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.

The longer the formula is hot/warm the quicker any remaining bacteria will grow - E. Sakazakii can grow at temps as low as 6C (so check your fridge is set to 4C or lower) but grows best at 37-43C. It also has the ability to stick to latex and silicon (the materials used to make bottle teats) and polycarbonate (the plastic used to make a lot of baby bottles). See here for details.

Flash cooling (sticking the bottles in ice water/very cold water but not up to the neck of the bottle or allowing the bottle to be submerged as that can draw the water into the bottle by negative pressure and contaminate the feed/dilute it) and then refrigerating in a less than 4C fridge is probably the next safest way to making up each feed as needed.

I just found this study and it shows the E. Sakazakii is particularly resistant to dessication (i.e. the drying process to turn formula from a liquid to a powder) which means that more survive even after the product has been dried.

Kayano - the 'rapid cool' bit I guess is to ensure you don't leave the milk out for hours before putting in the fridge.

Like if you've made a lasagne you plan to reheat the next day, you put it in the fridge asap after cooking, not sitting out for hours first iyswim.

MeconiumHappens - my beef is that not all HCPs tell mums to use 70C water to kill bacteria in the powder. Sorry if that wasn't clear. Storage, reheating etc are genuinely side issues to the biggie of killing the possibly incredibly nasty bugs in the powder.

That so, so many women now use the wee pots of formula and cold water to make up feeds whilst out and about is a sign that HVs (some HVs) are not doing their job correctly.

We get it, in an ideal world all mothers would be breastfeeding but that's not going to happen so pretending these issues aren't their responsibility (as people have testified, HVs refuse to help mums with ff) is downright professional misconduct IMO.

My experience in hospital of ff my first: I'd planned to breastfeed so had no clue what to do. Midwives all refused to help me or my husband with what equipment to buy and how to prepare it - it was only down to one lovely healthcare assistant who shut the curtains and spent ten minutes explaining it all to us that prevented me having a nervous breakdown. And her advice, whilst great, was based on her own experience as a ff mother and not as an HCP. Why did HCPs refuse to help me and others?

I'm completely confused now. How the blinking flip would you know if a bottle is 70 degs? Do you all have thermometers?

Possibly someone has said this upthread muslin, but could you please stop referring only to mums and women?

Making up formula (safely, of course) in possession of a penis is to be encouraged.

1 litre of water boiled in a domestic kettle then left to cool for no longer than 30 mins (100C-30C=70C and the assumption is that 1l of water loses 1C of heat each minute). Though if you are boiling less than 1l it might be wise to use a thermometer (prob a sugar/confectionery one would work rather than a forehead one!).

Truthsweet, Can I just ask a question re cooling - I usually make up bottles before bathtime, then by the time I feed them they have cooled to right temperature - is this wrong then? Should I instead make them up, rapid cool them and then reheat (they don't like cold milk)?

Somebody earlier in the thread said that it wasn't safe to reheat milk in a bottle warmer. Why is this?

I would flash cool all bar one of the bottles to refridgerator-able temp (because you can't put hot things in the fridge just cool/room temp stuff) and cool the last bottle to drinking temp and feed that one to baby but not leave it hanging around at feeding temps.

The issue is that some bottle warmers have a stay warm function and just keep the bottle warm - aka breeding bacteria temps. So if you forgot to take the bottle out after it had been warmed to the right temp it might just keep getting warmed....At least with a jug of hot water it goes cold eventually rather than keeping the bottle warm.

During the day I make them up as and when needed, with freshly boiled water (leave kettle for 5 mins or so as I don't fill it all the way) and then stock them in a jug of cold water to bring them down to drinking temp. For night time I make them up in the same way, but do a batch of three or four and stick them in the fridge and either warm up in a jug of boiling water, or in the microwave, depending on the volume of ds's screaming.

The issues with cooling and storing are not nearly as important as preparing the bottle correctly.

The chance of the baby becoming ill through incorrect cooling is low when the powder is mixed with 70°C water.

Than chance of the baby becoming ill through incorrect storage is low when the powder is mixed with 70°C water.

Both risks are higher when the bottle is prepared with cold or lukewarm water, and the biggest risk is when the bottle is not prepared properly and then not cooled.

Not cooling is an issue in hot climates, ie. over 30°C with an increased risk over 34°C.

