How do people ACTUALLY prepare formula??

[Tinaland]

Hi

I have had to start feeding my 3 week old formula. Just wondering how people ACTUALLY prepare it??

I know the instructions say make each bottle as needed with freshly boiled cooled water; do not store the boiled water or made up formula etc, but what do people do in the real world?

Do you store boiled water - in the fridge or not? Do you store made up feeds??

What about going out and about?

Thanks xxx

I've asked MNTowers if they will invite Mike Brady of Baby Milk Action to a MN webchat.

If others would like to see this then can you add your support to my request thread here.

I don't think it is necessary to sterilised anything after 6 months, or has it changed too? Mine is already liking everthing in her reach at 5 months (including her big sister shoes) and sometime I wonder why I am still sterilising her bottles. (but I will go on for a while as I am a chicken)

"Australian Infant Feeding Council report they just state that the risk is very low and that they are worried about scalding and loss of nutrients and that people are more likely to make in advance.

Canadian information they make a distinction between premature and high risk infants and others."

Tabouleh I think that is it. There was 60 case in the world of infection by that bacteria in 2005 and not all via contaminated powder, you can also get that bacteria from the hands of the carer if preparation is bad. There is much more than one baby a month with a burnt oesophagus (more often it is lethal too). I don't have the exact statistic but my cousin is a doc in ER and says that the most common accident with falls from highchairs for tiny babies.

I think the canadian info is probably the best. Use cartons for premmies and high risk infants. For others making the feeds at 40C is probably very low risk.

Anyhow I doudt that if the formula is that contaminated a quick scald at 70C is going to help much.
Bacteria are more resistant than that. If it is only one or 2 bacteria (or even an 100) it is not enough to make a (normalhealthy) baby sick, then the milk shouldn't be prepare in batch because then they will have time to grow, and be potentially over the safe threashold number.

Like any food the control in the fabrication of powdered milk is quite high and risky batch are taken out. I have visited a fabric of animal feeds, the bacteriologists were making sure that the feed were the safest as possible. I doubt that less care is taken when preparing feed for human babies. I am even sure that more care is taken. Otherwise there is something wrong with the world and we are all doomed!
Of course there is tragic accidents, but on the whole, powdered milk is safe for human baby consumption.

mamaloco - you will find threads/opinions where people say that you don't need to sterilise.

Obviously sterilising bottles and teats is designed to eliminate any bacteria which may remain after washing.

If people are very confident in their washing and handling techinques then they can make the choice not the sterilise.

However the problem with this comment: "Mine is already liking everthing in her reach at 5 months (including her big sister shoes)" - (and variants of this are often used), is that milk is an ideal breeding ground for nasty bacteria - more so that shoes etc.

So you have the risk that a teeny tiny speck of milk is stuck in a teat for example and bacteria is multiplying on it. This is why I stuck with the sterilising of bottles and teats.

Re your point about the # of cases - of course there may be many more unreported cases - I would suspect that there are since this would be a reason for the higher level of hospital admissions for D&V in FF babies.

"Anyhow I doudt that if the formula is that contaminated a quick scald at 70C is going to help much." - Sorry but you need to read the science! There have been experiments where they introduce the bacteria and then look at the impact of adding water at 70C plus other lower temperatures and the impact of holding times.

Scientific report commissioned by the FSA. I can't find links to the WHO ones ATM.

"If it is only one or 2 bacteria (or even an 100) it is not enough to make a (normalhealthy) baby sick, then the milk shouldn't be prepare in batch because then they will have time to grow, and be potentially over the safe threashold number." - I think that's the crux of it really isn't it - and I see that is what the Australian's are saying - however this is not what the experiments showed.

Sorry to have deconstructed parts of your post - I think it is really helpful to have different views particularly to assist with a strategy for communication of risks to parents.

Re the formula companies - I am afraid I think that they are completely unethical and they have to be FORCED kicking and screaming to comply with things.

