AIBU to be annoyed with HCPs about formula guidelines?

[MuslinSuit]

When making up formula, it is essential to use water of above 70 degrees, to ensure that the water kills any bacteria present in the powder .

HCPs including HVs are recommending using 'cooled boiled water' to make up feeds, and are giving the ok to mums going out with bottles of pre-boiled water, now cool, and little containers of formula to add to the water. Thus any bugs in the formula will not be killed!

So, so many mums I know or come across on tinternet do this, and it annoys me! It annoys me even more that HVs actually recommend this as a safe practice!

AIBU to think that HVs should be aware of how to make up formula hygienically and safely, and that formula companies need to make it clear too? I mean it says to cool the water for 30 minutes, but not why - 30 mins is optimum for the water to be hot enough to kill bugs but not scald the milk.

So many mums think that the point of using boiled water is to kill bugs in the water rather than in the formula! Maybe formula companies just don't care, but I do feel they should be promoting safest practice.

I batch make bottles 2-4 at a time, rapid cool them and store in the fridge btw. I warm them in a tub of hot water for no more than ten mins prior to a feed. That's the safest practical way to do it other than making each one up at the time, which no sane mother does.

Apparently the contamination often comes when the formula is dried or packaged up (E.Sakazakii) and as you would have to irradiate* the powder as it went into the packaging to sterilise it, it just isn't possible to have sterile powder and anyway as soon as you opened the pack......

E.Sakazakii in formula has been killing babies in the UK since 1961 (that scientists know of) so why it isn't more well known and publicised I don't know.

The rec. way of making up formula changed the year before DD1 was born yet we were congratulated on bringing 6 bottles with 2oz of cold boiled water and a pod in each bottle with the 2 scoops of formula. These were sitting in a hospital room on the bedside table to feed my very jaundiced 3 day old baby who was readmitted as she needed double bilibed therapy. We were lucky and I was able to restart fully bfing at 8 weeks but she still had 8 weeks of incorrectly made up formula. We were lucky and managed not to buy contaminated formula but there's no guarantee that we would be so lucky each time we bought formula

Faverolles - I assume it is because they would have to recall so many batches it would be cost-prohibitive.
Here is a recent study done on the frequency of contamination of PIF by Enterobacter sakazakii bacteria. The frequency was 6.6% (9 out of 149 samples). There was contamination in 24.2% of the samples with Enterobacteriaceae which are not very nice things to have in food.

On a very simplistic level this means out of every 100 cartons of PIF you buy 6 are contaminated with Enterobacter sakazakii. I realise the study was done in Japan but Japan is NOT a 3rd world country and if anything is MORE industrialised/developed than the UK.

• I assume no one would want to feed radioactive formula to their baby regardless of it's sterility

This is another thing I have never heard discussed anywhere else.

I have never known anyone who has made it up incorrectly, never heard any bad advice and every carton I've seen has perfectly clear instructions as has every baby book.

Sorry link for the 1961 thing here.

Mydog
Almost everyone I know made up bottles with cooled boiled water. And several posters have stated that is the way they make up their bottles.

Faverolles
I presume that it would be so prohibitively expensive to produce - and the risks can be very easily reduced by making up the bottles correctly.

I'm not disbelieving you or anyone else, just saying it's not something I've ever heard of before.

Interesting paper on the Belgian outbreak here

"Milk formula can serve not only as an ideal substrate for bacterial growth but also as a source of possible pathogens, as most formula products are intrinsically contaminated"

World Health Organisation publication on the subject.

"After reviewing the available scientific information, the expert meeting concluded that intrinsic contamination of powdered infant formula with E. sakazakii and Salmonella has been a cause of infection and illness in infants, including severe disease which can lead to serious developmental
sequelae and death."

"It is important to note that powdered infant formula meeting current standards is not a sterile product and may occasionally contain pathogens. The meeting did not identify a feasible method, using current technology, to produce commercially sterile powders or completely eliminate the potential of contamination."

"Data from the infant food industry and national control authorities indicate that the detection of Salmonella in finished powdered infant formula is rare. The current Codex specification for Salmonella is the absence of organisms in 60 samples of 25 g each. E. sakazakii is more commonly found than Salmonella in the manufacturing environment, which is a potential source of post-heat treatment contamination.

...

Even low levels of contamination of E. sakazakii in powdered infant formula were considered to be a risk factor, given the potential for multiplication during the preparation and holding time prior to consumption of reconstituted formula."

The last part is interesting, as formula is often the sole diet of an infant, and it is the repeated exposure that increases the risk. It's not comparable to the occasional ready meal as part of an adult diet, for example.

It was this statement from the European Food Safety Authority that led to the change of the bottle feeding guidelines in the UK.

MmeLindor

TheBigJessie
The salmonella is not on your worktops but in the formula. IN the powder.

If you use cooled water to make up a bottle then you risk the salmonella (that might be present) making your baby ill.

Of course you could carry on and everythign would be fine and you would be lucky enough to not feed your child a bottle that contained a dangerous bacteria. That is your decision to make."

Ah, erm, bit of confusion. I was making hmmphy faces at sootie for saying there was no point in sterilising the powder, because there could be salmonella on the worktop.

Poultry - you have a couple of options - buy a thermometer, use it a few times until you know how long it takes in your kettle to cool to 70 deg (with a given amount of water) or buy one of the new kettles that heat water to 70 deg :) (and boiling).

I make each bottle up fresh, it's no big deal. I mix the powder with some of the water at 70 deg, then add cold water to make it the correct temp for the baby to drink (you also get to know the levels of that really quickly too - but at first it pays to measure out the hot and the cold). Written down it sounds like a faff, but it's really not :)

Sorry, BigJessie. I misunderstood your post.

