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

mrsgordonfreeman · 01/03/2011 13:39

I must admit that my father is a biologist and did experiments at home, so I was brought up knowing the difference between sterile, aseptic and antiseptic and so forth.

So I know that putting a non sterile substance into a sterile one makes the end product non sterile, but I guess a lot of people without my background might not know that.

BIG CLEAR WRITING on formula tins might also help. It's tiny wee!

Guildenstern · 01/03/2011 13:40

I used to make up the feed with boiling water and then stick it in a jug of cold water to cool down. I reckon it took about 10 minutes.

We fed on demand and I really didn't find it hard. But maybe that's because I have no experience of making them up beforehand so I have nothing to compare it with?

RitaMorgan · 01/03/2011 14:13

The fact that those little powder pots that CBear6 mentioned are still sold doesn't help - it certainly implies that it's fine to make up bottles cold. There should be a warning on them too.

anonMum2 · 01/03/2011 14:24

I think most people think that everyone has done it that way and their children and all children they know are absolutely fine so they don't see a need to change their habits.

I'm quite paranoid and therefore have always made formula with hot water (I aim for 80 degrees :) and get teased by DH how I know its 80 degrees).

We also use the hot(mix formula) then add cool boiled water(from fridge) method and therefore it takes less than a minute to make up feed when baby cries. I wonder why they don't include that in the guidance? Just wondering if that would be the best, practical and safest way to make up formula and if it is, why not let other parents know?

mrsgordonfreeman · 01/03/2011 14:57

Well, it's something the formula companies should be doing. They ought to be funding the research into safer manufacturing and preparation.

Of course they won't, but anyway.

The presence of dodgy bacteria in the powder has been known about for at least 10 years, I know this because I was looking on Medline for relevant research papers at lunchtime.

TruthSweet · 01/03/2011 15:20

Can I post something which shows the effects of not doing the 70C water or will I get accused of being a member of the bfing ?

Disclaimer - I care that babies are fed safely not what they are fed. If someone left a bottle of EBM out for 10 hours and then fed their baby I would tell them, if they were taking meds incompatible with bfing I would tell them (and get them to check with Dr/MW of course). To me this is no different.

flyingcloud · 01/03/2011 15:28

Snap - you can explain then why in France the advice is to use mineral water and heat it in an bottle warmer?!

Whenever I mention to any of my French friends that the powder isn't sterile, they look at me as if I have ten heads.

mrsgordonfreeman · 01/03/2011 15:36

I don't see why not as long as it's not hysterical.

Actually you can leave a bottle of EBM out at room temperature for...

hang on...

cool room temperature (60F or 15C): 24 hours.

They're not really comparable substances.

Thawed EBM, though, you have to be a bit more careful with.

mrsgordonfreeman · 01/03/2011 15:42

flyingcloud, is that the "official" advice or just what everyone does?

TruthSweet · 01/03/2011 15:43

Ok here goes:-

www.siouxcityjournal.com/news/local/a1/article_8d4f5e4d-7e74-5603-8709-77ce9f0b8be9.html

And thanks for the info on ebm - shall we pretend I missed the 'thawed' bit? You got my gist though?

mousesma · 01/03/2011 16:48

RitaMorgan there is still a safe use for the little powder pots. If you're using a flask of boiling water to make feeds when out and about then you can use the little pots to carry the powder.

mousesma · 01/03/2011 16:49

although thinking about it I have those pots and the safe use isn't explained in the leaflet that comes with them :(

SnapFrakkleAndPop · 01/03/2011 17:14

Actually I brought this up with the mw at my antenatal class flying and she said that they're supposed to follow the WHO guidelines! I fundamentally do not get the supposition that Evian has magic bacteria killing properties

But the advice is to use mineral water because a lot of places have lead pipes still...

I might attend the 'atelier' on bottle prep at the maternité and see what they say.

gaelicsheep · 01/03/2011 21:05

Hi Anonmum2. I think the problem with the hot/cold water method, the way you describe it, is that you must be really careful that you make sure it is diluted enough. I don't know if you've done this, but you need to take note of the final volume of a particular amount of water PLUS powder, then ensure that you add cold water to that level. I think this method isn't promoted because people have enough trouble reading and understanding the current very simple guidelines.

What I remember I used to do is to keep some boiled water in bottles in the fridge and add boiling hot water to get to the correct volume at the correct temperature. This needs quite a lot of fiddling around with a thermometer to get to the right balance of hot/cold water, but that was the only way I could get bottles ready when DS needed them. And it still took too much time for DS's liking.

