bacteria in formula powder

[iloveeatingbogeys]

Please forgive in me advance for my very basic knowledge regarding bacteria and their optimum living conditions.

There seem to have been several threads lately on the correct preparation and storage of infant formula milk. It appears that some people are not aware that formula powder is not sterile and are not allowing boiled water to cool to no less than 70°C when preparing a feed. So my question is, how can bacteria can live and grow in a powder?

Bacteria remain dormant while it's a dry powder. They won't grow and multiply until you add water. Then the forumla provides the perfect environment for them to thrive... which is why you need to heat it to 70 degrees, to kill the bacteria off.

i think the risk is teeny tiny.

a few years ago there was no mention of it what-so-ever, and i have to say i dont know, or know of, or know anyone who has ever known anyone who has had a baby have problems / illness'es due to formular powder. The recommendations change all the time!

that said, now they have found there is a teeny tiny risk, they have to tell everyone, and advise accordingly to make the mini-scule risk, no longer a risk, and stop the formular compancy from being sued for making a baby ill, when advice is followed to the letter.

No idea how bacteria can live / grow in powder, and while its not worth taking the risk with a tiny baby, (when using boiling water stops it) i think most other things (such as being a pedestrain / going on a car journey) are more dangerous for a baby, than formular powder.

putting formular powder into water less than 70C is certainly not a death sentance, and is not likely to make baby ill...... Baby will almost certainly be fine, there is just the tiniest chance they might not.

The recommendations don't change all the time. The stuff about 70 deg came in about 5 years ago and this was the first change for at least a generation.

In the UK, babies are very unlikely to die as a result of bacteria in the formula powder, because treatment for infections such as salmonella and other gastric infections is readily available....but it's still not pleasant. Gastro-enteritis is very common in babies, with a much higher incidence in formula fed babies. It's not known how exactly many of these infections come from poorly-prepared infant formula, and I am surprised nannyl you are so certain you did not know of any babies who were ill as a result of this.....you presumably have come across babies who are ill. You can't know if this was the result of formula prep. or not.

It is known the risk of illness is indeed reduced by ensuring safer preparation.

There was no mention of it years ago because the connection had not been made between babies becoming ill and the bacteria in formula powder.

As i said, i dont know any one who was....
Have been nannying for 11 years, so back when I started it wasnt the current recommendation.

we made bottles up for the day and stored them in the fridge.... or if out and about put them in a cool bag thing and warmed as and when needed.
I dont think you are supposed to do that anymore?

But we did, everyone else did, and babies were fine and are now healthy 10 / 11 year olds.

The new way is the way we should do it of course, why take any risk when you dont have to? but the old way did not garentee illness / sickness.

In 11 years you've never known a ffed baby get a tummy bug or D&V?

No, it's not a guarantee of getting ill. Eating raw chicken isn't a guarantee of getting salmonella but I'm still not going to do it.

The risk is not teeny tiny. The risk is fucking HUGE.

The probability is tiny - very few batches of formula powder are contaminated and pass through quality control. The consequences are very serious. Risk is calculated by probability x severity of consequence.

Yes, salmonella (when identified) can be treated quickly. When it isn't it can lead to gastrointestinal damage or death. When treated the prognosis is good.

Other bacteria - such as E. Sakazakii - don't have such good recovery rates even when treated. The risk of death is much higher and resulting complications include meningitis, brain damage, problems with the digestive system, autoimmune problems, respiratory problems, sepsis....

nannyl you sort of know me and I assure you I've known a baby get very sick with an E. Sakazakii infection, which has left her with long term health problems :( There's pretty much no other way she could have got sick and I don't think her parents will ever forgive themselves knowing that it was very probably preventable.

You can still make bottles up (using 70C water) and cool them and store them in the fridge, which is immeasurably safer than using cooled, boiled water. Once you've reduced the level of the bacteria in the milk, by using hot water, and cooled it to below a temperature where bacteria can thrive, the milk will remain not sterile but safe.

Bacteria cannot grow in the powder, but they can be introduced at any stage of the preparation process and once the powder is opened and exposed to moisture then bacteria can start to grow again, which is why most tins of formula will say 'use within 3 weeks' or similar.

As you say, not doing it doesn't guarantee illness, but doing it properly pretty much eliminates the risk.

Please excuse my ignorance, but how do you follow these guidelines with Aptimil Comfort? If I use boiling water and then mix and leave it to cool, it goes too gloopy to pass through the teat. I've been boiling the water and then letting it cool and then mixing. What do you do if you go out? Do you have to just find boiling water from somewhere and then sit and let it cool? Am terrified I'm doing it all wrong!