I also make up bottles fresh each time for my twins, I cannot understand why anyone would take the risk of incorrectly preparing a feed for such small precious people!

There are very clear and detailed instructions on how to safely make up formula in the NHS Birth to Five book. I found these myself and followed them, as this is what is recommended. My HV flatly refused to discuss ff with me. When out and about, I would simply take the required number of pre-made cartons with me.

Hi,

Just looking for some advice. For the first morning feed dd wakes up screaming and dh goes of and makes her up a bottle to give her. Should this be made up teh night before using 70C water and then cooled over night in the fridge and then warmed up in some hot water in a jug? We don't own a microwave.

During the day do you put 70C water straight onto the powder in the bottle and then shake up and then add cooled water on top to make it up to the correct volume?

I think I will be switching to use cartons for when I am out and about from now on as we live down under and I'm not sure about keeping bottles cooled.

If you are doing the hot/cold water method you need to have two sterilised bottles - one to measure the hot in and one to measure the cold in.

i.e. a bottle with 4oz of 70C water then add 7 scoops of formula and mix and then a bottle of cold water with 3oz in. Add the cold to the hot water/formula mix and mix together. This would use 7oz of water and 7 scoops of formula. You might need to experiment on the exact proportions of hot and cold but they should always equal the no. of scoops used (so 5oz of hot/cold water to 5 scoops or 2oz of hot/cold water to 2 scoop)

If you add the formula to the empty bottle then add 70C water on top and then top up with cold water you would end up with a very concentrated mix and baby's kidneys could have problems and dehydration/hypernatremia could occur.

Truthsweet, could you expand? I don't really see the difference if you ensure you use the right quantity of water to scoops overall?
For example I will mix 7 scoops with 3oz hot water,then add enough cool water to get to around 8 oz as the powder takes up nearly 1oz of volume ( I used kitchen scales the first time to make sure). Is this ok?

Can somebody please answer these questions for me.
These threads always make my head spin.

1. Is is or is it not safe to make up bottles in advance, if using 70C water then cooling quickly and keeping in the fridge.

1. SIL does the following, I think it's not safe who is right? For a 6oz bottle put 4oz boiling water, leave to cool, when time for a feed add powder then top up to 6oz with boiling water. I think that that is not enough water and the water is not the right temperature to kill bugs.

Hmm a kettle that heats water to 70C you say? That would save the faff of waiting 30 mins for kettle to cool when making up bottles.

Notso - I believe reheating is fine, I do it. The major issue with formula preparation is killing bugs present in the powder. If you've done that, then chilling bottles and reheating (once) (for a max of ten mins) is safe.

Like chicken

It is best to do each bottle when needed, but this is the next best method.

And your SiL is wrong, wrong, wrong! She is exactly the person I am aiming the thread at

ceeveebee - It's difficult to get an accurate measurement if you are trying to measure the fluid as you add it on top of the powder in the bottle (the powder will start dissolving when the water hits it and the volume will change). It's always rec. to start with the water in the bottle then add powder to it.

notso - 1)It's not as safe as making up fresh each time but it's a heck of a lot safer than making up with cold water.

2. Your SIL has it the wrong way round - the powder needs to hit the hot water at 70C not cold water. It doesn't sound safe unfortunately.

Also your SiL is not using enough water! A 6oz feed including powder is over 7oz in total. Constipated, dehydrated baby anyone?! This is why you measure the water then add the powder to it.

I have formula fed 3 dds, I make up the bottles the same way MuslinSuit explains in her original post. I was given the NHS leaflet when I was in the maternity ward (I ff from birth) and the community midwife and H/V both checked that I was making the bottles up correctly on their initial visits. I have never had an issue with H/V advising on how to make up formula, although they obviously can't recommend a brand.

I would have made up 2-3 bottles at a time, my dds have all been cluster feeders so two bottles were usually taken in quite quick succession.

Thank you MuslinSuit

No-one will get through to SIL she ignores all advice which she feels incoveniences her and bases her theories on "well Blah did it and he/she is fine". Seriously my eyes can't roll far back enough for that woman.

This is what the NCT guidelines say:

"There is also a very small risk that the powdered milk may be contaminated by bacteria (mainly Enterobacter sakazakii and salmonella). For this reason, it is very important that formula is made up with boiled water that is hot enough to kill the bacteria. Although the chances of a baby becoming infected are very low, the consequences can be serious and lead to life-threatening illnesses such meningitis and septicaemia."

So the point, I guess, is that the likelihood of contamination is small, but if there is contamination, the consequences are really nasty.

YABU
So basically your post is slagging off HCP for not giving out the right advice (its on the tin!) then at the end you let everyone know that actually you make them up wrong anyway because you store them which is against best health advice (again on the tin!).
WTF.

Question:

I boil kettle
Leave for 20 mins
Make bottle...

Why do you need to rapid
Cool? Why can't you just leave it?

Genuine question

I too had a HV who refused to discuss FF with me and said she wasnt allowed to advise me (I FF because I have to take medication that would come out in breast milk, so its not like she was trying to persuade me to BF). Most unhelpful.

I made up each bottle individually each time with 70 degree water until I spoke to a midwife and a doctor. They both told me that the change to the newadvice to make them up each time (instead of making them with 70 degree water and storing in fridge) was concern that people would make up more than a days worth at a time and keep in the fridge or that people would forget about one at the back of the fridge and use it days later.

Govt advice to the nursery was to make them up each morning using 70 degree water, refrigerate immediately and then throw any unused away at the end of the day.

After that I made them up in batches of 2, then go braver and went to batches of 3.