Bottle feeding - what's the procedure?

[Pumpkin20]

I wonder if you could help a friend of mine. She gave birth last week and after a very traumatic delivery her baby wouldn?t take to the breast. She?s now bottle feeding but hasn?t had a chance to read up on it and she?s been getting a lot of conflicting advice about making up bottles.

One midwife is saying that current advice is that each bottle should be made when you need it and not in advance. Another is saying that you can make up the water in the bottle but not add the powder until the last minute. Others are saying that of course you can make up a day?s worth of bottles in advance ? how else is it practical?

What have you been told? What do you do? Any advice and tips very gratefully received.

She?s home from hospital tomorrow (Wed) so responses by then would be great.

Many, many thanks,

Pumpkin

[tiktok]

The way bottle feeding guidance has changed has led to a lot of confusion but really, the instructions are clear enough now for people to be able to help mothers without all this conflicting advice.

Your friend can see what she should be doinf here and there is a link to a leaflet she should already have had.

Does your friend know the option of breastfeeding is still open to her? It's sad when a bad delivery leads to a change in feeding plans, and with the right support, mothers can and do breastfeed and find a lot of emotional healing in doing so.
Hope this helps.

[pelvicflawed]

Hi pumpkin - this is one of my 'bugs' as a new mum that the advice often is confusing - I was only reading a parenting mag the other day and it contradicted itself in the same article. The link you've been give I think gives the current up to date information. My baby is six months old now and I've seen mums doing all sorts of different things and read different information so I don't think the correct advice is getting out there to mums. The first time I was aware that the advice had changed (I did read the formula packet instructions but that didn't explain why) was when I read an article in an NCT mag which was really useful in explaining the reasoning - but I don't think any health professional has ever advised me about not making up feeds in advance. I can't advise on breastfeeding (only managed a few weeks but if there is a chance give it a go if not don't worry a happy baby and mummy is the most important thing). The way I've managed to do my formula feeding and cut down on the wait with a hungry baby is to make sure the bottle is alawys sterile and ready, make up fresh formula with hot water as per instructions and then to speed up the cooling stage (and save water!) rather than run it under a tap pop the bottle in a jug of cooled water with ice cubes - it then only takes a few mins to cool (hopefully not gone against any advice with that tip!). When out and at night I used cartons expensive I know but it was all too much faff taking out flasks of hot water etc, also at night couldn't be bothered to boil kettle etc. Anyway if anyone else has any advice tips that would be great to hear I don't think the whole formaula thing has been explained well to new mums by professionals imo.

[riab]

I always make up bottles with boiled water and store them in the fridge for up to 24 hrs, then when feeding time comes round I can measure out the powdered formula. You can also get satchets of formula which have the exact amount for a 7oz bottle. (too big right now but good for when her baby is bigger)

Actually for a long time I made the bottles up in advance and popped them in the fridge.

If she has mumsnet access point her here

[tiktok]

Guidance says "Infant formula powder is not sterile; the risks associated with using powdered infant formula milk are reduced if:

• feeds are made up using boiled water that is greater than 70ºC; in practice, this means using water that has been left to cool for no more than half an hour.
• feeds are made up fresh for each feed; storing made up formula milk may increase the chance of a baby becoming ill and should be avoided.
• any left over milk is thrown away.
• mothers who require a feed for later are advised to keep water they have just boiled in a sealed flask and make up fresh formula milk when needed or use a liquid ready-to-feed formula."

Looks like keeping the water in the fridge and adding powder to it later is not following this....the point of the 70 degrees C is to kill any bacteria in the formula powder.

[TwinkleInSantasEye]

Have to say, in the early days before we got a routine established my DS would NOT wait for me to make up every feed at the time. I used to make up feeds in advance. Once I realised the reasoning behind the new advice I stopped doing this.

Now I tend to store bottles of cool boiled water in the fridge. I then add freshly boiled water in the right proportion to make it hot, but not boiling, then add the formula and cool to the right temperature. This way he's only waiting a couple of minutes for it to cool rather than 10 minutes plus. Have to say I've never measured the temperature to see if it's 70 plus degrees, but the advice on the HIPP website suggests 50-60 degrees is OK. Touch wood I've had no problems though.

