I didn't say anything to this new Mum, and now I wonder if I should have done...

[lurcherlover]

In Starbucks, a couple came in with their baby (brand new - no more than a couple of weeks old). Dad goes to get coffees, Mum sits down opposite me and starts to make a bottle up. She got a bottle of water out, mixed formula powder in it then proceeded to feed it straight to baby. Obviously therefore the water had been boiled at home, but allowed to cool while they were out. I assumed she didn't realise the bacteria are in the formula, but believed the widely-held myth that it's the water that's dangerous. I nearly said something - I wasn't at all going to be rude, I was going to say something along the lines of "I hope you don't mind me saying, but you'd be better keeping a flask of water straight from the kettle with you, mixing the powder in a bit of that and then topping it up with cooled boiled water so baby can drink it" - but I held off and didn't say anything because I'm a wimp I thought it wasn't my business. But afterwards, I thought, if it had been me and I was doing something (however unwittingly) that might be putting my baby's health at risk, I would want another Mum to tell me so in as non-threatening a way as possible. So I wonder if I should have said something. What do you think?

(Disclaimer: this is in NO WAY intended to be an anti-FF thread - I just wanted to point out to her the safest possible way to formula-feed her baby, not in any way to judge, so please don't think that comes into it)

I think the kettle has to be cooled for no more than 30 minutes cos the water has to be at least 70 degrees to sterilise the powder.

aldi, I see what you're saying and do agree to some degree about tolerance and immunity but the issue is that all bacteria are not equal. The bacteria of concern in formula are salmonella and enterobacter sakazakii which can cause very serious illness in quite low numbers. Neither of those are found on nipples.

YANBU but I wouldn't have said anything either . I tell close friends the guidelines though. From the reading I have done: the best way is water 70 degrees make feed then use within. 2 hours, if you can't do that then make with 70 degree water , chill rapidly and refrigerate? My BFs DH is a biomedical scientist & he does It the "wrong" way though as he thinks the destroying nutrients thing is worse. So their baby gets one method on BFs night and the other method on her DHs!

fwiw I'm also glad the OP said nothing!

Also breastmilk is generally drunk straight away so not the same chance of bacteria multiplying as a bottle left in the fridge all day. Pumped milk has a use by. And doesn't bm have anti bacterial/anti fungal properties anyway?
I mainly ff so nothing against it. But I do think it's wise to follow the most recent advice on making the milk up - even if your aunties gardeners goddaughter gave their child milk that they made up and left in the airing cupboard for a year and their child lived to tell the tale

I'm glad you didn't say anything. It would have been an embarrassing situation all round.

That said, the fact that hardly any of the mums I know who FF make up the milk correctly really really annoys me.

On the box I had in the later days (slowing down the breastfeeds, child not liking cows milk) the instructions always said to use cooled boiled water.

I must admit I don't understand why they'd suggest doing that if they were knowingly risking the health of hundreds of thousands of babies? If its a significant risk then I completely agree that is a major issue.

I also thought that formula contains friendly bacterias too? So if sterile wouldn't that eradicate the added healthy bacteria?

I openly admit this is new information to me and I am interested in what the risk is in real terms?

Thanks for clarity though mixedberries et al.

the risk of your child getting the e. sakakakakaka-ulrika bacteria on a per bottle basis is low. the risk of it killing them is high. the risk of your child being in a car crash on a per journey basis is low. the risk of them being injured is high.

the advice had certainly changed on the boxes over six years ago.

Are people getting confused with the instructions to use the water slightly cooled - as in not boiling? I don't think it says on the tins to use it cool - well not in the last 4 years at least.

I used to do exactly that for all of mine with no problems at all, so can't believe it's too awful. Maybe the advice was different in those days, god knows it seems to change every five minutes

I'm glad you didn't say anything. If the baby is very new it probably took them ages to get out for that trip. A comment like that, even though kindly meant, would for me anyway, have knocked my confidence pretty badly and have upset me.

Having a new baby to look after, especially in public, is like playing a complicated game of wits where everyone but you knows the rules.

Otoh as someone else pointed out, maybe it's not even her first anyway.

It seems to me that practically if you're at home the best thing is to make up the formula with boiled water that is still over 70 degrees each morning and then store it in the fridge and make up bottles as required. This minimises faffing and means the child gets their milk when they are hungry not 30 mins later.

But the reality is that if you're out and about for the day it would be totally impractical to do anything other than use a bottle of pre boiled water and add formula to it. Carrying around a flask of water might work but it seems to me there is a scalding risk to this and also the risk that it drops below 70 degrees anyway. The only alternative is cartons but they are much more expensive so not practical for a lot of people.

