Introducing a formula feed - advice for a novice please!

[JBroRo]

Hi

I'm a 1st time Mum so apologies if this sounds like the most basic question(s) ever!

My LO is EBF at the moment but I'm thinking about introducing 1 formula feed some time in the next few weeks. I'm thinking that I will introduce this feed at about 10-10.30pm.

I'm an intelligent person but seem to be having a complete mind blank when it comes to making up these feeds + timing

I've got a big tub of Aptamil and have been reading the instructions. It says to allow the kettle to cool down for 30 mins and to only make up a feed as you need it and not in advance? Therefore, because I can't exactly predict when my LO wants to feed how can I occupy them while Im waiting the 30mins for the water to cool?? By this point, I think she would be purple and hysterical.

Also, when it comes to her having formula during the day how do I go about making up a feed when I'm out and about?

Really, I'm looking for any top tips/suggestions that other more experienced mums have got.

I obviously don't want to cut corners/risk hygiene/health but want some ideas about to make things easier/more organised.

My mum's advice is to make up feeds in advance as that's what she used to do.

Many Thanks in advance

eStar

"FWIW, she is my fifth child and all the others managed to survive such neglectful milk-mixing too...."

God I hate that argument - it is worth nothing! This is mainly a low incidence but high risk problem - i.e. it doesn't happen often but when it does it is catastrophic.

The increased risks of D&V generally amongst FF children are caused by the "less harmful" bacteria and unsafe feeding practices.

"Powdered infant formula (PIF) contaminated with harmful bacteria has been implicated as a source of illness in infants. In recent years, the emergence of disease associated with a bacterium, Enterobacter sakazakii, in PIF has necessitated a new risk assessment.

The Food and Agricultural Organization of the United Nations (FAO) and the World Health Organization (WHO) have hosted two joint risk assessments on the subject (FAO/WHO, 2004 and 2006). One outcome of
these risk assessments has been a risk assessment model that has allowed for the examination of the relative risk to infants of different practices regarding the reconstitution of powdered infant formula and ensuing infant feeding practices. As a result of this work, the WHO has issued new
guidance on infant feeding (WHO, 2007)."

"Invasive E. sakazakii disease is not a common occurrence in infants.There have been approximately 60 reported cases of E. sakazakii infection worldwide since 1958 (Mullane et al, 2006). However, there is concern that it has been under reported. In 2003, a United States FoodNet survey
estimated the annual rate of invasive E. sakazakii infection to be one per 100,000 infants (children less than 12 months of age) (U.S. Centres for Disease Control and Prevention (CDC) unpublished data).

In infants of very low birth weight (less than 1,500g) the incidence was estimated to be 9.4 per 100,000 in a study of 19 neonatal intensive care units (Stoll et al, 2004). Children greater than 12 months of age and adults are thought to be a much lower risk group than infants. E. sakazakii has been associated with neonatal meningitis, necrotising enterocolitis (NEC), bacteraemia and necrotising meningoencephalitis (Muytjens et al, 1983; Iversen and Forsythe, 2003). Reported mortality rates are high; NEC 10-55% and meningitis 40-80% (Iversen and Forsythe, 2003).

A U.S. Centres for Disease Control and Prevention (CDC) report investigated the risk factors relating to ingestion of E. sakazakii in infants (Bowen and Braden, 2006). Forty-six cases were analysed (12 with bacteraemia, 33 with meningitis and one with a urinary infection). The infants
with meningitis tended to be near-term infants (median 37 weeks) of normal birth weight (median 2,454g) where infection tended to occur soon after birth (median six days after birth).

The infants with bacteraemia tended to have very low birth weight (median 850g), were pre-term (median 27.8 weeks) and developed infection after the first few weeks of life (median 35 days). Bowen and Braden concluded that their findings suggested that all neonates (infants ² 28 days) as well as premature infants should be included in the ?high-risk? infant category. FAO/WHO concluded that the high-risk group are all infants in the first two months of life (FAO/WHO, 2006) based on the knowledge that infants up to about two months are known to be at elevated risk for meningitis (Dr. A. Bowen CDC, pers. comm.)."

All taken from the Irish link I posted above.

blinder - maybe she did not expect to be shown the pro/cons of BF/FF? not everyone knows the dynamics of the boards (nor who is who).