EG - the World Health Organisation's code states that formula should not be advertised - but the UK law relates to marketing to babies under 6 months old - hence the invention of follow on formula which the Dept of Health does not recommend. The bloody product is just there as an advertising tool .

You see I am convinced by the evidence that countries which have no advertising have higher breastfeeding rates. I would hope that a ban on formula adverts would reduce the FF culture in this country. I would hope that that would lead to more initiation of breast feeding and a normalising of breastfeeding.

In my parallel universe, for me, everybody would have been going all out to help me and DS (including my DH, my parents, all HCPs etc) and then they may have diagnosed tongue tie, someone else may have BF my baby and strengthened him up and I would have been encouraged to do nothing apart from feed.
Obviously I am glad that formula exists and I do not doubt that it should be there both for a choice and for necessity. I just object to companies profiting from the promotion of it.

FSA scientific report quote:

^Bacterial growth and death rates in whey- and casein-based infant formulas for Cronobacter spp., Salmonella serovars, other Enterobacteriaceae, and Acinetobacter spp. (Category A and B organisms; FAO/WHO 2004 & 2006) were used with the JEMRA E. sakazakii risk model for 7 scenarios with reconstitution temperatures between 10 and 70°C. For all scenarios, reconstitution at 70°C predicted decreases in bacterial numbers ranging from 1 log for Salm. Senftenberg and Salm. Enteritidis, to >104 log decrease for Cr. sakazakii and was dependent on the formula base. The model also predicted overall decreases in bacterial numbers for all scenarios when the reconstitution temperature was 60°C, although this was less than a 0.5 log decrease for some strains. In contrast, at 50°C some strains had predicted increases depending upon the scenario and the formula base. For all strains growth was predicted for 2 scenarios of mixing in a 1 or 25 L container, 1 h preparation time at room temperature (20°C), refrigeration (4°C) for 6 h, rewarm to 37°C, and feed within 30 min (37°C).^

So this shows that using water at 50 degrees doesn't kill the bacteria.

It is a difficult area - and I can see that many find the current guidelines difficult to follow and I accept that the risk to older babies is small plus they should be able to fight it off.

The worst scenario is to make in advance but use cool water - however the real life risk of cool water and feed immediately versus make in advance with hot water? UK HCP are told that they can make it in advance provided the water is more that 70 degrees.

I think that the formula packs should have a sort of "patient info leaflet" like meds do which would set out all the information and risks etc.

Tabouleh You have been saying over and over that using 70C water sterilised the milk, this is not true and it is you who have to read the science correctly (no offence intended) If you have said from the beginning to used 70C water to decrease the amount of potentially toxic bacteira we wouldn't have that discussion, as it is your wording of sterilisuing which made me suspicious. Even the article you quote shows that it decreases the amount of bacteria, not make the milk sterile (steriled means 0 bacteria). They quote a decrease of more than 10 000 which is big but not sterile ("contaminations" are usually above 1 000 000).

have a read at that:www.foodbase.org.uk//admintools/reportdocuments/395-1-697_b13010.pdf which is very good.
they are also talking at babies from 0 to 6 months, I was asking for the recommandation for after 6 months.

It is also very interesting that in that article they found cronobacter in babies who haven't been FF, and that a hudge concern because there is another route of contaminations in the NICU.

I do agree that milk is a perfect breeding ground for bacteria (I am a microbiologist, I know). but a tiny speck on the bottle if not going to grown an indefinite number of bacteria (thay can only grow if there is food and water available) so drying should do it and cleaning properly as well.

They don't grow on powder milk either (they need water), they enter the food chain when there is still moisture, and lay dormant. A high contaminantion of the powder should be detected by the quality control, and stop the process.
Most of the infection happens because the milk was left long enough for bacteria to grow again, when the water is added.

But surely a decrease from 1million to 100 is significant enough?

Personally I would stop sterilising bottles etc (but still wash in boiling water/use a dishwasher) after 6months. Certainly before 3 months I keep sterilised things sterile in a steriliser until needed and resteriluse after opening the vessel.

