Tee2072 I hope you haven't hidden the thread. I find it very useful to get all points of view as it draws out questions and helps me think of how best to communicate this issue.
Is powder sterile & what about the USA?
In order to address your question about the powder not being sterile and what happens in the USA.
Yes it is shocking that formula powder is not sterile. Lots and lots of people don't know about this.
I understand as Mrs Badger has said that it is unfortunately impossible to make the powder 100% guaranteed sterile, whereas cartons of liquid have been subject to the UHT process (ultra high temp).
You ask about the USA. Well formula is not sterile in the USA either. The WHO information and guidelines apply across the whole world. I don't know why the US guidelines are not in accordance with the international WHO guidelines. (It may well have something to do with the US paeds being influenced by the formula manufacturers).
The International Formula Council whose members are predominately based in the US admit on their website that "Powdered formulas are not sterile"!
What are the guidelines?
I think that the message about making the formula with hot water which is > than 70 degrees C has become confused into "do not make your feeds in advance".
Now this is because this is what the formula tins say and what some of the basic leaflets say and what HCPs incorrectly say.
What they should be saying is:
Formula powder is not sterile. In fact it sometimes contains a very very nasty bacteria called E.sakazakii. As has been mentioned above this is not your common or garden everyday household bacteria.
Scientific tests have shown that the best way to manage this risk is to make up the formula with water which is at least 70 degrees C.
See results of the WHO study here.
As most of us are aware, bacteria multiply with time and more quickly at room temperature. We can inadvertantly introduce bacteria into the milk by: unwashed hands, surfaces, incorrect sterilisation the fact that the powder has been open for a few weeks etc etc.
Thus you put these 2 points above together and you come up with the Gold Standard for preparation:
- make each feed fresh using water which is > 70 degrees C.
Now it is at this point where lots of people panic and say "I can't do that - it's impossible".
I agree that it is very very difficult but you have options:
Using liquid ready to feed cartons. (This is what I did when DS was very young and did when out and about).
Then you have the option of boiling the kettle and storing water in a flask. This cuts down on time to boil and slightly cool the water.
Then you have the option of making in advance - YES MAKING IN ADVANCE! Fancy that - the very thing which people think is the big no no. This is actually recommended as the option when you can't do one of the above.
This is what I did when at home when DS was a bit older. I used to make a max of 3 bottles but the key thing is that I made it with water which was at least 70 degrees. I rapidly cooled and refridgerated.
I have not made these options up - they are the guidelines.
Here is the NHS leaflet.
The BIG NO NO - is do not make up formula with cool water!
Now other people have mentioned microwaves. Personally I never used them and bought into the "hot-spot" risk.
Other people have mentioned using hot water for say 4oz adding powder and then adding 3oz. I'd like to see some evidence or be persuaded that the formula can all dissolve in the smaller volume of liquid. Also if people use this method they need the cooler water to be measured accurately in order to end up with exactly 7oz liquid with 7 scoops of powder.
Additional recent info
The FSA issued a press release last month stating that:
"The Agency is reminding parents and childcarers who use powdered infant formula to use hot water to make up a feed. Formula powder isn?t sterile, so occasionally it could contain harmful bacteria, which could make babies ill. Using water that is 70°C, or higher, will kill any harmful bacteria in the powder.
In practice, this means boiling at least 1 litre of water in a kettle and leaving it to cool for no more than half an hour.
Recent research funded by the Agency has confirmed the importance of using hot water to make up powdered formula. But some parents aren?t aware of this advice and may use cold water, or boiled water that has been cooled for longer than half an hour."
The research report can be read here.
I think it is important that people understand the reason behind the guidelines and the different risks involved in different methods.
I would love for Tee2072 to let me know if I have in any way persuaded her to change her opinion based on the above.