Another one about making formula feeds in advance-sorry!

[NoTeaForMe]

Hi all,

Sorry I know this has been done and done again but I am confused and as I am planning on starting to formula feed my 3 week old I really want to make sure I get it right.

Clearly it's not practical to make up feeds each time as and when they're needed. My mother-in-law and other people who have used formula insist on boiling the kettle pouring the right amount into the bottle and then leave it on the side sealed. When needed you add the powder, shake and re-heat to drinking temp or give it to them at room temp if they'll take it.

According to advice on here that's not how you do it, so what's right? And why? My husband is convinced by the above method.

Help! Thanks in advance!

They now advise to put the powder into hot water in order to kill the bacteria in the powder. Then you can keep it in the fridge for up to 24 hours.

The way suggested by other people is how it was until a couple of years ago but has been changed due to research on the bacteria and how to kill it.

Read the instructions on the formula packet but you can make up a load of bottles at once as long as they are kept cold.

HTH

The powder isn't sterile, so the safest way to make it up is with water at 70c, so any bacteria is killed.

If you want to make in advance, you can make the bottles with hot water and powder, then cool them and keep them in the fridge for up to 24 hours. Warm each bottle again as you need it.

It's best to make each bottle fresh, but the most important thing is that the powder is mixed with freshly boiled water. Cold water isn't safe.

Oh, and when you're out I've invested in some cooler bottle holders but any cool bag will do. Alternatively take an empty sterilised bottle and a carton of ready-made - we did this all weekend when we were away and it made life a lot easier!

Here is the Food Standards Agency guidance:

www.dwrcymru.co.uk/English/library/publications/milk%20guidance/english.pdf

formula needs to be made up with water of 70 degrees to kill any bacteria

formula milk is NOT sterile, and there have been many cases, some recently (in europe) where babies have become seriously ill/died because of contaminated formula

the risk is small, but it certainly isn't one i would be willing to take with a tiny baby.

NoTeaForMe - please see my reply on your other thread. Before you crack open the formula, have you tried nipple shields?

Oh, and the method suggested to you by your MIL and others is totally totally wrong.

It should be pointed out that the babies who have died as a result of this contamination were all either premature or had weakened immune systems.

Once again though, as in so many things, the Govt advice actually makes things worse. People believe they can't make feeds in advance any more - they can, so long as made correctly to begin with and stored safely - so they ignore totally and make up in water that's not hot enough. I was formula feeding before the new advice came out and I would not have dreamt of making the feed with water that was not hot enough to kill bacteria. Anyone can see the powder is not sterile.

Anyhow, that's by the by. Just a bugbear of mine.

I hope you get on OK NoTeaForMe, however you decide to proceed with your feeding. Sending my huge sympathies your way.

stayingdavidtenantsgirl do you have figures on how many babies have been non fataly ill due to poorly prepared formula?

I don't, I'm afraid.

really staying?

can you point me in the direction of the source(s) of your info as I searched a while ago and couldn't get much further than that babies in France and Belgium had died

tho to be honest, even if a child doesn't die there are often long-term health effects from things such as enterobacter sakazakii

interesting article from WHO

it says that whilst babies under 28 days, preterm infants and immunocompromised infants are more at risk, that it has caused disease in all age groups

Can I ask if there is any reason why you can't make up the bottles with boiling water, why does it have to cool to 70C? It all sounds so much of a faff that dc3 will get bf for longer, I hope it encourages others to bf longer too.

AFAIK, it's a compromise - it's thought that 70 deg C will kill any bacteria sufficiently well, and not kill off fragile vitamins and other nutrients. Boiling or just-boiled is too hot.

As far as I know, any hotter than 70 degrees "de-natures" the proteins (they're complex, folded molecules, and I think the heat causes them to come unfolded). As others have said though, the water must be hot when you add the formula otherwise bacteria in the powder (which is not sterile) will not be killed.

