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)

Hang on, so can you make the bottle up with the boiling water then put it in the fridge for a couple of hours till its needed? Also, some thermos things keep the water really hot, so could you use those? I know you're not powered to use reboiled water, so I'd feel a bit weird asking for boiling water in a cafe and trying to make sure they emptied the kettle first.

We used a baby thermos, added powdered milk then fed when it was cool enough

www.google.co.uk/url?sa=t&source=web&cd=2&ved=0CCwQFjAB&url=http%3A%2F%2Fwww.nhs.uk%2FPlanners%2Fbirthtofive%2FPages%2Fformula-feeding-information.aspx&ei=FAVCT56yMujK0QXVwMmPDw&usg=AFQjCNENslordG24IMcDzaelZhEOT5HSRw

Bacteria starts to multiply as the liquid cools down so should be given as soon as it is cool enough to drink

'A review of cases in infants reported in the English literature from 1961 to 2003 found 48 cases of Enterobacter sakazakii induced illness among infants. The US FoodNet 2002 survey found that the rate of invasive Enterobacter sakazakii infection among infants under one years old was 1 per 100 000.'

The risks seem to be so small, I wonder why so much faf has been introduced to manage such a tiny risk.

So unless your baby is on a predictable schedule, you either make them wait for half an hour or so, or use the much more expensive cartons? Or carry around two thermos flanks, one hot, one cold,plus bottles and powder?

If breastmilk can be stored at room temp for 6 hours, why can't correctly made formula go in the fridge for a couple of hours? You can buy litre cartons of ready made formula and those can be left open in the fridge for 48 hours?

My twins are on weird prescription formula which has to be mixed with the water is COLD. Not cool, or drinkable, or room temperature but COLD. So we fill their bottles with boiling water when we leave the house, and estimate it takes about 90 mins for it to cool to stone cold. So OP the lady in the cafe might have been doing that.

I used to put the bottles in a bowl once I had made them up and leave them under a running tap to cool down

So unless your baby is on a predictable schedule, you either make them wait for half an hour or so, or use the much more expensive cartons?

Nope.

Or carry around two thermos flanks, one hot, one cold,plus bottles and powder?

You could. Or you could just ask for some hot water (reboiled water once in a while not poisonous ...) Or you could take out hot water and cool it, or if it has gone colder than you'd like, dunk it in boiling water. Or you could just risk it, given that the WHO has said that combining and using immediately is doable if there's not hot water to be had. And that's just off the top of my head... there are probably loads of other ways of dealing with the issue that don't include making it up incorrectly.

If breastmilk can be stored at room temp for 6 hours, why can't correctly made formula go in the fridge for a couple of hours? You can buy litre cartons of ready made formula and those can be left open in the fridge for 48 hours?

So you have missed that this is about one particular bacteria, which has already been killed in the cartons due to them having been presumably made up/treated at the right temp? unless your fridge is colonised with e. salazakii, that is.

as for bm, that's a living thing. totally different.

Re boiled water was work of the devil back in day!

nooka, i'll have a look for the mortality rate figs for the e whatsitscalled bacteria, of course i'll have to spell the damn thing properly to google it.

but you know why, valium, because of minerals etc in concentration. if you're doing it for all bottles, maybe there would be an effect, but what's the risk of actual harm, especially if it's only once in a while? that's an easier risk assessment to make.

I know about 1 gazillion people that do formula in this way, to no ill effect

THE EVIL FF BITCHES!!!! HA HA HA

Yes but 'back in the day' it was an absolute no no aitch

The 'new' way of preparing formula was introduced to minimise the risk of it happening because when it does happen it's catastrophic - the death rate can be as high as 80% (between 20-80% depending on what illness is caused and if it is treated with the right anti-biotics - which can only happen if the bacteria is identified in time).

It's a rare thing to happen (that we know of - there aren't many reporting streams in place so when it is traced it makes big news) but the risk of death or permanent brain damage/bowel damage is very high if you get it.

Everyone knows the signs of meningitis - purpura rash that doesn't blanch, shrill high pitched cry, lethargy, etc, but how many people know that the bacterial variety can be caused by the formula they have fed their baby (not always though)? I know I was terrified of meningitis when my babies were little (HV put the frighteners up me) but I had no idea I could do anything to help prevent it with DD1 (who was formula fed for her first 8 weeks) and if I had been told how to prepare it safely I certainly would have done regardless of the time taken.

