Dummy use is linked with otitis media (glue ear). Children with hearing difficulties do not develop their listening skills to the best of their ability.
Why is it better to give up a dummy before 12 months?
It is easier to give up dummy use before 12 months before it becomes a habit. Babies only have fleeting attention so it is easier to distract them with something other than the dummy before 12 months.
In what ways could dummy use affect children’s communication, speech and language development?
Difficulty in producing sounds accurately. Ear infections/glue ear can affect a child’s ability to listen and attend. When children have a dummy in their mouth they are less inclined to talk.
This could be as a result of malformation of the teeth/jaw. Having the dummy in can prevent babbling in babies or cause incorrect speech patterns in older children. Listening and attention skills are the foundations for the development of speech and language.
Partnership with Parents
At all times Grafton Childcare will endeavour to be sensitive to parents’ personal circumstances. Parents have a right to their own views and preferences but it is our responsibility as professionals to provide best practice here at Grafton Childcare.
Information about Grafton Childcare's policy and procedures and hygiene guidelines are shared openly with parents via this website, on our weekly blog and via our "Welcome Packs" given to parents when a child starts at Grafton Childcare.
The individual child’s current needs and preferences for dummies, bottles and cups are discussed during induction. If the child is not using a dummy or bottle then no further steps needs to be taken.
For all other situations a settling-in period is agreed and a date set for review. Settling-in review will be held when we will discuss the child’s readiness to move on with parents. If appropriate, we will outline small steps to move on. An additional review time will be agreed if necessary. Parents may find the moving on documents below helpful.
Grafton Childcare will continue to monitor all children’s bottle, cup and dummy use to ensure it is appropriate according to recommendations. Your child's key worker and or the manager will have open discussions with parents as necessary. Parents should decide how they would like their child to move on and be supported in this at each stage and Grafton Childcare will provide best practice here at each stage. All parents will be consulted about policy and procedures reviews
At all times Grafton Childcare will endeavour to be sensitive to parents’ personal circumstances. Parents have a right to their own views and preferences but it is our responsibility as professionals to provide best practice here at Grafton Childcare.
Information about Grafton Childcare's policy and procedures and hygiene guidelines are shared openly with parents via this website, on our weekly blog and via our "Welcome Packs" given to parents when a child starts at Grafton Childcare.
The individual child’s current needs and preferences for dummies, bottles and cups are discussed during induction. If the child is not using a dummy or bottle then no further steps needs to be taken.
For all other situations a settling-in period is agreed and a date set for review. Settling-in review will be held when we will discuss the child’s readiness to move on with parents. If appropriate, we will outline small steps to move on. An additional review time will be agreed if necessary. Parents may find the moving on documents below helpful.
Grafton Childcare will continue to monitor all children’s bottle, cup and dummy use to ensure it is appropriate according to recommendations. Your child's key worker and or the manager will have open discussions with parents as necessary. Parents should decide how they would like their child to move on and be supported in this at each stage and Grafton Childcare will provide best practice here at each stage. All parents will be consulted about policy and procedures reviews
| moving_on_to_open_cups.pdf |
| moving_on_from_dummies.pdf |
| moving_on_from_bottles.pdf |
Grafton Childcare's Policy for the hygiene and storage of Bottles, Cups and Dummies
|
Ages
Under 12 months |
Bottles Ready-made feeds will be prepared and transported following Food Standards Agency guidelines Before sterilising we will always wash the bottles in hot soapy water using a cleaning brush and ensure they are thoroughly rinsed Always sterilise according to instructions immediately before making up the feed Once used or after two hours, any remaining liquid will be poured away and the bottle washed in hot soapy water as soon as possible We will endeavour to send bottles home after they have been washed thoroughly |
Cups All cups should be washed in hot, soapy water before use Any remaining liquid will be poured away and the cup rinsed/washed immediately Should be washed and sterilised if dropped on the floor or contaminated in any other way All lids from cups will be sterilised |
Dummies Should be transported to Grafton Childcare in a sterilised, plastic, lidded container, not loose in your child's bag. Each individual dummy should be kept in its own lidded container Should be washed in hot soapy water and sterilised before each use Should be washed and sterilised if dropped on the floor or contaminated in any other way Should not be attached by clip to a child’s clothing as contamination could take place |
|
Over 12 months
|
Bottles
If still being bottles will be washed before sterilising we will always wash the bottles in hot soapy water using a cleaning brush and ensure they are thoroughly rinsed paying particular attention to teats/small bottle parts, thoroughly rinsed, then sterilised Once used any remaining liquid should be poured away and the bottle washed in hot soapy water as soon as possible We will endeavour to send bottles home after they have been washed thoroughly |
Cups
Consideration is given to how long cups are left out before use Cups are stored in such a way as to avoid contamination |
Dummies
Should be transported to Grafton Childcare in a sterilised, plastic, lidded container, not loose in your child's bag. From this point dummies need only be washed in hot soapy water and rinsed rather than sterilised before use and following contamination Should not be attached by clip to a child’s clothing as contamination could take place |
Created April 2015
