Making up formula with cooled boiled water...

[SeriousWispaHabit]

...is not correct, I know.

However, the whole of the local midwifery team would appear to think that it is.

I am a GP and have noticed a lot of people doing it this way at toddler groups/in cafes etc locally so thought I'd mention it to the midwives and health visitors to see if we can try and improve things - maybe with some leaflets at baby clinics or making sure it is covered in antenatal appointments etc.

She told me that as long as you make up the feed fresh and the water is cooled boiled water then it is fine. I explained why this is not true and she then phoned labour ward and checked with 3 colleagues who all agreed with her.

Now I know there are some new guidelines somewhere that have a NHS logo on them and possibly a unicef one that explain all this very nicely but my overworked and sleep deprived from non-sleeping baby brain cannot find them. If anyone could post me a link and maybe some links to some nice peer reviewed articles on why formula must be made with hot water I would be very grateful and will get on the case at trying to change the wrong advice being given.

Also, can a couple of you just come on here and post that I am right to be following this up and making a fuss and it is actually a big deal, because I am starting to doubt myself when faced with a ward full of midwives who clearly think I am a bit bonkers

Thanks!

This should help clear up the confusion .

There is a guide to bottle feeding as well as The health professional's guide to the above leaflet.

Good on you for flagging it up.

Thread here

Food Standards Agency and DoH should be able to help.

I believe some babies in Belgium died from formula not so long ago.

You are 100% right! Unbelievable!!

This is the WHO guidelines:

www.who.int/foodsafety/publications/micro/pif2007/en/index.html

the relevant section bit is in 2.2.5 on page 12.

You are supposed to cool the water to not less that 70 degrees, but it should not be boiling as such. Do you think this is what they are getting confused over?

Sorry - forgot shocked face

Shouldn't that be died from "incorrectly make up formula?" Rita Morgan...?! :)

I don't know Deanna - it's the formula that has the bacteria in it, using hot water reduces the risk.

Crikeybadger - that is the leaflet I was looking for, thanks.

I am going to make sure that the head of midwifery at the local hospital is aware of the problem and that some re-educating is done. Also, I think I'll check with the health visitors to see what they're telling people. I'll start with that and then go higher up the hospital management if I'm not getting listened to. Then once all the HCPs are on board, we can get on with the initial idea I had about trying to educate the local population.

It's only my second week back from maternity leave and I'm already on what DH calls 'one of my missions'

Well done SWH.

I don't think i've ever seen/known anyone do it as recommended. Lots of 'well i did it this way for dc1 and they're fine'. I've used the car seat analogy and met with blank looks.

Good on you for raising the issue.

Glad that was helpful Wispa

We need people who are 'on missions'- otherwise things won't ever get better.

so, forgive my baby brain, is it ok to make feeds up and store them in the fridge for 24 hours?

is this better than storing cooled boiled water (as recommended by mw) and adding formula when required?

making a fresh feed each time not feasible - can't predict when dd will be hungry. and she gets incredibly distressed waiting for water to cool. Like her mummy, this lady loves food .

Fucking hell. It's no wonder people ignore the guidelines if MWs are giving incorrect advice like that

whoamamma you can make with hot water, cool rapidly under cold running water to room temp (mustn't put it into fridge still hot) and then store at the back of 'the fridge although I personally wouldn't for 24 hours OR you can make with half very hot water (don't scaled yourself) eg 3oz, then all the formula, eg 6 scoops, shake to dissolve and kill lurking bacteria, then add remaining 3oz of cooled, boiled water either at room temp or from fridge, depending how warm you want to milk to be, and it's ready almost instantly.

And yes, storing in fridge is infinitely better than using cooled boiled water. Cooled boiled water won't kill bacteria, hot water will. Storing the bottles in the fridge then prevents the bacteria from multiplying (or as rapidly as they would at room temp) until you warm it up again, which will be when you want to feed, and then you follow the guidelines about discarding the milk just as you would for fresh made.

This is extraordinary, isn't it?

Guidance changed about five years ago.

It is actually quite simple stuff - you reduce the risk of bacteria making babies ill (sometimes, very ill, and on rare occasions, fatally ill) by making sure the water that hits the powder is hot enough to zap the bugs in a sufficiently high number.