I'm with Whoamireally for the "all sorts" style in preparing formula - naughty, but such a faff...
What we do on a good day is boil kettle and mix 1/2 boiling water with 1/2 cooled boiled water, to which we add powder. In need of rapid cooling, we swirl the bottle under the tap.

Would BF longer, but at 10 mo, DD would have eaten me away, and being rigged to a breastpump 4 times a day to produce just enough milk while at my desk and dodging appointments became too much. The tin had to come out.

Hi read this thread and just hijacking slightly, I am now trying to cut down on the bfeeding and am introducing ff once a day. I tried withh DD1 and now DD2 with the ready made cartons and had great troubles with stomach upsets after this. Never had this problem with powdered formula. My HV has said this is due to the preservatives in this milk so it can sit on shelves.

Has anyone else had this issue?

Also with the powder containers that can sit inside the bottles with the milk. If I was going out for the day and added 70 degree water to the bottle with the powder dispenser inside how long can the bottle sit? Or are these designed to be used with the bottle warmers?

Again JbroRo, sorry for the hijack

Mimile do you use your FF prep method as an informed choice, knowing the risks - or is it because you weren't aware?

Or would you follow them for a premature/newborn/under 2 month old?

Genuniely interested. Luckily I found out the info when I started FFing and decided for me that although the risk is small - why would I want to feed my DC an unsterile product as his only source of nutrition.

The lack of awareness of this amongst HCPs is stunning.

lola0109 - I have heard anecdotal evidence of DCs being effected by RTF formula.

Not sure I fully understand your question - if you want to use water at 70 degrees then you'd need to take a flask of water out with you and have a method of cooling the formula.

Alternatively you could make in advance and coool and store with ice packs - but this is more risky and it you're not sure of the temperatures then don't.

Have a look at the FSA and WHO leaflets I linked to in my first post on this thread.

Tabouleh I mean the instructions aren't clear on the pack of these. My SIL is adding the water to the bottle then adds the powder from the dispenser when needed but the water would be cool by then but I was under the impression that the water had to be above a certain temp to kill bacteria in the powder (although I'm now finding out it has to be below a certain temp too) Argghhh, BF definitely easier but unfortunately I'm going to have to stop soon as going back to work and can't express.

Anyway, I digress, so if I was using these powder dispensers I'd need to use one of the insulated cases to keep water at a certain temp to make the bottle?

Basically, if I was going out for say a whole day whats the best methods to make bottles to ensure sterile and hygenic?

tabouleh - informed choice indeed, but mainly on the basis that DD has been EBF for 6mo, is on solid foods etc...
Would she be

makes me wonder what is done in nurseries...

Basically:

1. Ready to Feed or

1. A flask containing water which is ~ 70 degrees.

"If you are out and cannot boil water how do you make up a feed?
Mothers should be advised to fill a vacuum flask with boiling water. If the flask is full and sealed the water will stay above 70° C for several hours. This flask can be safely transported and used to make up a feed when necessary.
Do vacuum flasks need to be sterilised if they are used to store boiled water for making up a feed later?
No, the vacuum flasks do not need to be sterilised but they should be washed thoroughly and rinsed with boiling water before being filled with boiling water intended for the feed. The boiling water should kill bacteria present in the vacuum flask." From here.

I am not sure how long it would take for the water to get down to 70 degrees if boiling was placed into a flask. Or how long water which has been cooled for 10 mins say would remain at a temp above 70 degrees.

Bear in mind the risk of scalding though.

I might do some experiments to satisfy my curiosity. My DH has a handy infra red thermometer!

Not that i'm trying to throw a further spanner in the works but have you FF'ers checked that your baby bottles don't contain BPA? I was shocked to find that some of the sippy cups I had used with my older children and still had in the house did contain BPA.

info here

There is also a company selling stainless steel bottles now which are excellent and can be used very long term as they can be addapted to sippy cups etc..I could find the link if anyone was interested

Good luck OP, You are obviously trying to do the right thing, and the question you asked is an important one, can I ask how old is your LO? and why have you decided to introduce a FF? I'm genuinly interested in the reason, there is a lot of help on the boards, come back.

lola, how old will your baby be when you go back to work?
tabouleh/tiktok thanks for getting back to me about the ff method, despite seeing the 70degrees figure it had never actually occured to me that the water had to be below a certain temperature too - I'd assumed just boiled was best (but then obviously would have to be cooled!).