When DD3 had to have formula due to me being in hospital and not able to pump enough she had RTF cartons and she was 6m because DH didn't like the odds of buying a box of formula that was contaminated as DD3 had a weak immune system so we went with the safest yet most expensive option (small cartons of RTF)

Just a thought but if formula is good outside the fridge for 2 hours - how about making up a bottle fresh every two hours? That way it doesn't matter if baby needs a feed straight after it is made or 1 1/2 hours after. It's now recommended babies are fed on demand and not to a schedule so always having a freshly made up bottle would be in keeping with that.

I've only had time to read the OP but, I'm so glad you didn't say anything. You assume she is a new mum, but I have a 4 year gap between dds 2 and 3, so when the older girls are at school and I go out with dd3, people could wrongly assume I am a new mum. Also, dd3 is disabled and at 5 months old weighs only 7lb 14oz, so people always wrongly assume she is a newborn. Added to that, she has had various prescription formulae, one of which needed to be mixed with cooled boiled water, not freshly boiled.

And lastly, that is how I made up bottles for dds 1 and 2 and they are fine.

You can srill cool it down quickly by running it under the tap once it has been made up

presumably the widely-quoted 2/3 figure is an aggregate of the 40-80%?

www.ncbi.nlm.nih.gov/pubmed/9039558

Enterobacter sakazakii: a review.
Nazarowec-White M, Farber JM.
Source
Ottawa-Carleton Institute of Biology, University of Ottawa, Ontario, Canada. [email protected]
Abstract
Enterobacter sakazakii, previously referred to as a yellow-pigmented Enterobacter cloacae was designated as a unique species in 1980. This reclassification was based on differences from E. cloacae in DNA relatedness, pigment production and biochemical reactions. E. sakazakii has been implicated in a severe form of neonatal meningitis. Although studies have failed to identify an environmental source for the organism, dried-infant formula has been implicated in both outbreaks and sporadic cases of E. sakazakii meningitis. The high mortality rate (40-80%), the severity of the infection in infants, plus the scarcity of information on the ecology and pathogenicity of this organism warranted a review of the clinical and microbiological features of this putative foodborne pathogen.

but valium, back in the day it could only ever have been an absolute no-no if you never thought about why it might be a problem. same with microwave hotspots.

We were told it was harmful to our babies, because of the concentration of minerals etc. This was drummed into me and all the mothers I knew at the time, it really was a no no along with making up bottles with bottled water. There wasn't the info around back then that there is now to make an informed decision - I know this was only 11 years ago but we had only just got a lap top at home back then, I didn't even know how to use it let alone research and make an informed decision. Bloody hell, a lot has happened in the last decade considering quite how much we rely on the computer now

Microwave hot spots - we were just told to shake really well before feeding.

true, but really... if you'd stopped to think about it...
same with babies and cow's milk with weaning, assuming no allergies it's okay to use it in food, but people act like it's poison. it's not, it's just not as nutritionally complete as the denatured powdered stuff, so can't be used for bottles every day.

So the only totally guaranteed way to FF nowadays is to use the cartons? I bet that is the method making the highest profits for the manufacturers too

But back then it wasn't the done thing to question the HV's advice and that was the only port of call we had and if you got a nutter you were in trouble

I remember it being talk of the playgroup when one mum stopped sterilising and just used her dishwasher - that is completely standard these days.

Quite Amaretti!

yep. and the manufacturers will insist on putting the most complicated-sounding instructions on the side of the packs...
the cartons are exposed to 70degs for long enough to get rid of e sakawotsit, one does wonder why the boxes can't be (even if it would still not guarantee sterility once box is opened). the manufacturers of infant food have their own website where they say 'BUT IT'S BEEN FOUND IN KITCHENS!!' a lot. in that case, why not take themselves out of the mix by treating their own product appropriately?

Well fuck me with a red slipper. I got sacked from a nannying job because I made up the formula with 'recently boiled' water (ie, boiled and left for 10 mins). I feel like phoning them up and shouting "HA! IN YOUR FACE"