I didn't actually realise when I was ff that you could keep the bottle for 2 hours at room temperature. I always thought it was an hour which was why it seemed particularly impractical. But tbh with a young baby the chances of boiling a kettle, leaving it to cool and then actually remembering to make up the bottle before it cools too much AND not have said baby screaming for a feed in the meantime? Pretty much zero.

flyingcloud · 01/03/2011 21:43

Snap - I used to catch DH putting Evian in the kettle, as we were trying to find our happy medium. He was convinced our (boiled) tap water would be far more dangerous than any bacteria in the formula.

breatheslowly · 01/03/2011 22:11

I was curious about the actual risk of salmonella in babies as a result of powdered formula and my google search returned this. With a rate of about 2/1000 infants, not to mention the ones that go unreported, the risk from incorrect preparation seems sufficient to bother adding the powder to hot water rather than cold.

SnapFrakkleAndPop · 02/03/2011 13:59

It's not just salmonella too. There's e. Sakazakii as well, rarer but more serious.

Plus most people have bonkers approach to risk, to put it politely. Risk is calculated on likelihood x severity of consequences and the potential consequences are severe illness leading to significant brain damage and death. If people know a child who has had an e. Sakazakii infection you wouldn't ever say there was no risk doing it the old way. Small likelihood statistically but it just doesn't bear thinking about.

Even 2/1000 is huge by itself though!

FluffyFrog · 02/03/2011 22:51

Hi - conflicting advice again I think -but I checked with my friend who is a dairy microbiologist. She said it would be fine to make up bottles of boiled water, keep for up to 24 hours, then add the powder just prior to feeding. From her scientific opinion if formula is kept dry within the 4 week guideline on the tin, it should not be growing any bacteria & therefore should not require any hot water to kill any bacteria. I BFed 2 children until 6 months then really struggled with DC3 so checked her advice before FF. Just make sure you keep the formula scoop dry so you are not introducing moisture. It seems like they make the guidelines super strict to allow for some deviation. A bit like the guidelines on certain cheese when pregnant - my friend has scientific opinions on that too - but that's another story.

Everything else I agree with.

gaelicsheep · 02/03/2011 22:58

But the formula powder isn't even sterile when it goes in the tin so I don't understand her advice at all. The bacteria can already be there, then once it is added to water (around 50 degrees is the most dangerous apparently) the bacteria quickly multiplies unless the water is hot enough to kill it.

gaelicsheep · 02/03/2011 23:00

SnapFrakkleAndPop - I find it particularly interesting/puzzling when compared with people's approach to risk over vaccinations. It's the same with the apparent lack of concern over the fact that many of the ingredients in formula are untested on young babies. Translate that to a vaccine and there would be (and was) an outcry.

tiktok · 02/03/2011 23:10

FluffyFrog - a dairy microbiologist, dealing with agricultural economics and cows milk, I guess, is not the person to ask about safe preparation of formula milk powder for human babies.

She is clearly unaware of the concern that formula milk powder becomes affected in the manufacturing and processing - this is apparently an unavoidable hazard and unaffected by keeping the scoop dry etc etc.

breatheslowly · 02/03/2011 23:11

FluffyFrog - formula powder has been tested and found to contain these bacteria and outbreaks of illness have been traced back to the formula powder.

FluffyFrog · 02/03/2011 23:25

gaelicsheep, tiktok, breatheslowly please continue to make your bottles up with hot water. I was merely quoting advice from my experienced friend. I will challenge her advice with your comments & come back & post again.

Rusty06 · 10/03/2011 00:08

Hi Just wanted to say how grateful I am for this thread. I have a 3 week old baby and have been geting myself in such a pickle over the preparation of feeds. I had been so determined to brest feed I hadn't even looked and at bottle feeding methods before hand so the lack of knowledge multiplied with the guilt of not breast feeding has really been wearing me out, so thank you for all the info and reference to the guidelines.

Rachel

japhrimel · 10/03/2011 08:16

Yup, the issue is that formula may be contaminated. It's not that it goes "off".

I'm in a quandary atm about whether to forward the leaflet onto friends. Some of my NCT group are FF and I know they don't follow the guidelines about hot water. But as I'm now EBF, I think they'll see it as interfering if I point this out (I have tried mentioning it casually to one of them and her answer was basically that she didn't care). I might just forward the leaflet, but it doesn't make it clear IMO that the hot water is the important point.

And why aren't NHS staff more aware of the guidelines and if they are, why don't they point out to Mums if they're not doing it safely? At my childrens centre post-natal group, loads of mums were making up formula with cold water and those in-bottle tubs and the nurse didn't say anything!