Same formula, different country, different rules!

[PaulineCampbellJones]

I have needed to buy 9 month old DD some Aptamil while we are away in Spain as she has turned into a milk monster. The rules on the package are completely different to the ones on UK packets. Use mineral water so you don't have to boil the water!
Both are a complete no no and have seen many thread debates on this. Are we just living in a nanny state or is there a reason?
I will continue to boil water though as don't want to subject DD to too much change.

Nicely thought through Bertie

You could sterilise it with radiation..... i wonder how popular that would be!!!

skiHorseWonAWean,

I don't think you are a witch.

Its interesting reading that different countries have different ideas. Life is a balance of lots of different risks. Its interesting to see what one nationality percieves to be risk.

I'm surprised that a Dutch HV was so anti a moses basket and grobag, yet almost very British baby starts off life in a moses basket. Which is the greater risk, being too hot in a moses basket or stick in a different room to mummy? Maybe the Dutch have more space in their rooms so do not have make that kind of decision.

I wonder if there is some discussion in the Netherlands about the risks of scalding? SkiHorse can't answer this as she is not engaging with the debate , but it could be that powers-that-be elsewhere have decided that to encourage mixing of powder with next-to-boiling water (and 70 deg is hot enough to hurt, if not scald) is to risk scalds...and that is thought to be more of a health issue than the risk of bacterial infection? I mean, it could be something to do with the way kitchen surfaces are organised elsewhere. Electric kettles - with spouts and lids - are far more commonly used in the UK than elsewhere, and this makes scalds less likely I would have thought....tablouleh, what do you think?

re: sachets of powder: When DS1 was a baby I bought formula in Israel packaged in individual sachets - ie it was a sachet of powder to add to 200ml of water. Very convienient when on the go (this was before the days of the 70c thing) - although ready to go cartons not available.
Bigger boxes of powder also available too.

Single service sachets would remove the risk of contamination there is from the scoop/kitchen/mositure getting into the tub,

but

The risk which lead to the advice to make the formula with 70 degree water was due to bacteria geting into the powder during the manufacturing process.

From this document

The presence of Enterobacteriaceae, including E. sakazakii, in packaged PIF is thus not considered to be due to survival of the organism but to recontamination of the product after drying and during the subsequent processing steps (e.g. conveying, tipping and mixing with additional
ingredients) up to the point of filling/packaging.

Recontamination is related to the following three factors, the first two of which are linked:

1. The presence of these microorganisms in the processing environment (i.e. external parts of equipment and surroundings of the processing lines), making it possible for them to get into the processing lines.

1. The presence of these microorganisms originating from the processing environment (1) on

internal surfaces of equipment that are in direct contact with the product.

1. The presence of these microorganisms in ingredients added and mixed into the dry base

powder after the heat-processing step.

Re the Netherlands - well to the extend that it has not adopted the 70 degree guidelines - it is no different to many other European countries.

I do think that the reason the formula companies have not adopted the guidelines are as they see the risk of

• bad PR/legal action as being greater from scalding to person making formula/risk that it is not cooled sufficiently for the baby

• as being greater than the risk to them re infant deaths/serious illness - probably because it is difficult to PROVE the causality?

The main difference for the Netherlands as far as I can see is using water straight from the tap. I wonder if people then heat the formula to serve.

I live in the Netherlands, and yes we do have leaflets like the NHS ones. I'll see if I can find one with the FF instructions and will translate them for you all. As I remember, powder is made up with tap water, and warmed in the microwave, shaking the bottle to remove hot spots. My DS is EBF though so will have to double check.

Oooh that will be interesting thanks baroness

tiktoks kettle point is a good one as well. I had forgotten about the signifigance of british tea consumption in all of this

Trust me, we are living in a Nanny State!!( see my discussion on school).

I'm from the Netherlands but currently live in the UK. NONE of my friends back home make up bottles with tap water.

Just looked at the instructions on the Nutrilon (same as Aptamil) website, which says:

"Let boiled water cool down to handwarm temperature (approx. 37 degress) and pour the appropriate amount of water in the bottle."

So they don't adhere to the 70 degrees, but do recommend boiling water.

Sorry that first sentence should say unboiled tap water

Driver8 - thanks for that - maybe different parts of the country issue separate guidance saying that it is ok to use water straight from the tap, or maybe it was just "skihorse's" HCPs?

Can you tell me whether your friends from the Netherlands steralise the bottles?

Ruthie i personally can not be bothered to trawl all over the threads to try and understand your point if you can't even be bothered to state it yourself. the nanny state argument is imo often used by people who would like to ignore the advice as it doesn't suit them but don't quite have the courage of their convictions. Obviously you are free to disregard the guidelines, even in our "nanny state" they are not the law.

Driver what you say scares me! Wouldn't hand hot be the perfect temperature for the bacteria in the powder to breed?

ruthie48 - we are discussing guidelines, in fact widely misunderstood and not widely used guidelines.

Surely in a Nanny State things are mandated.

Presumably you do not oppose clear directions and side effects being displayed on the packets of medicines and foods?

Are you aware of the levels of hospital admissions for babies due to D&V? It is much higher amongst FF babies and quite a proportion of that is thought to be due to the way the formula is made (other proporiton due to FF babies having less antibodies). There are also some serious and fatal infections which can be caused by formula powder which is not sterile. These are more likely for new borns.

Which part of spreading information on this topic do you diagree with?

I would think that supression of free speech would be the ultimate Nanny state?