Not sure about Aptimil Comfort specifically - if you let the water cool down a little off boiling does it still go gloopy?

If you're going out, you can make the bottle up correctly with hot water, cool it quickly and then store it in the fridge or a cool bag. Then you can warm it when necessary.

Bagofholly- why don't you bring a thermos out with the hot water in it?

The water does not have to be boiling...but not left longer than 30 mins after boiling which is the point at which it would reach 70c

70c (or plus) is the temp that will kill off any of the nasties mentioned above

A thermos won't necessarily keep water at above 70c for a long period of time. If you were to then add that water to powder that had a bacteria in it they would multiply

True.

Do aptamil do a carton version of the comfort milk?

According to the thread currently on AIBU, if the water is too hot it destroys some of the nutrients.

OP, I am enjoying your name combined with the opening line of your post

I think Aptamil comfort may be one of the milks that have to be mixed with cold water.Ds was prescribed one because of his reflux. It had to be made with fridge cold water, as it thickened with warmth.

I have often wondered how this works with regards to the guidelines.

There's no carton version. Both my twins are on it - they had terrible colic, and they also have reflux, so my GP prescribed Gaviscon, which when you add that in, it thickens everything so much it literally sets, like wallpaper paste.
I have 12 week old twins, and started out intending to exclusively BF so all this is a shock to the system. I have to give the gaviscon separately, with each feed, they have 6 feeds a day so that's 24 bottles. To think I've been doing so much of it wrong, and maybe even making them more ill, is v v upsetting.

what does it say on the tin of aptimel comfort?

I would do exactly as it says on the tin so to speak

I think the position with milks like aptamil comfort is that they have to be made with cold water, the risk of the baby getting ill from bacteria etc is deemed to be outweighed by the risks to the baby of being ill by having "normal" formula.

It says this:

Boil freshly run tap water and leave to cool for 30 mins, unless otherwise indicated on pack. Measure required amount of water (refer to on-pack instructions) into a sterilised bottle. Do not use repeatedly boiled water.

So, I've done all this with the exception of the 30 minute thing. I feel idiotic saying this, but is that bit really so important? It's so sodding impractical, especially with two. (And a two year old). Effectively I have to be within striking distance of a tap and kettle, and be able to wait for 30 mins, just to go out? Blimey!

The water temperature is important, yes.

BagofHolly, now that your twins are 12 weeks old and colic usually starts to tail off around this age, would it be possible to switch to aptamil first formula and continue with the gaviscon.

Am hoping so, we're seeing the gastro consultant this week, in the hope he'll recommend or prescribe something a bit more user friendly. The reflux is rotten and they still have shocking smelly wind too but at least they're not constipated.

Good luck seeing the consultant. I hope things start to improve for you soon

Bag of Holly, I am surprised the gp said to use Gaviscon with Aptamil Comfort, we were told by ds's consultant to stop using Gaviscon when we were using the prescribed milk, as it already has a thickener in.

Gaviscon shouldn't make the milk that thick, especially as it should only be added when the milk is ready to be used.

Sorry, BagofHolly, I also meant to say that we found Aptamil one of the worst, for wind and explosive diarrhoea, that smelt of eggs (grim!).

I hope you get some help soon. We have been through the mill with ds and silent reflux, there is a support thread on the feeding board which is very good for advice, or pm me if you fancy a chat.

Just found the instructions for making up the Enfamil AR that we were prescribed, and it definitely says to make it up with COLD water.

Hello, so am I correct in thinking - you make the bottle up with the boiling (70+ degrees water), the bacteria should be killed off, so you can then leave the bottle to sit in room temperature and feed at room temp? therefore you can make up the next few feeds (i.e. over night) and leave them to sit at room temp as no saliva has been in contact with the bottle yet, only boiling water which theoretically should have killed off anything to survive. Historically it was believed that the saliva was what activated the bacteria and that is why you were to feed the bottle with an hour of making it/starting the feed. This would eliminate the hassle of boiling bottles and rapidly cooling in the middle of the night or when out right? (I only feed at room temp as it eliminates the issue that can sometimes crop up with baby getting bored of milk half way though when it has cooled down and no longer warm)

No you can leave at room temperature. Once the milk powder has been mixed, it needs to be used within an hour or refridgerated

Boil kettle, add hot water to bottle. Add powder. Lid on and swirl to mix. Run hot bottle under cold tap until drinking temp. 5-10 mins start to finish