[TwinkleInSantasEye]

Actually, while we're (kind of) on the subject, has anyone ever found anything in a box of formula that shouldn't be there. I recently had to throw away an almost full tub of Cow & Gate because I found two or three small brown seed-like things in it. I didn't take it back or complain though because I couldn't be one hundred percent certain that I hadn't somehow contaminated it. Must say this made me more concerned about the safety of formula powder.

[LittleHarrysMum]

Hi,

I have always made up 24 hours worth of feeds and kept them in the fridge and (touch wood) have had no probs with this.

[TwinkleInSantasEye]

I was just thinking actually. As the problem seems to be bacteria that may be in the powder, it must be safer to make up feeds in advance using really hot water than to make them up at the time with water that's probably not as hot. I read on another thread that the advice changed not because storing in the fridge is bad, but because there had been problems caused by incorrect storage. Thinking of going back to making up in advance now.

[riab]

I think like alot of advice what happens is you get one or two cases where someone misreads the information or takes a risk or just plain doesn't KNOW what to do safely and so you end up with a tragedy.

For example one of the reasons that in this country they are so adamant about boiling water for feeds is that they take the WHO guidelines as the starting point. The WHO guidelines are designed for use across the world and so they specify using boiled water because in many ocunteries the quality of tap water isn't good. If you are confident about the quality and safety of tap water then you may choose to use that.

Likewise if you figured that by the time baby was grabbing at the bottle teat, crawling all over the floor, chewing dust etc he was getting plenty of germs you may stop sterlising.

Everything you do with a baby/child has 'potential' risks attached to it, from making up a bottle to going to the shops. We all make our own decisions about our risk factors.

Personally I was religous about sterilising - still do it now as I don't want traces old milk left in bottles. I also wash up with antibac washing up liquid. But I always make up bottles of water in advance and I also take out a bottle of water and leave it by my bedside for if he wakes up in the night. I figured that if UK tap water was going to kill him then we didn't have much chance of keeping him alive anyway.

(PS this was all once he got past 8 weeks, for the first two months i nearly went mad worrying over it all. clean sterile towel laid out when making up bottles, wash hands with anti bac 2x during each bottle session etc)

[tiktok]

Some errors, there, riab, sorry

The rule is to boil the water (and then cool it) not because there is anything especially wrong with the water in the UK - though you'd be advised to let water run free for a bit as there can be bugs inside the tap - but because i) the powder is not sterile and ii) some brands of powder won't mix well with unheated water.

I think, like you, it makes sense to be extra careful with a tiny baby, and then to relax a bit about cleanliness when the baby starts eating carpet fluff (and worse!)

[tiktok]

PS: it's worth pointing out that the guidance in the UK (and Europe) changed not because some people did not obey the previous rules, but because people were obeying them, but the powder had a lethal bacteria in it, and babies became seriously ill and a few died. This has been an issue for many years, though of course it is very rare indeed. If you want to know more, google on formula deaths enterobacter sakazakii.

[TwinkleInSantasEye]

So Tiktok, can I just clarify? Given that for a baby like mine it is not practical to make up the feed with really hot water at the time it is needed (as he will not wait for it to cool) is it safer to

a) make up the feed with water that's not as hot as recommended - ie using partly refridgerated and partly fresh boiled water
b) make up the bottles in advance with really hot water and store in the fridge then warm up when needed?

[tiktok]

Twinkle, best to look at the guidance for this. It says to keep the water hot in a flask and then make up the feed, if you need to prepare in advance.

I don't know, sorry, which of the alternatives you suggest would be the safer one.

[TwinkleInSantasEye]

That's quite scary Tiktok. Didn't realise quite how nasty the bacteria are that are being referred to - thought it was just things causing gastro-enteritis. It's quite amazing that this state of affairs is being allowed to continue.