Can I have the lowdown on formula please?

[ButterpieBride]

I have a 9.5mo DD who will take a bottle of ebm or ready made formula. We got a pack of the powder today and it took ages to make up- with DD1 I'm sure we just made up six bottles with cold kettle water and used them over the day.

I don't need to sterilise the bloody bottles do I? I'm sure I read some kind of cheaty way of making up the powder that was still safe on here somewhere, but can't find it- any ideas?

Also, would giving her cows milk be really bad? my mum seems to think it would be ok, watered down and with a bit of bovril added but somehow I don't think that is the case.

How do you know when to feed them? The box says she should have three feeds a day by now- it is more than ten usually at the boob, but no idea how much she is taking.

Also...sigh. Didn't think I'd be making this post. I don't know ANY ff babies.

jemjabella - unfortunately midwives/Health Visitors and doctors do not seem to know what the guidelines are nor the reasons for them - formula companies are not properly labelling their product and many people will understandable turn to friends/family for info.

Therefore I feel that it is unkind to label fellow Mums as "lazy" just because they are not following the guidelines.

Other countries have not adopted the WHO guidelines so some people may be following the guidelines for their own country.

The message coming through seems to be - make each bottle fresh each time. Understandably this is difficult - therefore it is important that people have access to info on how to make up in advance and some info on the risks etc.

tabouleh - when mums admit that what they are doing is not following the guidelines (which is all over these sorts of threads), that means they know what the guidelines are and are ignoring them anyway. This is a different kettle of fish to someone who simply doesn't know the guidelines are there in the first place. It is that which is lazy.

Useless/crappy advice from HCPs is a given on all aspects of parenting, unfortunately.

In the previous post "It is that which is lazy." should have been before "This is a different kettle of fish ..."

ISWYM but I feel that a contributing factor is that HCPs don't take the guidelines seriously and they are not generally and widely known about.

So here is an analogy (which some will get upset about - if you are upset then go research the guidelines and the reason behind them).

Guidelines are to make sure raw chicken is properly cooked to remove salmonella.

You don't get people saying "ooh naughty me I don't follow those silly guidelines and cook my chicken until it is no longer pink".

You do get people saying "ooh naughty me I don't follow the formula guidelines" - now the outcome can be the same - salmonella - and in fact the impact on a baby of salmonella is far worse than for an adult however because there is a smaller risk less people have heard about babies with salmonella etc from formula.

I feel that due to cultural practices people find it easier to ignore the formula guidelines that those for cooking chicken.

I am not saying it is right - just trying to explain - I think that there should be a campaign to ensure that HCPs understand and explain the guidelines and then correct formula prepration will become the "norm" rather than the "exception".

Indeed, I'm sure you're right tabouleh.

From reading the leaflets and guidelines i can't find anywhere that says it matters if the water is hotter than 70 degrees though some of you are saying it destroys nutrients. Where have you got that from? It just takes so much longer to make a feed if you have to wait for the kettle to cool down

OK, please settle a discussion- once you have killed the bacteria with hot, just boiled, water for the first couple of ounces, why is it you can't use tap for the rest? Given that the baby drinks tap water in cordial and juice, has her eating and drinking equipment washed in tap water, eats sand and mud, drinks bath water, etc

(obviously we don't give her soil and bathwater for her tea, but, y'know, kids...)

Mums who make formula milk the right way are can be extremely self-righteous. I made milk the very very right way but actually feel embarassed about it because no other parents I know do that and I always get funny looks when I tell them.

Anyway, it doesn't matter how great we are at keeping them clean. My precious little 6 month old went to nursery and started eating grass, soil, worms and was given tap water from day one. Nothing I can do about that unless I become an obsessive parent and stop him from nursery and keep him under my constant scrutiny(which I did by the way before he was 18 months old, drove me nuts as I was obsessive about it!).

I have no idea Butterpie!

Marzipan, I've always wondered this too. I have never seen anybody state a source for it. I always thought that the literature said "Water no cooler than 70 degrees" and people were misunderstanding it to mean "70 degrees exactly".

I'm also bemused by why the guidelines always state that water will be 70 degrees at 30 minutes past boiling - this is based on a LITRE of water! If you are supposed to make bottles up as needed, rather than in advance, it makes absolutely no sense to boil an entire litre for 200ml or so of formula. What a waste!

Also, comparing raw chicken with formula milk is very different. I get sickness and diarrhoea each and every bloody time I eat a slightly pink chicken (in asia it's very common for them to serve pink chicken, that's how I know. But I've never ever been ill taking DS's formula milk. I pop a tiny scoop into my mouth every now and again, a habit developed when I was a kid/teenager as I was brought up on powder milk, and I've yet to have a single episode of sickness and diarrhoea from it. So fine, the chances are there, but my chances of winning the lottery is probably greater than catching anything from his milk. Don't agree with babies tummies being more sensitive than ours either once they are over 2 months old, DS has always been tougher than me.

I suppose (I'm hoping..) you can't really say I'm a 'lazy mum' or anything like that because I made milk the 'right way' for 18 months. sigh..

My god, don't some people get het up about this discussion. You would think we were trying to poison our babies.

jemjabella you seriously need to get a life and stop obsessing about FF.

Folk make up milk, the babies are fine and get fed. C'est Tout.

General guidelines ie don't warm milk in the microwave are aimed at the lowest common denominator ie those who are too thick to realise that you have to shake the bottle to warm it right through.

It really makes me that there is this added layer of crap re FF on top of all the other things you have to deal with as a mother of a small baby.

I don't think calling you lazy counts as obsessing, but OK. Whatever it takes to appease your conscience.