I ALWAYS prepare feeds with water above 70. Even if it's just a decrease in the number of bacteria it could be the difference between life and death for a baby, especially one as tiny as the OPs.

Yes, if we're getting technical it doesn't sterilise the powder but that explains it sufficiently in layman's terms, don't you think? The objective is to kill sufficient numbers if bacteria that the risk decreases to an acceptable level, which is the point of what most people refer to as sterilisation. True sterilisation is virtually impossible unless you have an autoclave, steam the room you use for feeds regularly ask prepare feeds gloved, gowned and masked.

Nothing you put in a baby's mouth is going to be complety sterile at any point anyway.

mamaloco - not offence taken - I am enjoying the debate! I apologise if I am using the wrong terms - and you can certainly set me straight as you are a microbiologist .

Please can you look at page 15 of this report which summarises the WHO research

That was the link I was looking for for one of my earlier posts.

Maybe I am reading it wrong but to me it is showing that in all of the scenarios they test at various temps and holding times - the addition of water at 70 degrees decreases the risk by more than 100,000 times - and this is even if you prepare in advance and then refridgerate and reheat.

I can't actually see where I said "that using 70C water sterilised the milk"?

The UK Food Standards Authority guidance was designed to make parents aware that powdered formula was not "sterile" - they use this word. They did some research which showed that parents assumed that it was sterile in the packet the same as ready to feed is a sterile liquid. Info here.

I like your wording "use 70C water to decrease the amount of potentially toxic bacteria" - I will probably steal that and use it in the future .

Re "a tiny speck on the bottle if not going to grown an indefinite number of bacteria (thay can only grow if there is food and water available) so drying should do it and cleaning properly as well." - I did not trust my cleaning and drying etc and this is why I personally stuck to the guidelines which state in the UK that bottles and teats should be sterilised by boiling, steaming or using a chemical (Milton). There is a famous thread here about it not being necessary.

Re this:

I never say it wasn't significant.
I am saying that even 100 is a lot for a baby in NICU. I am shocked that they are still fed the same formula as "normal" babies. It is like giving unpasterised cheeses to an immunocompromised pregnant woman.

Also I am probably really really naive, but I can't imagine why if the formula is so contaminated the quality controls don't stop it being sold.

This may be obvious, but do you still need to use 70c water for a baby over 6 months?

Quality control is not foolproof. Look at the Chinese formula scandal.

I don't know why NICU babies get the same formula either but I'm not a paeds nurse or a doctor! Seems odd to me as the prem babies I looked after had special formula that was premade in pouches.

Grapes - I would always use 70C water for any age. Whilst they're putting things in their mouth feeding a baby milk made with warm/cold water is almost the same as feeding them raw chicken.

Although I understand the theory behind making up bottles with water at 70 degrees to minimise the risk of the milk containing bacteria it did not work for me. I tried it over the last few days with Aptamil Comfort and it changed the consistency of the milk completley. I am not sure if it fermented it quicker but my ds could not finish the bottle, which he normally always does, and he posseted a lot more than normal after all his feeds. I spoke to 2 pediatricans here in Portugal who both said that there was no need to make bottles up in this way if you are making sure the bottles are cleaned and sterilised and you give the milk immediatley and throw away aftr 45 mins. I will continue to fill sterilsed bottles with boiled water, store in cool cupboard and then warm and add powder at time of feed.

I wonder if the companies are open to litigation if a baby becomes ill or dies because they haven't printed the 70 degree thing on the packs.

Vivelafreak - Do you mean the level of bacteria is the same as raw chicken? Where did you get this information??

I can see what you mean vivelafrak - but I think that your analogy is a bit dramatic and OTT -

but to the extent that there could be said to be a comparison it is this:

-we cook raw chicken as we know that it may contain dangerous bacteria

-the WHO are telling us (and have proved by their experiments) that we should make formula with water which is 70 deg because it may contain dangerous bacteria

Sorry, haven't read the entire thread and I can see from the latest posts that the debate is moving into theory, BUT, my method was:

Boil kettle and pour about 1/3 required amount of freshly boiled water into the bottle. Add in the full amount of powder and shake to dissolve. Then top up to a little bit over the final amount with cooled boiled water from the fridge.

