# Situation: A nurse is the charge nurse of the 30-bed postpartum ward of a government hospital. Each shift is staffed by registered nurses and nursing attendants. A mother on the ward will not breastfeed because her physician advised against it for a medical reason, and infant formula has been prescribed for her baby. Under the Milk Code (Executive Order 51), what should the nurse do?

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> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A nurse is the charge nurse of the 30-bed postpartum ward of a government hospital. Each shift is staffed by registered nurses and nursing attendants.

A mother on the ward will not breastfeed because her physician advised against it for a medical reason, and infant formula has been prescribed for her baby. Under the Milk Code (Executive Order 51), what should the nurse do?

## 보기

1. Show all the mothers on the ward how to prepare formula in a class
2. Avoid any talk of formula, since the Milk Code bans formula teaching
3. Teach this mother alone how to prepare and give the formula safely **✔ 정답**
4. Give her the free formula samples a company left for such cases

**정답: 3**

## 해설

The Milk Code restricts the promotion of breastmilk substitutes, bottles, and teats; it does not forbid their proper use. When formula is medically indicated, the health worker teaches the individual mother safe preparation and feeding. Group demonstrations and free samples from companies are forms of promotion that the Code prohibits.

## 심화 해설

Understanding the Milk Code (EO 51)

The Philippine Milk Code, formally Executive Order 51, was enacted to regulate the marketing and promotion of breastmilk substitutes, feeding bottles, and teats. Its core purpose is to protect and promote breastfeeding by preventing commercial pressures that might discourage mothers from nursing. However, the Code does not prohibit the legitimate use of formula when there is a valid medical indication. Instead, it draws a clear line between promotion and proper clinical use [1].

When a physician prescribes infant formula for a specific medical reason, the health worker’s duty shifts to ensuring the mother can prepare and administer it safely. This is not a promotional activity but a necessary component of individualized patient care. Group demonstrations, distribution of free samples, or displaying formula brand names in a ward would cross into promotion and are prohibited [1].

Key point! The Milk Code restricts *marketing*, not *medical use*. A prescribed formula is a treatment, and teaching its safe preparation is a nursing responsibility.

Why the Other Options Are Incorrect

| Option | Why It Is Wrong | Code Violation |
| --- | --- | --- |
| 1. Group class on formula preparation | Teaching all mothers, including those who are breastfeeding, constitutes group promotion of a breastmilk substitute. | Yes — prohibited promotion |
| 2. Avoid any talk of formula | This misinterprets the Code. It does not ban formula teaching when medically indicated; it bans promotion. | No violation, but clinically unsafe |
| 4. Give free formula samples | Distributing company-provided samples is a direct form of marketing prohibited by the Code. | Yes — prohibited promotion |

Clinical Application for the Nurse

The nurse should teach this mother alone, in a private setting, covering proper hand hygiene, correct dilution, safe storage, and feeding technique. The teaching must be brand-neutral; the nurse should not endorse a specific product. This approach aligns with the Code’s intent while fulfilling the duty to provide safe, individualized care when breastfeeding is medically contraindicated [1].

Watch out! In licensure exams, the Milk Code is often tested by contrasting *individualized medical teaching* (allowed) with *group promotion or sample distribution* (prohibited). The presence of a physician’s prescription is the key factor that shifts the action from prohibited to required.
References (research sources)

- [1]Mother-Baby Friendly Philippines: Using Citizen Reporting to Improve Compliance to the International Code of Marketing of Breastmilk Substitutes.Research articleReinsma K, Ballesteros AJC, Bucu RAA, Dizon TS, Jumalon NJU, Ramirez LC (2022) · DOI: 10.9745/GHSP-D-21-00071

## 임상 시나리오

Milk Code (EO 51) Formula TeachingIndividualized teaching for medically indicated formula use
When formula is medically indicated and prescribed by a physician, teach only that mother safe preparation and feeding. This is clinical care, not promotion.

Prohibited activities include group demonstrations, free formula samples from companies, and displaying brand names in the ward.

CautionNever conduct formula teaching in a group setting or distribute company samples, even if labeled for medically indicated cases.

## 핵심 개념

- **Milk Code (EO 51)** — Philippine executive order regulating marketing of breastmilk substitutes, bottles, and teats to protect breastfeeding.
- **Breastmilk substitute** — Any food marketed as a partial or total replacement for breastmilk, including infant formula.
- **Medical indication** — A valid clinical reason documented by a physician that justifies use of formula instead of breastfeeding.
- **Promotion vs. clinical use** — The Code prohibits promotional activities like group demos and free samples but allows individualized teaching for prescribed formula.

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