Can I prepare bottles of boiling water in advance for formula?

[Jojonewmaman]

I have just started mixed feeding, expressing some feeds and using formula. I know the advice is very much to prepare bottles as required however I have read that some parents have pre prepared bottles of boiling water, then quickly cooled and stored them in the fridge and added formula when required. Is this safe? And does the powder mix as well in cold water? TIA

It's very unlikely that even following the advice to the letter will produce a truly sterile product. Unless you're using an autoclave, you'll always have some viable organisms in the final product so the less time they have to multiply, the better. Formula also presents another problem: it lacks the immunological component of breast milk that babies rely on for a specific immune response until their own adaptive system starts to function.

Things get even more risky if you're making up in bulk since the transfer from the large container to the bottles creates additional chances for environmental bacteria to enter the formula. This coupled with a longer time for incubation (even in the fridge) is effectively rolling the dice (for a harmful infection) more times than is absolutely necessary. I don't mean this as an indictment of formula, it's just that a better understanding of the risks potentially gives a better understanding of the rationale behind directions.

I agree with a further up thread that said best to only make one bottle up in advance and keep in back of fridge if making them ahead of time. I think the perfect prep machine is a great idea for nighttime feeds if filled with pre boiled water.

a pp*

*This whole 'add formula to boiling water' is a brand new load of bollocks. As long as you are meticulous in washing up the bottles and sterilising them there should be no probs

People say this shit when they did it differently which we now know was not the best way to do it, and feel misplaced guilt. So they want you to also do it the wrong way to make themselves feel better.

You have to make it up with v hot water (not boiling as it harms some of the nutrients) as the powder is not sterile, by a long shot. It doesn't matter if you have sterilised everything else because the milk powder is not at all sterile. Babies can and do get very sick and die from things like cronobacter in unsterile formula.

Putting it bluntly, are you going to listen the World Health Organisation, the CDC, the NHS, safefood.eu. and the RCM...or some randoms on MN? Your choice.

www.who.int/foodsafety/publications/micro/pif_guidelines.pdf

I've used the perfect prep machine with both babies and found it a godsend. The only controversy i read about it was here in relation to people finding mold in the pipework. I read up on it and contacted TT, they said it was to do with people using incorrect filters and if I only used TT filters it should be fine. I opened up the machine and the pipes were spotless. I only ran a cleaning cycle when the filter needed to be changed.

One baby was fed from 6 weeks with it, the other from 7 months, so far so good. According to their product support, the machine adheres to WHO/NHS guidelines.

I also asked my PHN if she had received any information about them in relation to them being unsafe and she said no, and if it made life easier, fire ahead.

Laurie I used to believe this also but here on MN afew people corrected me saying that infact nutrients weren’t killed. The 70 guideline was apparently there to avoid scalds and it’s quicker to cool and avoids bottle exploding if making up whole feeds than shook

Interesting. I was told about the nutrients thing by an acquaintance who works for a major formula brand (though not in the U.K.)

I think more clarity and transparency would be helpful. People usually follow instructions better when they know why they're doing it.

If it's just about avoiding scalds - and I were in charge of the public health campaign - I'd be tempted to drop the 'wait' altogether and advise people to make up bottles with a boiling kettle.

Simpler message, less confusion, less hassle, no danger that the temp dips lower than 70 degrees.

I bottle fed both of mine from birth. I boil the kettle, leave it sit for 40 minutes and then pour it into a thermos. I use this throughout the day and can make warm ready to drink bottles as needed, without having to faff around with cooling it.

I boil the kettle, leave it sit for 40 minutes and then pour it into a thermos. I use this throughout the day and can make warm ready to drink bottles as needed, without having to faff around with cooling it.

The purpose of boiling is primarily to make the water hot enough to destroy the majority of potential microbes in the powder. It is unlikely that it is anywhere near 70C after more than an hour in the thermos. I would also point out that making up the formula in the thermos is risky too because any surviving microbes (or those introduced when the thermos is opened) will now have a nice warm environment in which to multiply once the temperature drops.

Exactly Laurie and it’s even confusing on the NHS guidelines thats say to make up the formula with water that’s ‘at least 70c.’ It should say exactly 70 and not hotter if it does affect the nutrients in the powder. This should also be stipulated on the back of formula boxes. For instance they emphasise the dangers of using too much or too little powder to water ratio but do not contain a warning on using hotter than 70c water. I always thought the same as you until a few people told me otherwise and pointed out the ‘at least’ part and now I really don’t know what to believe. Even when I research it online there are conflicting answers.

that*

I was told that the vitamins/proteins will not be affected by using boiling water. Apparently to make formula it is heated well beyond 100c. No idea if any truth in that.

I used to pre-boil water, then put in the fridge, adding formula when needed, then warming up slowly. Never longer than 12 hours. This is 11 years ago, so things may have changed. Our nicu advised against making bottles up in advance for the fridge. Bub never got ill.

"My baby was fine" is not a good basis for giving outdated advice. I rode around in cars as a kid with no car seat or seat belt and I was just fine. Doesn't mean anyone now should just throw their kid in the car to rattle around, does it?