I was in exactly your position 2 years ago - it drove me bonkers that the advice was "feed on demand, but make the formula up fresh each time, but be sure to let the water cool to 70 deg" - unless you are psychic, this advice is literally impossible to follow. My way round it was to use cartons of pre-prepared formula - but I was lucky I could afford to do that. As for the risk posed by the old fashioned method of making up a batch of bottles with water the right temperature, and cooling rapidly, then storing in the fridge for 24 hours, as far as I know, there is a rare gut disease that is not killed by 70 deg heat, though there will only be a few of the bacteria in the milk if you use it immediately, so very very low risk. However, milk is an almost ideal culture medium for the growth of bugs so they will multiply rapidly if the milk is stored. But to the best of my knowledge the risk is still low even then (a handful of cases in the whole of western Europe - though my only source for this figure is my mumsnet thread of several years ago). If anyone does have the exact figures and a reference to the peer-reviewed literature, please put it up here! And if any of you work for the NHS, please suplement the guidlines with "here are the reasons why" - they're currently rubbish, just a "nanny knows best" list of here's what you must do, with no explanations.

Totally agree with you about the utter rubbishness of the guidelines to parents about this, Lurcio. When presenting stuff that is different from what people have done for decades, you need to explain why.

People have always thought it's the water and the bottles where the bugs lie - hence the traditional strictness about boiling water and sterilising of bottles and teats. A clean, clear bottle and teat, that's been properly washed in very hot water with a brush to remove all traces of stray milk and stored in a clean place is fine. To introduce the concept that the milk powder itself needs special preparation has to be done with an explanation.

Many HCPs have not understood this (though I don't know why - they mustn't read their own info).

I second the point about HCPs - when I raised the problem of demand feeding (wanted to keep as close to what I'd been trying to do with BF as possible) one of my health visitors actually told me to store boiled water in the fridge and just add powder (fortunately I was in the lucky position of being clued up enough to know the milk powder wouldn't be sterile, but not everyone would realise that). (Should just point out that I was on the whole lucky with my HVs - that was the one duff piece of advice I got in an otherwise very positive set of experiences - I know a lot of mumsnetters are HCPs and would hate them to think I'm HV-bashing).

:(

Yes - they think the problem is with the water.

So does this mean you should never make feeds up in advance? Can you not make a feed (with 70 degree water) then put in fridge for use during the night. Or put in bottle warmer to take out with you (e.g. if going for a walk around park or somewhere you can't borrow a kettle to make the feed fresh?)

I don't want to be trapped in the house all day with DS as he feeds every 2 hours so I need to make bottles in advance for use out and about. Plus he would scream the place down and never go back to sleep if I made him wait 30mins for feed in middle of night

no you definately can make the bottles up in advance. The key is that you want to retard any bacterial regrowth as much as possible so...

make up your bottles using hot water ( 70 degrees) then rapidly cool them in a tub of cold water for about 10 minutes, then put them striaght in the back of the fridge. You could skip the cold water step if your fridge is really nice and cold.

THe hot water kills the bacteria and rapidly cooling and keeping them cold will retard any regrowth. You can keep them for up to 24 hours this way if you need to. Just zap them in the microwave to bring them back to room temp or higher if baby prefers (15-30 sec usually does the job but remember to shake to remove any hotspots).

If you are out and about for more than about 2 hours though i use the ready to serve cartons unless i know i can keep it cold.

Also on the 70 degrees point i have found that hot water poured into a clean jug cools much faster than 30 minutes. After seeing others testing this time frame i did it and found that water still bubbling from the keetle got to 70 degrees in 10 minutes in a 2 litre open jug.

Thanks sugarplum - I live in a country that doesn't sell the ready made cartons though so do you think it would be best to put 70 degree water in bottle, keep in bottle warmer then add formula when I'm sat in the park ready to feed.

Or to make up bottle, chill in fridge then keep it cool somehow when I'm out and about then give it to DS cool?

i think it depends on the temp of where you are. If it is a cold place, i would probably be ok to take out a premade bottle and keep it in one of those insulated bags. They usually work quite well to keep things reasonably hot or cold.

If it is hot i would take out hot water in a thermos and when i wanted to make the bottle up i would put the powder in, 1/2 the required hot water, stir and shake to make sure all the powder is dissolved then add the other half cold water from the tap. You should then have an instantly drinkable bottle of sterile formula. Taking the hot water with you is the faff though. i suggest a thermos only because the water will stay hotter longer. You could put it straight into the bottles but i am not sure how long you could keep it at 70 or higher even in an insulated bag.

So why can't the formula manufacturers deal with their problem of selling a product containing dangerous bacteria?

becuase as soon as you open it, it will become unsterile.

They would have to design some kind of delivery system that would never expose the powder to air which i dont think is very practical.

Formula is not hard to use if you are given the correct information. Unfortunately for various reasons few seem to be.