I think most adults can handle boiling water without scalding themselves! My kids never had to wait 1/2 hr for a feed and I followed the guidelines. I would generally know when they would want feeding in the next hour or so would make a bottle up ready. If they were hungry unexpectedly I would boil the kettle. leave for a few mins - make up the formula and dump it in ice water - it would be ready a few minutes later.

Aldi cartons are sterile, powdered milk can't be guaranteed to be sterile due to manufacturing process rather than because the ff manufacturers are protecting their probiotic bacteria. As poster above says, chance is low but risk of harm if effected very high.

tbh if you're in a cafe it's easy enough to get hold of some boiling water and add it to cooled boiled water to make it the right temp. after you've made up a few bottles you know. i used to stick really hot water in teh bottles and then the powder in one of those 'in the neck' containers, i always wondered if they were killing the bacteria anyway or if it had to be in teh water.
tbh i think people who think it's really difficult want it to be difficult in order to justiify their own position.

Wow, my son is lucky to be alive. Not only did I make up bottles in the way the mum in the OP did (5 years ago) but I also blew up the steriliser when he was 7 weeks old so had to hand wash the bottles until we bought a new one.

Scary how we're given the wrong information.

Btw, if the formula manufacturers can't make the powder sterile, how do we know the pre prepared formula cartons are?

actually, careful washing and air drying is as good as sterilising.

everyone does understand that it's ONE bacteria in particular that is the problem, don't they? i mean, that's not being lost to all teh sarcasm, surely?

and the cartons are guaranteed, the boxes are not.

you know, i've been on a few of these kinds of thread in my time on MN and the weirdness of the responses never cease to amaze.

you 'wow, it's a wonder my kid never died' lot are going to be the mother in laws from hell... i hope none of you have sons cos your daughters in law will loathe you.

Actually I wasn't being sarcastic. I was serious - we think we're doing the best thing but it turns out we're not.

If the cartons are sterile, you do wonder how they can't make the powder sterile. (Cartons weren't available in Singapore where we lived, anyway.)

I haven't seen one of these since linking to MN threads on this subject got me banned from Netmums, but my baby is much older now so I'm not around on the feeding forums.

MN thread on sterilising which is very illuminating.

Very different issues, sterilisation and avoiding deadly bacteria. LOL at Aitch's scientist friend saying, erm, well, just shake the microwaved bottle then

even if they could make the powder sterile, what would be the point? it's unsterile the minute it's opened. one would imagine the prepacks have been treated at 70degrees, ie made up properly.

Interesting thread. I fed mine years ago and when out and about did pretty much what the lady in the OP's story did. At home I made feeds up with boiled (very hot) water and stored bottles in the fridge until needed, and then either microwaved or topped up with freshly boiled water once I figured out the right ratio. But I also breastfed for the first few months, so I suspect the most vulnerable period had probably passed. However that brings me to my main thought on this thread, which is that the information does not appear to be (easily) available for anyone to make a risk assessment of any accuracy.

For example the site that Chipping posted as giving the reasons why 70C was recommended, was actually an argument saying that 70C (in the opinion of FF manufacturers) introduced a number of other risks which the WHO had not considered (including destroying nutritional value, scalding, that the instructions were too complicated and would therefore be ignored etc).

Then the contamination/illness/death risk. If the contamination rate is as high as 6% then during the period before the new advice was issued many many babies would have been exposed, so it simply cannot be that 2/3 of babies who drink contaminated milk not made up in this new way will die, because there would be thousands if not millions of deaths. In fact if you assume that a FF fed baby goes through about 1 tin per week, then over a year 3 of those tins (0.06x52) would be contaminated, likelihood is that at least one of the 35 feeds from each of those contaminated tins would not be prepared correctly, so using this model most if not all babies fed according to the previous guidelines would be expected to die before they reached the age of one. Which is clearly nonsensical.

It seems to me that most advice given to pregnant women and new mothers assumes that they are a)total idiots, and b)are totally risk averse. Personally I don't think either of these things are true, although in practice most people are not very good at assessing risk, either because they don't have the information needed, or because of a host of biases (NB I am a risk manager, so this is something of a pet subject ).

How would they know that formula-related deaths are from non-sterile poder rather than, for example, improper bottle sterilisation? Not being sarcastic, just wondering.

I'd imagine that there were a cluster of very seriously ill babies with the same infection and they traced it back to the batch of formula they were given.

Ok, that makes sense.

I'm pretty sure I was told that it was only when the formula became liquid that bacteria could multiply, hence transporting powder ok but need to drink as soon as made up. Is that not true? Or are we talking now about two difference bacterial issues to manage?