I think the formula manufacturers need to sort this the hell out. Either make the powder sterile or print the info about 70degrees on the sodding tins.

and they could maybe throw in a little freebie milk thermometer - one that could be sterilised if such a thing is possible???

Infra-red thermometer - this is what I used (as DH happened to have one in his tool box - apparently for testing the temp of the radiators!

However using the latest advice from the FSA then you boil a litre of water and after 30 minutes it is still over 70 degrees.

I did my own experiment the other day .

The results were as follows (1 litre of water boiled and temp tested after increasing amounts of time).

10 mins: 80 deg C
20 mins: 77 deg C
30 mins: 74 deg C
40 mins: 71 deg C
50 mins: 66 deg C
60 mins: 65 deg C
70 mins: 63 deg C

I am planning to do some experiments with a thermos.

So, is it better to add powder to water above 70C (I usually wait 10-15 mins so now know that I am at 80 or just under - thanks Tabouleh!) and then put in fridge to use later in day OR is it better to risk water being less than 70C but make feed up for use immediately? I do a) but am now wondering about the use immediately part...

pommedeterre - the science shows that adding the powder to water above 70C and then rapidly cooling and storing is safer than making up with room temp water.

That is why there are guidelines for making bottles in advance.

If you look at these slides from a WHO/FSA meeting - especially page 15 - you will see a range of scenarios of making up formula (contaning the nasty bacteria) with different temps and holding times.

The baseline scenario was making up with water which is 30 degrees and feeding immediately. In all cases using water at 70 degrees led to a reduction in risk of more than 100,000 times - this was regardless of the time between preparation and feeding.

I asked Mike Brady of Baby Milk Action about the lack of proper guidelines on the packaging and he said:

"We did succeed in getting something about this into the Guidance Notes that accompany the Infant Formula and Follow-on Formula Regulations and now powdered formula on sale in the UK does warn it is not sterile. However, the instructions are not in line with the recommendations of WHO, as you say.

We continue to campaign on this both for the UK and internationally."

Anyone who would like to add their support to my request for a webchat with Mike Brady - please add your support here.

Also anyone who would like to badger MNTowers into revamping the bottlefeeding section on MN then please add your support here.

Thanks!

Am imagining your kitchen last night, tabouleh

I think it is fair enough for people to respond to a question like the OP's with observations about breastfeeding (in this case, being a solution to a breastfed baby screaming with hunger) and observations about formula and its downsides.

No one has said 'don't FF - BF!' at all!

Mimile - the OP may not have wanted any mention of bf, but if you post to a discussion board, it's reasonable to expect a discussion. She also accused me of giving her a lecture, and not responding to her practical questions - most unfair and a bit rude, too.

blinder, thanks for your nice words

This thread has scared me. I had to give DS a bit of formula right from birth (long story) and it's only reading this that I realise I was doing it all wrong.

I used to add formula to freshly boiled water - I thought that it could be left for up to half an hour, not that it should be.

Also used to make it up before I went out anywhere and just pop it in an insulated pocket, and it would cool down to drinking temperature by the time he needed it. That's bad, isn't it? That's what I did with expressed milk so I suppose I never really thought about it.

I'm not particularly stupid, either.

At least I'll know what to do if I ever introduce a bottle for DD.

Adding formula to too-hot water will at least mean it'll kill the bacteria. But the milk won't be as nutritious.

It's not in the formula company's interests to make it clear how difficult it is to FF as per guidelines! They make a bloody fortune out of Mums who think it's the easy option, whilst having tiny small print somewhere saying formula isn't sterile as a get-out clause for if a baby gets sick from wrongly prepared formula. Makes me mad that they can get away with it!

"I thought that it could be left for up to half an hour, not that it should be. "
Yes that's exactly what I thought - it really is complicated, isn't it?

Tabouleh, I've been following your work with interest. It's been an eye opener.

Op, I'd use cartons myself if it's just one feed a day.

Nothing from the OP....?

Tabouleh, I though I was the only person who bought a liquid thermometre and did these experiments! Glad to see that I'm not the only one!
OP - yes cartons sound like the answer for you.

Of course you are not stupid Careful, it is really confusing and unclear which given the possible consequences is pretty outrageous!