The bacteria in the powder are more dangerous than any bacteria that might come out of the tap - given our water is pretty clean in the UK (though it makes sense to run the water out the tap first, to get rid of any water that's been sitting in the tap overnight).

I am at a loss to know what planet midwives and HVs have been on not to know this , and yet many of them apparently do not. Leaflets for mothers, and guidance for HPs, have been consistent for several years now.

I think most people do think it is about the water having the bacteria rather than the formula, so them thinking making it with cooled boiled would seem logical. It really needs explaining better. I dont think the packaging explains clearly enough the reasons why it must be made with hot water.

In my red book, the mw ticked yes to each question in the bit about 'have you shown how to make feeds up' etc was ticked by mw, for each question -she didn't explain a single thing. I didn't get any leaflets or advice until I asked, and was then told to not make and keep in the fridge. Aaaagh, wish EBF had worked for me as planned.

No excuse for my slovenly ff ways, but just an example of how people aren't being educated about this. Will mend my ways from the next feed, and help spread the word.

confusing first sentence above, but you get my drift.
Off for some light relief in Style and Beauty!

Sounds pretty lazy of the midwife to tick the boxes without even bothering to show you - maybe worth a letter to the head of midwifery?

Brilliant! Thanks for following this up. And yes, as a GP, I really think you should. I've been horrified at the lack of intervention from nurses/MWs at my local Childrens Centre when FF mums make up formula with cold water. I've tried mentioning the new guidelines tactfully but have been dismissed by all and as I'm now ebf, there is a perception that I am attacking FF mums.

I've struggled with getting any information on my unexpected bottle-feeding - had no advice before I left the hospital, even had to buy bottles and formula on the way home!

My HV said it's fine to make it up with cold water as long as you use the feed straight away, that way there's no time for any bacteria present to multiply to harmful levels. A friend's HV told her it's fine to make up with freshly boiled water, not even waiting for it to cool.

Also what are you supposed to do while out? Even if you take a flask of hot water to make the formula up with how are you supposed to cool it down properly?
There's just a complete and utter lack of advice and support, but I've found midwives and HV's general attitude to be along the lines of "you're bottlefeeding? We're not allowed to talk about that or give you any help due to the breastfeeding guidelines."

Not an issue for me anymore though, we use Staydown milk now which has to be made with chilled water anyway!

It is just all so confusing which is why people choose a way that suits them.

When DS was a baby 10 years ago i would make the feeds with boiling water, cool in a sink of cold water then store in fridge till needed.

When DD was a baby 5 years ago we used to fill all bottles with boiling water and measure the powder into small tubs and leave them all on side till needed then feed would be made when needed.

I now have DS2 due in 7 weeks and have decided to use the half boiled water half cooled boiled water method. So i intend to measure out powder into small containers (tommee tippee ones) then make up half the water and leave bottles then i will top up with boiling water and add powder when feeds are needed.

It really is all confusing and as a nursery manager i try to keep on top of guidelines ofr bottle feeding/sterilising and weaning but they change so often its difficult.

Absolutely amazing and deeply worrying that these health professionals are ignorant of this "new" advice. Honestly, I am really really really shocked .

Bonkerz just remember the powder has to go into the hot water, not room temperature. I fact your method with your first DS was fine.

bibbity - I agree! Shouldn't midwifes and HVs have some sort of continuous development/training so they stay abreast of current guidelines? You'd think 5 years would be enough for it to filter through.

It is deeply worrying! I gave birth to DD2 4 and a half weeks ago and the MW in the hospital was telling me how to make up formula. I said, "oh yes, the powder has to be added when the water is 70 degrees doesn't it, as the powder isn't sterile?" She looked at me like I was as mad as a box of frogs and gave me a look, and said "no, you add it to cooled boiled water!"

Just to add that now I think about it, when DS was about 3 weeks old (he's 5 months now), my HV said she used to have booklets on formula feeding, but she'd run out and couldn't get them any more because they'd been taken off of the website that she orders them from. She thought it was because they're not supposed to offer any information on formula-feeding, you have to specifically ask (of course if you don't know anything, then you don't know what specifically to ask!)

With ref to midwives and HV getting continuous training to stay abreast of guidelines - don't get me started on the conflicting weaning advice I've been getting!

Yes, weaning advice too! What is the obsession they have with weaning at 17 weeks?