Realistically, what is the best way to make up bottles?

[12ylnon]

I'm expecting in May, and i've just read the WHO's guidelines on how to make up a bottle... well bloody hell, i won't be doing anything else if i do it that way! I mean, what are you supposed to do when you're out and about, or at night?

DS1 was born 6 years ago and back then, i would put the bottles in the dishwasher overnight, boil the kettle when i came down in the morning, leave it to cool for a while, then fill all of the bottles with water, seal them and store them in the fridge for when i needed them. All i had to do was add the formula.
Clearly i was doing it wrong! But really, is there any real reason why it can't be done this way? Or is there a better way? Or should i just stop being so lazy and do it how the WHO recommends?

[jave]

Thanks guys. She's had some and not thrown it up as yet. Its distressing to watch and can't be comfortable. If it was harmful making it that way, it would not be on the shelf for sale!

[fraktion]

Again it's about the risk/benefit. The benefit of using the comfort milk which can't be made with hot water outweighs the risk in that case. However for most babies who don't need that the risk outweighs the benefit.

[hazeyjane]

Jave, a lot of the anti reflux milks have to be made up with either hand hot (tepid) water, or fridge cold water. They have to be made like this because otherwise the thickening agent, which is in a lot of these milks won't work properly in water over 70degrees. Annoyingly it contravenes the guidelines, but it is important the instructions on the side of the packet. If you are worried, and the milk needs to be thickened, in order to stay down, then you can get a prescription for Carobel, which is a natural flavourless thickener, based on carob seed powder. This can be added to the milk afterwards.

[jave]

Its interesting, i'm just going onto aptamil anti-reflux formula and it states on the carton that the feed has to be made up with 'hand hot water', as in water you can put your hand in! I have no idea how to prepare it. If I went with the cartons guidelines my baby would be screaming out in hunger. I plan on using 2oz of boiled water in a bottle, allow to cool, put in fridge and then when I need it, top it up with 3oz of boiled water, put feed in and hopefully that will be the right temp, 'hand hot', to kill any germs. Any other suggestions welcome!

[GoldPlatedNineDoors]

NHS website says you can refirdgerate made formula for 24 hours.

I had four bottles. I would.wash, sterilose and make up all four at once. Cool and refidgerate. I would remove from the fridge one hour before needed and it would be room.temp for feeds. Ive never given dd a warm bottle (even though I make all feeds woth hot water).

[gingergaskell]

Hazey, I agreed with you on the last page that it no doubt was in the WHO guidelines at the time, just not well known. My oldest was born in HK, so I'm not familiar with the birth to 5 book. Since I haven't heard of it, that means I didn't get it for my second born here in 2008 either {is it an NCT thing?}, but as I said it was not something any of my friends with babies did from either of those times, {in either country} which is similar to the OP's experience, which is why I bought it up, to reassure her.

From the link up post it seems there was a scare in 2011, so I'm assuming it's become widely known / common place from then?

At any rate the articles I mentioned about the risk of scalding being considered a higher one that the risk of the bacteria are current articles. So my point was about the advice given in them, NOT the relevance of my own experience at all. {So NOT trying to say 'I did it so it must be OK'!}

And once again I have stated initially, and reiterated in each post, that I am NOT advocating not preparing bottles in that way, just thought the information was relevant to the thread.

[fraktion]

Ready to feed is pasteurised so there should be no bacteria providing the seal isn't broken.

It's all about perception of risk. The chances are small but the consequences severe. That makes it high risk for most people.

Personally I know one infant and know of another, exclusively FF, non-mobile, who have contracted bacterial infections from incorrectly prepared formula. I'm sure there were babies who had formula from the same batch who didn't become ill because the formula was properly prepared. There's also an MNer whose baby had salmonella before being weaned.

Even if the formula isn't contaminated during the production process it can easily be infested with all sorts once the tin has been opened. Kitchens are often lovely warm damp places.

[Bottleoffish]

12nylon, I'd be interested in the link to the food safety website in NZ that says cronobacter is found in breastmilk, the only info I can find talks about it being found in breast milk fortifiers. The Study mentioned in th blog you linked to also talks about cronobacter being found in fortified breastmilk. The CDC website claims that cronobacter is extremely rare in exclusively breasted infants, with virtually no cases being reported.

[narmada]

Nothing is completely safe, but powdered formula is very much more strongly associated with cronobacter than BM or ready-to-feed.

[hazeyjane]

Ginger, the instructions on the formula in 2006, were to make up bottles as per the WHO guidelines (ie make up fresh each time, with water over 70 degrees, cool rapidly and feed to your baby within 2 hours). It was also in the birth to five book, and the leaflet given out by the MW. I remember very clearly because of talking to baby group friends about the best way of doing it.

[gingergaskell]

Narmada, not an argument at all, I was careful to state originally and reiterate that. all of us do what is best, I'm not advocating not doing it at all.