I have bought 'stick packs' of formula in Australia. These are individually packaged portions of powder - very convenient when travelling and got me round the fluid restrictions on flights (this was a few years ago when the restrictions were very tight).

The instructions were to prepare with cooled, boiled water. I am not sure what the instructions are on big powder cartons there (I am now in UK). I do know that they have changed their advice about the temperature that domestic hot water systems should be at because they have decided that the risk of scals is greater than the risk of Legionnaires. So it may be that some countries have decided the scald risk from recently boiled water is greater than the infection risk from non-sterile powder. I have to say I don't agree with this. If recently boiled water is realy so dangerous to adults, they had better ban kettles, tea, coffee, soup, boiling vegetables etc.

If the powder is sterile then I guess you can make it up with whatever takes your fancy (froot shoots? )

If it's not sterile and you need water at min 70% to kill the bugs then I'm surprised that info isn't universal.

i can see the thing about scald risk but really - if it's dangerous to feed formula prepared with water which is too cool - and it's dangerous with hot because of scalding - then shouldn't they be presssuring the formula manufacturers to come up with something which is safe? i mean, why do the countries health services have to make decisions about which is least harmful, bacteria or scalding. it seems potty.

tabouleh - Yes, they all sterilise the bottles.

Here's the link for the official advice in the Netherlands (in Dutch): www.voedingscentrum.nl/nl/eten-gezondheid/zwangerschap-en-kind/flesvoeding/klaarmaken-van-flesvoeding.aspx?highlight=flesvoeding

I'll translate it below.

"The preperation of the bottles must be exact and hygenic. Little babies can pick up infections very easily. Bacteria can multiply very well in prepared formula. The right dosage is also of importance. Check this on the packaging. Only use the measuring spoon which comes with the packaging and don't give the baby a spoonful more or less.

The Preparation of the Bottle

• wash your hands

-check that the place where you are preparing the bottle is clean -check that the bottle is clean -read the packaging to see how the formula must be prepared and warmed (see further below) -prepare it with water out the tap. The water in the Netherlands is so safe that you don't need to boil it first.

• check on the inside of your wrist that the prepared milk is not too hot
• give the bottle to the child as soon as it's the right temperature
• don't let the child drink the milk for longer than half an hour. Throw away any milk that's left!

The Cleaning of the Bottle

• immediantly after drinking rinse the bottle and teat with cold water
• wash the bottle and teat after every feed in a dishwasher on a minimum temperature of 55c. Or wash throughly in hot soapy water using a bottle brush.
• place the bottle and teat upside down on a clean dry cloth to dry.

The Warming of the Bottle

You can heat the bottle in different ways: in a bain-marie (that is in a pan with warm water), in a bottlewarmer, or in the microwave. The formula must not be warmer than 30-35C (drinking temperature). If you heat the bottle in a microwave the outside may still feel cool. But the contents can already be hot. Therefore you must always shake the bottle to evenly spread the warmth of the milk.

The bottle should be heated approximately so long in a microwave:

• a bottle of 100ml about 30 seconds at 600 watts*
• a bottle of 150ml about 45 seconds at 600 watts
• a bottle of 200ml about 60 seconds at 600 watts

• by another wattage of the microwave you'll need to adjust the times"

tap water and no sterilising of bottles!

Barroness thanks for that - anyone that you know who FFs - do they also use tap water and not sterilise?

Have you ever heard anyone talking about a discrepancy in the health authorities advice v the on packet instructions?

I know that when the midwives made up formula for my DS they used tap water and microwaved it, and then taught my DH how to finger-feed him with a syringe that had been washed under the tap. Only did it three times though, as after much pumping my milk finally came in and DS's weight stabilised. (to cut a long story short!)

I'll ask around but likely to be a good few days before I see anyone.

Can any of you explain to me why Nutramigen - which is a hypoallergenic formula for babies who can't have cow's milk proteins (which are in aptimil/SMA etc etc) - has instructions which do NOT require putting the formula into water that is 70 degrees? The instructions are to boil water, cool to room temperature and then add the formula. This is formula sold in the UK. If the E. sakazakii thing is such a big deal, why is it not factored into the instructions for Nutramigen?

I'm sorry but I come down on the side of the debate that says we are way over cautious on this stuff in the UK - except in the case of brand new born babies and those with gastroenterological/immunological issues in which case I agree that water of 70 degrees should be used to be sure of killing any bacteria present in the formula.

RelaxedAndCalm - I am rapidly coming to the same conclusion - ie guidelines here being too over cautious. In other threads have seen that SMA staydown sold in UK has to be made with fridge temp water see here and that aptamil sell porridge with milk powder to be added to cool water - if it really was that dangerous it wouldn't be possible at all.

I am aware that some special formulas cannot be made with water at 70 degrees.

The advice in the WHO guidelines is that these should always be made fresh and consumed ASAP.

I believe that these special formulas are made in smaller production runs to higher standards.

Also the benefit of the specialised formulas is seen to outweigh the risk.

That issue is mentioned in the Irish Guidance Note 22 (haven't got time to check where).

here is a good example which illustrates that milk isn't sterile and the UK guidelines is to kill bugs in the milk. not bugs in the water. Aptamil sees no advantage in writing the updated guidelines on the packet, I suspect.

It takes a while for bacteria to grow. I note that the dutch say you have to use the bottle straight away and take it away after 1/2 hour.

I don't know the ins and outs (not a microbiologist!) but are our instructions to sterilise because they are concerned that people in the UK will leave the bottles/let the baby have them for ages/make them up in advance, which will give the bacteria time to multiply and become more of a risk?