I got the "don't use boiling water" thing from some guidelines (WHO?) that were posted on here. Needless to say, I now can't find the link!

I don't see why you couldn't top up with tap water either though. It's not like we have to boil our water to make it safe anyway, even for babies. God, FF is so complicated! No wonder the formula companies don't make it clearer how complicated it is!

I do think the 70C or over minimum is important for younger babies. After all, why bother sterilising bottles if you then fill them with something that was never sterile?

From the Irish Guidance Note 22 - page 20

Why should the boiling water not be used immediately but left to cool for 30 min?

At high temperatures, some of the heat labile vitamins and other nutrients in the PIF will be destroyed.The higher the water temperature, the greater the amount of nutrient degradation.

The choice of the best water temperature is a practical balance between a high enough temperature to kill the harmful bacteria but a low enough temperature to retain sufficient amounts of nutrients.

Ideally a clean thermometer should be used to ensure the boiled water is at 70°C. However, it is unlikely that such equipment is available in a domestic setting.

Consequently, a practical approach must be selected.The closer the temperature of the water is to 70°C the better. Hence, using the boiled water immediately will increase nutrient degradation and is not recommended.

The 30 minute rule is recommended as a practical means of achieving water temperature between 80°C and 70°C without the need for a thermometer.

FunnysInTheGarden

"My god, don't some people get het up about this discussion. You would think we were trying to poison our babies."

I actually couldn't give a stuff how people feed their babies provided that they have the correct information - i.e. that formula is not sterile, why the guidelines are to make it up with water which is 70 degrees and what the risks re Enterobacter sakazakii are.

I am getting really really sick of grief I am getting on MN for trying to make sure that people have this info.

If you don't like what I am saying then ignore it.

Personally I was gutted gutted gutted when BF did not work out. I was then enraged to find out that formula powder is not sterile and that formula companies refused to put the recommended WHO guidance/wording on their packs. Enraged that HCPs don't know all about this.

So for me personally, with BFing having failed it was very important for me to know that :

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).

"Folk make up milk, the babies are fine and get fed. C'est Tout."

Well, apart from the babies who get very sick and die. Yes it is a small risk and it is a much higher risk for newborns, low birth weight and immune-compromised children.

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).

But, for me personally I was shocked that it is not widely known that formula powder is not guaranteed sterile. Liquid ready to feed, however, is sterile. New born babies are so vulnerable to infections. .

Bacteria your baby gets from licking the floor/eating mud etc - these are in much lower quantaties and are different bateria to those which can be found within formula.

Also milk is the perfect breeding ground for bacteria.

I think it's pretty shocking too. Have got to wonder how much effort the formula companies put into making this kind of info NOT widely known about. I think a lot less people would buy formula if they knew what a faff it was to just make it safe.

If you know formula is not sterile and are happy to feed a newborn it made up an easy non-sterile way, then that is your choice.

But so many Mums seem to stress so much about sterilising bottles, dummies, etc but then give unsterile formula because they don't know any better.

FunnysintheGarden - wow.

So you think people should not be informed how to make up formula feeds safely, then?

Your response - 'you'd think we were poisoning our babies!' - is totally out of order. No one is suggesting 'poison' - but the fact people don't know the facts is putting babies at risk of illness at the very least. Why would it not be sensible to make sure people knew this?

Your disparaging description of 'the lowest common denominator' being 'thick' shows you up very poorly :( It's not 'thickness' that means mothers might forget to shake, but tiredness and absent-mindedness which anyone can succumb to. Heating liquids in a microwave does produce 'hotspots' that persist even after shaking or stirring - you have to shake well to ensure they are dispersed. It doesn't matter for an adult - they get a burnt mouth at worst and know to sip anyway. A baby could be badly scalded.

But let's not worry too much about making up bottles safely, shall we? We'll get a life instead, eh? After all, if a baby gets a bit sick, they'll probably recover and we have hospitals and doctors anyway. Very few babies actually die, so we can safely ignore any info about risk - and actually, even better, let's have a jolly good chortle at the stupid idiots who do think it matters that they have the right information.

Tabouleh - what you say needs to be said. Ignore the rude people :)

Tabouleh - I think your campaign is great, please don't get disheartened. I think you are doing amazing work on helping people understand how to make up bottle properly.
I too expected to bf and ended up ff and was amazed how clueless I was about it all. I do think that this is a practical consideration that does need to be addressed with the 'Breast is Best' campaign (the other one being the emotional guilt of ff).
FunnysintheGarden - that cannot be what you really think/feel.

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).

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.

This article done in Italy showed only 11% of parents prepared formula correctly. According to the article mixing PIF with baby cereals increases the risk of contamination (doesn't say why though - is it because baby cereal is contaiminated or the cereal feeds the bacteria in the PIF?)

"It's not 'thickness' that means mothers might forget to shake, but tiredness and absent-mindedness which anyone can succumb to."

God yes. It doesn't matter how / what you feed your baby, the tiredness gets you at one stage or another.

Feed your child how you feel is best, chances of poisoning your healthy good weight child in this country regardless of how you do it is somewhat slim. Health and weight ultimately should be the deciding factor.

We are however very good at making people feel guilty about how they feed their children.

(ps when I was feeling lazy I bought premade and steribottles, so was actually more sterile during my lazy moments )

what a hoot.Cannot be bothered to quote text or reply one to one. You are all overreacting.

And pommedeterre it is exactly what I think.

I also think that failed BF's are far more militant about these things than normal run of the mill parents who just want to see their babies happy and fed.

Jesus jemabella chillax

jemjabella would not want to be picked up on a spelling error after all

LunarRose Exactly

(pulls out a flame retartand screen)