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!

weaning is another huge grey area.
With DS it was at 4 months. With DD i was given NO advice and just followed her lead.
As a nursery manager we were advised a while ago not to give any baby any solid food till they had reached 6 months and then it was to be a gradual process ie vegetables to be introduced individually and fruit etc individually and the meat individually untill one year when they could have meals!

Now we have been told at nursery that new guidelines are to start weaning from 4 months again because they have found that more children are being diagnosed with allergies and food issues due to previous guidelines.

My sister has a 17 week old baby and the HV has been nagging her to wean him since 14 weeks........he is happy taking first stage formula and still only taking 5oz at a time so she feels he is contented as he is sleeping 12 hours at night and gaining weight steadily. HV has told her he needs to be on 2 meals minimum by the time he reaches 6 months!

Who told you guidelines have changed to 4 months?

Weaning is another one where people seem to think it changes all the time, but actually as I understand it, it was changed to 6 months in 2003 (?) and had been 4 months for donkey's years before that, certainly back to the early 80s.

In a way it's much easier now with the internet as we can go and look up the NHS guidelines for ourselves, rather than having to rely on an HV's personal "interpretation".

RITA: we were told at the nursery by a community health visitor who we have regular contact with. this 4 months guideline has been confirmed by my sisters health visitor who is nagging my sister to wean her 17 week old son!

You've not experienced weaning confusion until you've had one HV tell you 4 months, a different one tell you 6 months, but both say "but your son was 6 weeks premature and premature babies are often weaned early." "How early?" "That depends...your paediatrician will tell you." "He's not under a paediatrician." "Oh." Very helpful!

Forgot had weaning "advice" to look forward to. At least the FF stress will go!
Have mended my ways - made up feeds for today using (slightly) cooled boiled water, cooled them in bowl of cold water and under cold tap, stored in fridge. Warmed with wanky bottle warmer that made them boiling again!
This is ok, right?

tempted to just buy sodding cartons.

Juicy lips said: It really needs explaining better. I dont think the packaging explains clearly enough the reasons why it must be made with hot water.

Yep, there may be instructions on the back of the tin that say how to make it up, but because they don't give the reasons why (the 70c bit) confusion and thus different ways to make formula up arises - this must be where the 'using previously boiled water, even if now cold' bit creeps in.

It does say on the back of the tin that "formula is not sterile" but then fails to explain what this means and why the hot water is necessary. I really think they need to add this. But they're unlikely to do this are they? They'd certainly have room to put it if they took off all the bumpf about follow on milks etc (which are "neither needed or recommended" says the NHS. Grrrrrr)

too many bits of confusing advice, drives me mad too!
i have a 4 month old and i put 4 oz cool boiled water into his bottles and then add 3 oz boiling hot water fom a flask, then add my 7 scoops of formula from a tommy tippie tub! perfect temp for him straight away and never been any side affects! one health visitor was disgusted and another thought it was great and convenient! Surely they should all be on the same page?! :) ps- this method has been great in this weather as i can be out all day and have his milk on tap, hehe!

Bonkerz - sounds like the HV has got confused by that research that was in the papers a few weeks back? I don't think NHS guidelines have changed though.

happidays - afraid that's not a safe way to make up bottles, the powder has to go into hot water.

So at work yesterday I gave the DOH/FSA guidelines for HCPs on making up formula to the midwife who was at the surgery yesterday afternoon (a different one) and again amazement was expressed at the 70 degrees thing. Apparently it must be really new guidance for them to have missed it. I told her I thought it was a few years old but she said that it must be from the last few months

Does anyone know when the guidance changed and was it ever the case that you were supposed to use cooled boiled water.

It is really worrying that other people, supposedly in different areas, have also been told that cooled boiled water is ok by midwives/health visitors. It's a public health issue really. Not sure exactly what to do about it at the moment but need to do something.

Tiktok or anyone else, does anyone have any links to an article that will explain the actual statistical risks of contamination and their consequences. I feel I need to be as knowledgable as possible before I start making a fuss.

It changed in 2005 I think - certainly before my son was born as I remember hoiking my judgey pants at a friend not doing it. The FoodSafety website certainly has a new report in Feb 2006 for the revision which included ready to drink milk advice in it.

The DOH confirmed late last year that the weaning advice was NOT changing, nor did they have any plans to do so. This rumour seems to be widespread, but there is no basis for it.

www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_100887

This is guidance issued as 'new guidance for healthcare professionals' dated Nov 2005.

Any midwife or HV still unaware needs to ask herself why this has passed her by.

There is a link from the page I linked to, which shows the risks, Wispa.

Thank you CMOT and Tiktok, will be writing a letter to Head of Midwifery detailing my concerns at the apparent widespread lack of knowledge in this area and subsequent bad advice to parents. I also think there needs to be a plan to ensure all are re-educated and a plan to ensure all pregnant women are told how to make up formula safely. The midwife also told me they only tell the ones who say they don't plan to breastfeed but I would have thought that given the percentage of women who use formula at some point, it should be part of the routine antenatal care.

I think the fact that it has passed so many of the midwives by really is worrying. I am meeting some of the HVs on Tuesday to find out what they are telling people to do, ad try and make some sort of plan for educating the local population. I am hoping they take me more seriously in a professional capacity, because they've got me down as a bit of a lentil-weavery-yoghurt-knittery sort of mother. I shall wear my sharpest suit and try very hard not to have bits of porridge (courtesy of DD2) in my hair.