I didn't start with formula until after 6 months when we weaned, but my feeling was that the boiling water would deal with the tiny risk from the powder, and the proportions of hot to cold meant we got to my DS's preferred temp without having to wait around giving bacteria a chance to multiply.

LadyBee the problem with making up your own methods is that they have not been subject to scientific tests.

There are concerns that boiling water (100deg) or just boiled (say 90deg/80deg) may destroy vital nutrients in the formula.

Also it is unclear whether even adding a smaller volume of water of the recommended 70 deg would be enough to elimiate any dangerous bacteria.

The idea is I think worthy of research - in fact Baby Milk Action suggested this should be researched a few years ago (can't find link ATM).

My point with that analogy was that some batches have been found to contain salmonella, like raw chicken, amongst other nasties. We cook chicken to kill the bacteria, so in the same way formula be 'cooked'. Also that the consequences of contaminated raw chicken and contaminated formula are roughly the same.

I wasn't in any way implying that the levels are the same - that would be completely unacceptable! Or that the incidences of contamination are comparable.

However in some senses the risks are the same. The consequences are just more probable with chicken.

Personally, I boil the kettle with fresh water, then leave it for 15-20 mins to cool. Then I make up formula with the hot water and powder. I cool them in ice water, so they cool quickly and then keep them in the fridge. I tend to keep them for no more than 12 hours.

By the way, I know I shouldn't keep them in the fridge, but i do. I understand the risks of doing this, but my personal feeling is that the statistical likelihood of her becoming ill because of the way I make my formula is much lower than many of the other risks she will experience just by being a child / being mobile / getting in the car (just my opinion, necessarily think it's right for everyone else's child, but it's fine for mine).

edit: don't think it's right for everyone's child, but fine for mine.

enzed - you ARE using one of the methods in the WHO and FSA guidance - because you are using water which is 70 degrees to make up the powder.

Per the experiments what you are doing is much much lower risk than someone who adds powder to room temperature water.

Unfortunately the guidelines have been misinterpreted by practically everyone into "Don't make bottles in advance" where as the key info is "MAKE BOTTLES WITH WATER AT 70 DEG C!".

It is safer to make fresh - and this can be done using a thermos flask.

People also need to be aware that the risk is much much higher for newborns.

Could someone please tell me if this way is ok.
I sterilise 6 bottles at a time, keep the bottles in the steriliser and just take one out when needed. I boil the kettle with fresh water then and it straight to the bottle, measure the amount of formula in to a separate sterilised pot and then pour that in to the bottle, pop the lid on, shake and sit the bottle In cold water until it's the right temp.

I was breastfeeding but couldn't produce enough to keep up with my daughters demand. I don't know any other mums so have no idea if I'm doing it right x

Wow, this is an old thread :)

The safe way to prepare powdered formula is to ensure that the powder is only ever mixed with water that is no cooler than 70 degrees C. It should not be boiling or just boiled for safety reasons - using water that's too hot could scald you or your baby (it won't affect the nutrition of the powder, though).

So your way is fine, except you need to wait for the water to cool a little.

Your health visitor or midwife should be able to reassure you on this.

Have you had a chance to discuss how to ensure you make sufficient milk, or to work out if your daughter really does need the formula?

I got discharged from my midwife and health visitor quite a while ago, my daughters now 3 months old.

The reason I ask if I'm doing it right is that she's suddenly decided that she doesent wany any more that 3-4oz every 3-4 hours. Where as the other week she was happy to have 5oz ever 2-3 hours x

???? You still have a health visitor - the hv is yours, until your child is five :) You have a baby clinic yes? You can go any time and ask what you want :)

With regard to the amounts your daughter is having - if you are not breastfeeding at all, then yes, it sounds on the low side. But this would not be related to the way you are preparing. She may go back to having more in a day or so....but this is something you can certainly discuss with the HV.

hope you get the chance to talk about it in real life.