Don't listen to people repeating outdated advice. We know more, we do better. It's called progress.Listen to the experts, no-one else.

I always made bottles fresh, I'd have some pre boiled water in bottles in the fridge and some boiled water in a flask, when I needed to make a bottle I'd put 1oz of boiled water in the bottle if she was having more I'd do 2oz then put the top in and shake so all the powder was sterilised by the hot water then top up with 4oz out of the fridge it was then the perfect temp to give my baby so no time to wait for it to cool down. I managed to get it down to been able to make a bottle in a minute so was faster than a prep machine. You can get little measuring cups if your bottle doesn't have 1oz measurements on it.

When I was out I'd take the flask, and empty bottle and couple of bottles out of the fridge with me.

I'd never pre make the bottles and take them out as bacteria starts to develop as soon as a bottle is made so would need to be used within 2 hours and probably in the hot weather we've had recently 1hour.

I used to use the premade formula in a carton when I was really stuck and those disposable bottles but only in emergencies

mamapud I used the same method minus the need for cool boiled water and it worked fine but i only formula fed from 6-12 months so didn’t have a night feed to deal with. I would have found this method to faffy in the middle of the nightif sleep deprived with a new born and turned most probably to the perfect prep filled with cool boiled for night feeds. Any risk there would be far outweighed by my zombie tired self handling flasks and doing science experiments in the dark with hot water.

too*

I made my bottles in advance. As long as the water is hot when you make them, you’re fine.

I've done a quick literature search since it seems like some papers might be nice. These three seemed most pertinent:

Regarding nutrition, for human breast milk, significant immunological components are lost even with mild warming (i.e. >40C):

^Bransburg-Zabary S, Virozub A, Mimouni FB. Human Milk Warming Temperatures Using a Simulation of Currently Available Storage and Warming Methods. Simeoni U, ed. PLoS ONE. 2015;10(6):e0128806. doi:10.1371/journal.pone.0128806.^

Article

However, there is no immunological content in formula so the main degradation is of the nutritional content. The most conservative figures I could find came from the ESPGHAN Committee on Nutrition:

^Agostoni, C., Axelsson, I., Goulet, O., Koletzko, B., Michaelsen, K., & Puntis, J. et al. (2004). Preparation and Handling of Powdered Infant Formula: A Commentary by the ESPGHAN Committee on Nutrition. Journal Of Pediatric Gastroenterology And Nutrition, 39(4), 320-322. doi: 10.1097/00005176-200410000-00002^

PDF

In short, they reccomended that reconstitution be performed with water temperatures not exceeding 80C. This leaves a nice wide margin for the recommendations made in 2016, which gave particular attention to Cronobacter:

^Silano M, Paganin P, Davanzo R. Time for the 70 °C water precautionary option in the home dilution of powdered infant formula. Italian Journal of Pediatrics. 2016;42:17. doi:10.1186/s13052-016-0228-9.^

Article

I neglected to add, the final article does mention that it is acceptable for formula to be reconstituted and refrigerated for up to a day prior to use. This does not mean for the average home user, it is a recommendation for facilities equipped to handle the reconstituted formula without introducing further contamination. This is not a disparagement of the cleanliness standards of MNers homes but it is likely that most homes are not properly equipped to prevent further contamination of reconstituted formula during transfer to bottles or to ensure those bottles are fully sterile in the first place unless you happen to have an autoclave on the kitchen counter (merely boiling is insufficient) and can also ensure that the kitchen (or other working environment) remains sterile during day-to-day use.

Attached you can see the instructions in French and German from the Swiss aptamil i bought today. It very clearly states to boil the kettle and then leave the water to cool to 40 degrees before filling the bottle and adding the powder.

Interestingly, my Swiss midwife advised me, when DS was 1 week old, that I need to sterilize only once a week and use the dishwasher in between! My British mum was shocked, but happy for the reduced workload!

And France has ongoing issues with babies getting sick from salmonella in formula...
www.nytimes.com/2018/02/01/business/france-baby-formula-lactalis.html

It’s crazy how there’s such a big difference in formula guidelines internationally. With something so important surely it should be the same everywhere.

DC3 was in hospital long term and ng tube fed with milk made up of sterile cool water and powdered milk but it was a prescription formula, not a tin of cow & gate from a Tesco shelf.

It is rare for a tin of formula to be or become contaminated however when a baby has formula milk that isn't prepared correctly and ingests that bacteria they become very, very ill, it's fatal in lots of these cases.

People who prepare their baby's milk with cool boiled water are essentially gambling each time they make a bottle up.

It's really very shocking, I don't know if it's wilful ignorance or plain stupidity, whatever the fuck it is please just stop it.

If I was going out I'd pre-boil the kettle and put the water in a sterilised Medela breast pump bottle thingy to cool. Then fill a thermos with boiling water and take that. Then when it was time to feed I'd, for example, put 2ml of boiling water from the thermos in the bottle, add the formula, shake it up well and then top up to the required amount with the cooled boiled water. Otherwise buy the pre-made bottles and warm them up in a jug of boiling water for a minute or two.