Just can sympathise with OP, who my post was aimed at, not everyone else.
If I had a first born now, I'm sure I would be saying / advising / feeling comfortable doing the same as you for sure.

Having {'rightly' or 'wrongly'} not had that advice {or at least known about it} for my children as babies, then my own risk assessment having a baby now like OP would be different based on my own experience. I'll be honest and say I would feel comfortable not doing it based on that. But I'm NOT suggesting you OR OP for that matter shouldn't though. I thought she might find it helpful to know though.

[12ylnon]

www.fearlessformulafeeder.com/2012/10/ready-to-feed-formula-may-prevent-cronobacter-infection-in-babies/

[12ylnon]

I just read an article on the government food safety website in NZ that states that cronobacter could also be found in ready made formula and breast milk, so really, nothing is safe. In fact, this website says that the lowest instances of cronobacter contamination was in ready made formula, even lower than bm.

[narmada]

Oops cross post. But I don't see the point in 'we didn't do it in my day and we were all fine!' type arguments.

[narmada]

But the point is that e.sakazakii - or cronobacter- Is very dangerous - think sepsis or bacterial meningitis and a historical mortality rate of 40 to 80%. The risks are greatest in tiny newborns. Why take unnecessary risks?

[gingergaskell]

Probably Hazey, but like OP, with my children born in 2006 and 2008, no one else I knew at the time did so, so it was not the norm, or common knowledge. This was across 2 x countries, one of my children was born in HK and one here in the UK {the youngest}.

And again to reiterate, I'm not trying to challenge or advise against it, just stating the risk. .

[Bottleoffish]

12nylon, lots of people don't know how to make formula up correctly.

The bacteria that can be found in powdered formula milks are much worse than anything a baby will find othe floor and put in their mouth. Would you give our baby raw chicken to eat? No, we'll formula powder can carry salmonella as well as e.sakazikii, which babies in Europe have died from due to incorrectly made up formula.

The risk may be small, but the consequences are potentially huge.

[12ylnon]

gaskell thats very interesting, i guess i'll just have to see. Tbh, theres probably more of a chance of the baby picking something up from shoving a toy or it's own fingers in it's mouth than from infant formula.
I'm sure the guidelines were different then! Everyone i knew did it the same way as me i swear i'm not a slob!
Thanks everyone!

[hazeyjane]

Also, the 'bacteria' that led to the guidelines being as they are is a very particular nasty called e.sakazakii, and whilst the risks are small, the contaminant has been found in powdered baby milk and is fatal.

[claricestar]

my tip for flash cooling: keep a load of those plastic ice cubes in the freezer to put in your sink/bowl of cold water. my bottles cool a lot faster that way and a lot less faff than making ice cubes.

[hazeyjane]

Sorry Ginger, but those guidelines have been in place for at least 6 years.

I just googled 'making up formula' and the first page was the nhs one which recommends exactly as per WHO's guidelines.

[gingergaskell]

I saw the WHO advice about the 70 deg for the first time in a travel question on here recently.
I wasn't aware of it before, so the advice wasn't about / prevalent at the time I had my children.

So I googled it to find out what it was about. Most of the articles that came up were actually about not heeding that advice! Apparently there is greater risk of scalding yourself dealing with water that hot, than risk from the bacteria. The risk was .001 % of infection by the bacteria, and that careful storage and preparation of the formula was more important in it's prevention.
Whereas water over 70 deg can scald / cause sever burns to a baby within a second or two on the other hand, so the argument was that risk of that is greater, using water that hot.

Obviously it's important to sterlise / prepare the way that you feel most comfortable with, I'm not trying to convince those that are happy to do so to stop boiling the water to that temperature. .

But I thought that might help reassure you OP, since you didn't follow those guidelines with your first, to be able to weigh up the risks for yourself, and see if you thought it was worthwhile to do so, in answer to what is 'best'.

[Fairylea]

Cool in iced water or in a sink full of cold water - don't leave it on the counter to cool as it won't cool quickly enough and the bacteria will multiply.

You can make up a few in one go. I think most people just make 2 or 3 so they are reasonably fresh.

You won't find any info about doing it that way online as officially it's still compromise - the proper guidelines say make each one fresh. But I think most people find that impossible or very stressful so make a compromise.

[12ylnon]

Ok so- boil the kettle, fill the bottle, add formula, cool it on the counter top/ in iced water. Use it.
Whats stopping me from making up two at once and keeping one in the fridge to reheat when i need it?
Sorry i'm being so dense, but every website i look at says something different.

[Gooseysgirl]

When DD was on 6 bottles a day we used to make 3 up in the morning and 3 in the evening, so they were not in the fridge longer than 12hrs. We use the water about 20 mins after the kettle boils to make up the feeds then flash cool in a sink of cold water. Another method... If making a 8oz bottle mix 8 scoops powder with 2oz of boiled water (over 70c) then add 6 oz cooled boiled water. That way the hot boiled water kills the nasties in the powder and the cooled boiled water gets the bottle to room temp straight away.