New guidelines for making up formula, issued 24/2/2011

[BoysAreLikeDogs]

here

So it's still a case of 'throw un-drunk milk away immediately', except when it's 'use made up formula within 24 hours'.

I think it's just the ready made formula in cartons that can be kept - once it's heated/in a bottle in has to be chucked.

I thought that too Rita but page 20 suggests (to me, possibly I'm reading it wrong though) that formula made from powder can be kept for up to 24 hours in the fridge.

And also, a litre of water to make ever bottle?! That's an absolutely appalling waste of energy. Absolutely disgusting. Surely it would be cheaper to buy a thermometer than to boil a whole litre every single time baby needs a 200ml bottle?

Still think the guidelines are enormously flawed in terms of clarity and being realistic.

Ah yes, the guidelines for making in advance are that bottles can be kept for 24 hours. It's clear that it isn't ideal to make in advance though.

I doubt many people would bother buying a thermometer.

does anyone actually do that? like make up all the feeds at once?

This is useful, I have 2 week old dd and had a few questions about ff which are mostly answered here.

I have been making up 3 or 4 bottles for night time and keeping in the fridge - so technically they are only in the fridge for about 10 hours at the most which seems ok by these guidlelines?

God its confusing, shame I'm not rich and can't afford to buy cartons all the time :)

These are not new guidelines as such, just a new leaflet explaining the existing DH and FSA guidelines

FWIW I make up 2 feeds at night and put them in the fridge, one in case DD wakes up during the night and one for her morning feed. In the morning I then make her other 3 feeds and put them in the fridge.

The most important thing it to make sure the water used to make the feeds is above 70C and that the bottles are cooled quickly before placing in the fridge.

It is good to have these guidelines more explicitly explained for those who wish to FF but I wish they would advise every FF parent to buy a thermometer to check how quickly their kettle cools the water from boiling to 70C. I bought one recently as I was switching from 1/2 bottle of FF a day to fully FF and wanted to experiment to see how long water stayed at 70C in a flask so I could make up bottles when out and about. I was shocked to find out that my kettle actually cools from boiling to 70C in 5 minutes when a litre of water is boiled. So despite following the guidelines I had been making DD's bottles at temperatures less than 40C for months because I hadn't thought to check.

P.S. I'm going to continue working with the WHO guidelines (see here)

It is interesting that the WHO guidelines are more accepting of the need to make feeds in advance for practical reasons. In the UK guidance this is buried in the booklet at a point where it is unlikely to be seen. I still worry that by promoting the totally unrealistic make fresh method (fine if you're GF but what about those of us with normal babies?) in effect people will just disregard all the advice. I wish the UK guidelines were more pragmatic and sensible.

Gaelicsheep, I agree. I think by making these guidelines so unrealistic they are setting parents up to fail and the parents I work with who take a lax approach to hygiene with regard to preparing/storing feeds are more likely to comply if you tell them a good compromise is to prepare a couple of bottles with water, store in the fridge and add formula as you need it.
And realistically, I wonder how many babies who do develop serious gastric problems are simply victims of child neglect rather than someone making a bottle up in advance with scrupulous hygiene and storing it in the fridge.
My personal opinion is that it is made impractical on purpose in order to deter people from ff, rather than to help them do so safely. The WHO guidance is far more practical.

I really hope that isn't the case although I can confirm it is a by product, for me anyway. The thought of the hassle of formula feeding again was a significant factor in my determination to succeed with breastfeeding DD.

reikizen, just to clarify, the WHO advice isn't to "prepare a couple of bottles with water, store in the fridge and add formula as you need it". The water must always be at above 70c when you add the formula.

The advice is to make the bottles up by adding the formula to the water at no less then 70C then rapidly cooling and storing in the fridge.

I don't understand why the make them fresh approach is unrealistic. I did it with both my babies and didn't have a problem with it.

Guildenstern, I think it's the length of time it takes the formula to cool. It would feel like an eternity if you had a screaming baby.
How did you manage it?

Make fresh is fine if you know in advance when they feed but making fresh in anticipation doesn't always work because once made and at room temp it can only keep an hour.

