Making up bottle feeds

[tinygigolo]

My DD will be starting nursery in a couple of weeks, she's 9mo. She is currently on formula during the day as I'm back at work and my DH is on parental leave at the moment - she usually has one bottle a day.

Nursery have asked us to take in the correct amount of cool boiled water in a bottle and the powder separately, so that they can tip the powder into the water to make up the bottle for her. My understanding was that powder had to be made up with hot water or it could make your baby ill - is the nursery in the wrong or am I over stressing? Should I say something?

[BunloafAndCrumpets]

I have ff my baby since she was tiny. I used to use boiling water to make up feeds but moved on to using cooled boiled water and powder when I was out and about when she was about 4mo old. I saw other people doing it and tried it with no ill effects. Interestingly, in the last couple of months our formula box has changed their prep instructions and now says you can make feeds up with cooled boiled water, where previously it said to use boiling water and then let the milk cool.

I think the rationale behind using boiling water is that the powder isn't sterile and so the boiling water kills the bugs. I wonder if in practice, bugs don't get a chance to grow if the milk is used straight away.

Personally I would be happy with what your nursery are proposing, but if you're not happy, tell them. I guess an alternative is to supply them with a fridge-cold pre made formula that they can heat up?

[FATEdestiny]

At 9 months old is she crawling? Is she putting stuff in her mouth with her hands (like when eating)? Is she picking up toys and chewing them?

In which case - why be concerned with sterilising?

It is this common sense leap of faith that is needed when you realise that your child has far greater chance of coming into contact with germs through normal play than through the formula he drinks.

The need to use boiled water is to do with sterilising. No need to sterilise anymore. Of course it does no harm to use boiled water and sterilise if you want to and it is convenient, but there is much less of a need to do this at 9 months old.

[Focusfocus]

The issue with formula is that formula powder is not sterile (the boxes still state that) and the powder itself may contain bacteria like salmonella or worse enterobacter sakazaki. Hence the need for boiled hot water no less than 70 for the formula.

At nine months? Who knows.

[NickyEds]

As FATE says I sometimes feel a total mug sterilising dds bottles when i look over and see ds picking a dummy up off the floor and putting it in her mouth! But sterilise i do, because that's the current best practice. Formula powder isn't sterile so needs to be made up with very hot water as per the instructions on the tin- or at least SMA first milk does. I would expect nursery to do it like this and yes, I would say something- "I want my baby's milk made up as it says on the tin please" . I'm sure they'll be fine about it.

[tinygigolo]

That was my thought, I'm less concerned about bottle sterilising, but I was under the impression that there were potential nasties in formula that needed killing.

Hmm, maybe I will just ask nicely if they wouldn't mind

[NickyEds]

Don't ask, tell, you're paying them. I'm very surprised they aren't just doing it correctly as a matter of course!

[BunloafAndCrumpets]

I think the thing is that formula milk provides an ideal culture medium - it's warm and nutritious so bacteria can thrive in it. If you don't sterilise bottles then the residue that's left in the crevices will be a lovely home for lots of bacteria to flourish. This is entirely different to the environment of a plastic toy or the floor - a cold, nutrient-free surface isn't as likely to support numerous bacteria. So I would sterilise formula milk bottles, personally.

I agree with pp; tell the nursery how you'd like them to care for your baby, they should listen. But I'm not sure that what they are doing isn't 'best practice' now..as I said above, the instructions on the brand of formula we use have changed and now recommend the proposed method!

[Junosmum]

For decades they advised what the nursery are doing and the change to boiling water is pretty recent. Part of me feels its a bit of pro bf propaganda (making ff harder) as they haven't changed how they make formula from a sterile environment to a none-sterile one.

[Artandco]

I would just take a ready made formula carton tbh for one feed per day. Easy, safe

[BunloafAndCrumpets]

That's interesting Juno. Most of pregnancy and baby advice seems relatively evidence-free; wonder where this came from..

[BasinHaircut]

Why don't you make up the formula, chill in the fridge the night before and just send in to be warmed up? That way you can make it with boiling water but the nursery staff don't have to do it themselves.

[BasinHaircut]

Or yes, pre-made cartons.

Unfortunately I didn't have that luxury as DS was on prescription formula so it never occurs to me!

[frangipani13]

Interestingly our LO is on prescription formula and the instructions on the tin say to use boiled water that is room temp rather than boiling. When out and about we use your nursery's method and so far she has been OK.

[BunloafAndCrumpets]

Same here frangi.

[tiktok]

Oh dear....it's not breastfeeding propaganda! It's based on the European Food Safety Authority's biohazard reports.

www.efsa.europa.eu/en/press/news/biohaz041118

Of course the environment in which formula powder is made is the same as ever - but research into what the risks are is new.

The risks are small, and affect vulnerable babies more than older ones, and babies cared for outside the home rather than inside....but a nursery should really be checking all the right boxes, IMO, and in any case should follow parental preferences.

[pookamoo]

This is the third thread I have seen this week on this topic.

here is another with several useful links

Guidelines are there for a reason and should ideally be followed by everyone. Tiktok is right.

[pookamoo]

bunloaf most advice I have been given re. pregnancy and baby has definitely been based on evidence.

[BunloafAndCrumpets]

Hehe lucky you pooka, am pleased to hear it!

Thanks for the link tiktok

[BunloafAndCrumpets]

So reading that link - cooled boiled water is ok to use to reconstitute powder, as long as the rest of the guidance is followed (sterilise equipment, use quickly). However in vulnerable babies, pre-made formula is best - have I interpreted that correctly?

[BasinHaircut]

Really frangi and bun? That's interesting. Which one?

We had Aptamil Pepti.

[BunloafAndCrumpets]

Nutramigen 1

Until a few weeks ago it said to use boiling water, then the tins started coming with leaflets saying 'new preparation instructions!', and said to use cooled boiled.

They didn't explain the change though. It's weird as it's hardly a selling point for the formula - well it is but it doesn't need to have a selling point as its prescription for babies who are intolerant to shop-bought, if you see what i mean!

[frangipani13]

Nutrimigen here too. A friend's son is also on this and their paediatrician explained that boiling water nukes the probiotics contained in the formula, which for our babies are quite key. My LO is now 5 months and as other poster pointed out, puts everything in her mouth. I do think it's important to get a happy medium between maintaining good hygiene practices and exposing them to every day bacteria to build up their immunity. We have friends who are doctors who also believe this and are way more lax in regard to sterilizing for their older babies.

[BunloafAndCrumpets]

Ahh that's interesting about the probiotics! I have a pp machine - will try making up the milk differently as my dd still has v runny poo - maybe it will make a difference!

I'm also a dr and happy to let my baby roam around putting stuff in her mouth, but wouldn't take a risk with sterilising stuff users for milk - different strokes for different folks I guess!

[NickyEds]

As I understand it the risks of using cooled water are very small but the consequences can be very serious. Nursery should be following the instructions on the tin. Once made up you can safely use milk for two hours so it isn't a major hardship.

It's not bf propaganda designed to make ff harder . No one's out to deliberately make ff harder.