I would be very interested to hear of anyone else who has heard of people being told this is ok to do by MWs or HVs and your rough location if possible. I am hoping this is just a small group of midwives who have got it wrong and not a whole country full!

its ok in my area......leicestershire. The bottles being made with cooled boiled water is advocated and HV hassling my sister to wean her DS aged 17 weeks!

Hi

I just wanted to say how much I appreciate you taking this on Wispa. I'm a FF by circumstances not by design (just stating facts not judging!) but this meant that I was at a complete loss when we left the hospital having to mix feed. If it wasn't for the fact that I was already hooked on MN and therefore had access to this talk topic, I would have no clue about the proper way to make up bottles and was given little to no support from HV/MW apart from the constant suggestion of 'try a BF cafe/clinic' to get my DS to latch. This rankled with me because we'd had a horrific time in hospital and I was doing the best I could under very difficult circumstances, including expressing as much as possible, and I felt that I really needed the support/information re FFing once the decision had been made to mix feed.

The guidance out there is practically non-existent - if I was going on the varied advice from NCT mums/friends in the area I would be even more confused - some do the cold boiled water method, some do the hot boiled/cold boiled method and everyone seems to think their way is the correct way - and everyone seems to have been given this advice by either their HV/MW. (NB: as I've had no advice, this is purely anecdotal!). The HV's I've spoken to about the lack of information have told me that they are hamstrung by the requirement to recommend BFing exclusively, which is so frustrating to hear.

I'm in Surrey/London borders where there is also an expectation of weaning at 4 months in this area, in fact the local HV's run the weaning talks when your baby is 4 months. My DS is 5 months old today and I am the only one out of my NCT group not weaning yet (we're going to do BLW at 6 months) despite the fact that several of the babies are patently not ready yet (tongue thrust still present, not sitting independently etc).

I'll be watching this thread with interest!

I make up our DS2's feeds by using hot water stored in a flask (saves time boiling the kettle) then plunging the finished bottle in cold water in a jug - sometimes I change the water to speed the cooling process. Works a treat though I will admit to using cartons when out and that I will make a feed up to an hour before needed (keeping it in the cold water). Any more than about an hour and it gets binned. There are plenty of parenting shortcuts that I'm up for but risking my DS's health from a stomach upset is not one of them. I've been to talks where HPs have advised using cool boiled water and sometimes feel slightly embarassed when others see me faffing around making up each feed. The only reason I understand why its important to make it this way was because of MN!!! (I only got my DoH birth to 5 book with DS2 never with DS1 which also explains it). One idle thought I've had is, if you make up formula as per the instructions, why do you need bottle warmer ?(as in the mothercare cat.) - surely what we need is a rapid bottle cooler????

Makinglists - excellent point about the rapid bottle cooler...

Bottle warmer presumably for bottles made in advance and put in fridge, but a rapid bottle cooler would make it obvious that you're supposed to make them HOT.

Birmingham were giving incorrect advice in 2007, Bucks (near Beaconsfield/High Wycombe) in 2009.

bonkerz am in leics too. Thanks to this thread am now making bottles up with hot water. Putting a batch in fridge though for a few hours and will do so until rapid cooler is invented!

Right, so as well as doing my bit for the health of babies up and down the country, it looks like I will also be appearing on Dragon's Den with my 'KoolItKwik' (TM) bottle cooler

Actually, it's not a bad idea...

I'm at a loss to understand how HVs and midwives, presumably people with an excellent understanding of infection control, could think that formula made up with cooled boiled water would ever be sterile.

Wispa, recognised good practice is to give all mothers information on infant feeding antenatally but not to go into details of how to make up bottles and so on at that time - the reason is that this is not a good way of ensuring people retain the information and it undermines breastfeeding. You don't need to go into details of mastitis, finer points of positioning and so on, with bf at that time either.

Baby Friendly (UNICEF) which is the standard all maternity units should be aiming for (per NICE) has clear guidance on this.

Mothers who are formula feeding, or who decide to do this when the baby is born, need careful instruction in the safe preparation of formula, preferably in their own kitchens (community midwife could easily do this in one of the postnatal visits). The leaflets given out by the NHS, the info in the Birth to 5 book, have all been saying the same thing for 5 years now, and midwives and HVs cause huge confusion if they are not telling mothers the same thing. The instructions on the formula packs also detail the hot water info.

Support for breastfeeding does not mean HVs cannot explain about safer formula feeding, and it is ignorance that leads them to say this - the Baby Friendly stuff explains this perfectly well.

Re weaning, my red book says it can start at 4 months and both the consultant and the Health Visitor have told me 4 months. I know you can but it's not recommended is it?

Tiktok have set aside some time later to read the UNICEF baby friendly/NICE guidance etc, whatever I can find really.

I can see how the information would not be retained antenatally but I think it needs to be made clearer that if at some point a formula feed is given, then it is important that it is made up correctly. It needs to then be explained how to access that information if needed, and the information needs to be readily accessible.

The best way for this to happen is if it were printed on the side of formula tins in big bold letters, in a much clearer way than it currently is. Hmm...