Much better in those case to make in advance following the guidines for making fresh, cool rapidly and put in the fridge.

Adding formula to boiled/cooled water, whether at room or fridge temp is just a huge no-no but so many people do it for the convenience :(

I think make them fresh is easy if your baby follows a routine but much more difficult if their feeds are unpredictable.

Also everyone is very hung up on leaving the water to cool for exactly 30 minutes. The advice is to not leave for longer than 30 minutes, so as long as the water is not so hot it could scald then you could leave the water for less time.

There is an argument that using very hot water degrades nutrients but the only evidence I could find is that some vitamin C may be lost but this only has a detrimental effect on pre-term babies. N.B. this evidence is part of the Irish guidance but I can't find a link to it now.

I don't think babies who develop serious gastric effects are necessarily the victims of child neglect. I do however think that because problems caused by incorrectly prepared formula are so rare (but very very serious) the weight of anecdotal evidence sometimes overwhelms the advice given.

I can see how someone who is surrounded by friends and family who have always maded formula with cold water with no problems might end up feeling like an overprotective loon for following the guidance. The problem is that people are told the guidance but not told why following it is important.

You can speed up preparation by doing: boil kettle, transfer half the required volume of water to bottle (smaller volume cools quicker), add powder, shake to dissolve, top up with boiled/cooled to make up the quantity and bring the feed down to room temp - you will need to measure this is a separate bottle because the formula powder will have altered the volume of water in the original bottle and you end up with a too-strong feed if you top up to where the water originally should have been. 7oz water makes something like 7,5oz volume of formula. Then you only have to wait for the kettle to boil and the small amount if water to cool but it does mean experimenting with a bottle to see how long you need to leave it and brands vary in cooling time.

When DS was on the bottles I used to make up feed for the day in advance. I had these little Tommee Tippee pots that held the powder and went inside the bottle so the milk was separate from the water. I'd boil the kettle and pour in the water, then measure the powder into the pots, a pot in each bottle, lids/teats on, and store them until ready for a feed. I'd do three or four at a time so I always had a bottle on standby and I just poured the powder in when ready and fed it to him at room temperature. I was told that so long as it's properly stored then the water will keep for 24 hours, it's only once the powder is added that it needs to be used asap.

It's not the water you need to worry about sterilising, it's the powder, so you should NEVER add powder to cool or room temp water.

A feed needs to be used ASAP if the powder and water are together at room temp. If they're cooled they can be stored for 24 hours at less than 5C.

This is very interesting. I'm glad I found this thread as I was going to post a question about the whole 30-minute malarkey. I'm afraid I make up a batch of bottles and store them in the fridge, but was wondering why you need to wait 30 minutes before using the water? Can't I just boil the kettle and make up the bottles? Any advice gratefully received!! Thanks, Sarah

dorsetbod I think its because if the water is too hot it destroys some of the nutrients in the formula. I've ff two girls and am currently ff dd3 (2 weeks old) the best advice/tip I got was to buy a cheap second kettle to use for the bottles so you not waiting on water cooling down and can have tea whenever you want Of course you could just pour the water out and wait on it cooling but that would be too sensible for me!

There is some worry that water which is too hot will denature some if the ingredients so 70C is the best compromise.

I saw a friend of mine making up formula whilst we were out with cold water.

He and his wife are very bright people, but they had interpreted the instructions on the formula tin as "leave the kettle to cool down". I think a lot of people do.

I said, gently, that they had been doing it contrary to the guidance and that the formula powder isn't sterile. The surprise and incomprehension they expressed made me feel really bad but I explained that if they wanted to carry on as they were, that was up to them, but that I wouldn't feel right if I hadn't mentioned it.

I wish it could be summarised in a catchy way: "hot must hit powder" or some such.

So true mrsg - a catchy slogan would get the message across and the instructions are very ambiguous even when you are familiar with the science behind them.

I've lost count of how many people I've tried to explain the 'powder isn't sterile, hot water kills the bacteria which live in the powder' logic to.

The problem I have is that I don't want people to think that I want to make their life difficult on purpose or that I'm punishing them for not breastfeeding by overcomplicating matters.

I'm not! I just want all babies to be as healthy as possible.