Since most MNetters live in UK, you are absolutely on the safe side if you heat the water to 70°C, cool and refrigerate. When going out for the day take in a cool bag or use pre-prepared milk cartons.

I bought a kettle that boiled then cooled to 70°C and then peeped. It kept the water at 70°C for a certain period.

I honestly do not see the huge risk. Our first born ate a handful of dirt in the garden once we didnt boil that to kill all the crap. Child is fine.

maybe formula companies should have a better process so the formula doesnt have harmful bacteria in it.

Ds' formula (Sma staydown) had to
Be made with chilled boiled water so the guidance was irrelevant.

minimischief did you read the thread? The bacteria in formula can be extremely harmful to a baby, life threatening. That's the huge risk

Mmelindor, could you tell me what brand your kettle is? I have done some googling but can only find kettles that can heat up to 70degrees, ie the water isn't boiled and then cooled to 70degrees. Thanks

mini
Why don't you read the thread if you want to understand the issue here. The information is there.

It is not about eating dirt, or being overly cautious.

CeeVee
Not sure it is still made, my youngest is 7yo. It was one for making green tea, if that helps. Will try and find it for you

Anyone who really thinks that EVERYONE sticks to the rules when it comes to making up a bottle needs to read this In the Daily Mail, no less.

If you had bothered to read the thread you would know what the risk is

MmeLindor oh my dear God how can the DM publish that in clear conscience?!

Oh and MmeLindor we need a new kettle anyway, and DH has an obsession with fine teas - I told him of this kettle of which you speak and he is a man on a iPad mission to find such an object!

Would also be handy for milk preparation, but I don't think that's his motivation

I had a look, but I cannot find that kettle. I seem to remember buying it in UK though, not in Germany where I was living at the time.

The whole how to make up formula is very confusing especially when guidelines differ from country to country. I'm not sure if it is true but I had read that some countries do say it is safe to make up formula with tap water. To be honest it should be safe in the UK - at least tap water contains chlorine which kills off bacteria. By the time you've boiled the water all that chlorine would have evaporated. I would love to see some research on this.

With my first baby I used cartons of pre-made formula when she was very young as she was prem and low birthweight, then switched to the boiling water and waiting 30 mins (actually checking it was 70 deg c) method. It was very laborious although using a thermos helped to keep water at 70 deg c for a few hours. But then you still have to cool the milk to room temp.

When she was older I just filled my sterilised bottles with boiling water then added the powder as and when we needed it - making sure any left over milk was discarded after 30mins. From what I've read I believe that the bacteria will only multiply when the milk is made up - so reducing that time reduced the amount of potential bugs your baby will ingest - keeping it below the threshold that would cause illness. In hindsight I think this is the best method - plus it reduces the risk of scolding. I'll try and find my reference for this - although I'm sure I've read something along these lines on MN before.

Can I check if I'm making the bottles up correctly?

I sterilise the bottles first.
Boil the kettle with fresh tap water and leave it to stand for 30 minutes.
Add the cooled boiled water to the sterilised bottles and then add the milk powder, shake thoroughly to mix.
Put the bottles in the fridge straight away.
Reheat the milk by standing the bottle in a bowl of boiling water ( ensuring the water in the bowl is lower than the screw top of the bottle) for about 5 minutes.

I make up 3 bottles at a time and they are used within 12 hours.

I feed DS as soon as the bottles are warmed up, and chuck away whatever he doesn't finish.

My friend with new born baby gets up in the middle of the night - boils a kettle - waits for it to cool to the right temp - then makes up the bottle. She and her husband follow this procedure for each feed. The baby feeds every 3/4. They boil a fresh batch of water for each bottle. They are following C&G instructions to the letter. I am cconfused.

If I ever have a DC3 I am going to build the cost of cartons of ready-made formula into the budget. Fuck knows I wasted enough money on all sorts of unnecessary things for my first two children.

Not quite sure why anyone would use powdered formula these days tbh with the rising cost of electricity. It probably isn't that much more expensive. Little cartons on the night-table with capped bottles. Sterilised scissors if you like. Lovely.

Powder does smell lovely though, and gives you something to do in the early days. DC2 was a bottle-refusnik for a year and I had fun with breast-pumps and freezer bags and sterilising things so can understand the initial appeal of wanting to make up bottles.