so if powdered baby milk is not sterile, does making it with boiling water, elminate bacteria/nasties or just reduce the chances

[whiteandyellowiris]

only 11 weeks pregnant with my third child, and just been thinking about feeding, i struggled to feed my dd but somehow managed by feeding non stop.
however i dont have so much time these days to dedicate the whoel day to bf
so i'm thinking i may need to consder formula at some point

and im weighing up the different between rtf and powder

Reduce but close to eliminate if you follow directions. There's a bit of inbuilt compromise in the 70 degree rule anyway. The risk is very low anyway but of something very nasty.

Also, if you read the WHO and dept of health guidance, it's clear that the babies at most risk are those that are early, small, very young or immune-compromised. That doesn't mean others aren't at risk of course but for reassurance, you could use cartons when they're tiny, then move to powder.

thanks for your reply, but ive got my dim head on today, what do you mean by 'there's a bit of inbuilt compromise in the 70 degree rule anyway'

what age would you class as non tiny? 6 months?

70 degrees is not boiling, boiling water would kill the nutrients! So the compromise is that it's hot enough to kill most bacteria but not all.

oh is that not boiling water, i thought you where supposed to mix the powder with boiling water, i assumed that was 70degrees
or now you say that is ti 90 degress?

so if you need to use water that 70 degress, what are you supposed to do, boil the kettle then leave the water to cool for a bit?

The compromise is that boiling water is better at killing bacteria but also destroys some vitamins. So 70c is recommended. Bacteria should be killed. Some manufacturers add pro-biotics, of unproven value as I understand it, which are damaged by heat. One organic company was advising 50c for this reason, which does break DoH guidelines.

Tiny and young are your own judgements to make. If the baby is full term, average weight, healthy, I'd move to powder sooner than if prem or unwell for example.

Water boils at 100 degrees c.

Yes, boil then cool for up to half an hour. Google the WHO guidelines for more explanation.

If you do find yourself breastfeeding non stop you might be able to get sorted with that anyway - it's not necessarily the case that you have to BF all day, so it might not be an issue. Was your DD checked for tongue tie at all?

Another thing to think about is how often you plan to give formula, because the tins only last a week or two once opened and then have to be thrown away, so it's probably only worth using tins if you're mixed feeding with more than 2 bottles per day.

Start off with bf if you can, even if one meal a day: the more antibodies you can pass on in colostrum and early milk, the better. Use sterile UHT portions for 1st 6 weeks. Then after that, go to powder made with hot water. That's what we did, after it was blatantly obvious that I was onto a loser with ebf.

We did use mostly boiling water to make up formula in batches prior to very rapid cooling. The only horrible tummy bug he got while a baby was rotavirus, which is not caught from formula. And it still makes me wince when I see other mums tip powder into cold water...

oh this is boggling my mind!

dd was never checked for tongue tie, the hv kept advising me to put her on formula, but i carried on with the breast feeding

i also didnt know you had to throw it away after 2 weeks

Ok, here comes the maths bit...

Aptamil tub says to use within 4 weeks. There is 900g in the tub. If you use 180ml/6 scoops of powder per day (the recommended amounts per bottle from 8 weeks+) that's approximately 770g per 4-week period. If you wanted to use the whole tub, you'd be looking at getting through it in about 4 and a half weeks. I combination fed from 6 weeks (just 60-80ml per day initially) because of weight-gain issues and never realised there was a 4-week expiry (bad mum alert!) and I don't think it had any adverse effects, however if I'd realised I probably would have discarded the tub after a month. I wouldn't worry about using it for just over 4 weeks personally.

The cartons are 200ml and have to be used within 24hrs, so using the example of 180ml above, you would get through 1 per day. By my calculations, 1 carton per day would work out at over £20 per month (cartons cost 69p in Tesco) whereas the powder is around £9 for a 900g tub. So, the tub works out considerably cheaper.

Although the powder is a bit of a faff, I found I still had to warm up the carton milk (rather than waiting for it to cool down), as my baby did better with warm milk, so it wasn't much easier. The info posted above about water temperatures is a bit confusing IMO - the general instructions are to add the formula powder to the water 30 minutes after it's boiled (as I guess it's at 70 degrees at that point).

The only general thing I would say about combination feeding is to make sure you get breastfeeding well established first and stick with exclusive bf for as long as you can. You might also want to consider expressing so you can get help with feeds in the early days. Depending how long expressing takes for you (and how long your baby feeds for), this could also speed up the feeding process (and you can express while doing other things once you get the hang of it!) You can also continue to express after you introduce formula to maintain your supply (freezing the milk if not needed straight away). I found bedtime was the best time to give a bottle so my partner could help out - also, this is generally when your supply will be at its lowest (once fully established).

Also, don't listen to anyone who says combination feeding is a slippery slope - I am still breastfeeding my 11mo and love it! I didn't think I'd ever say that in the early days - expressing and introducing a small amount of formula helped me to carry on.

Good luck and well done for being so organised! I didn't think about any of this until my baby was here!!

p.s. my DD had tongue tie - always worth asking to get it checked - both after birth and once you're home (not all midwives are trained to spot it).

Oh four weeks sounds better. Sorry I knew there was an expiry after opening.

Basically feeding non stop isn't normal, and it's more likely that there was a problem with the baby's palate or attachment in general, than there being a problem with you/your boobs. It is usual to be feeding very frequently in the early weeks, but certainly not after that. Definitely good to have a back up plan in place, but don't assume that's just the way breastfeeding is, because it isn't - it might be worth seeking out a decent support group before the baby is born this time too.

thanks for the advice, its starting to sink in now

when dd was born i had a big pph, and ive wondered since if that made bf so difficult

Ooh yes, I second the tip about finding a local support group. My local one (in Bristol) has a creche for older siblings, but we may just be lucky!? I also had loads of support from a bf counsellor (La Leche League/Bristol breastfeeding peer support service). She visited me before I had my LO and was amazing in the early weeks. Totally invaluable. In my experience, Health Visitors generally just don't have the knowledge/time to give the help and support you often need with bf issues.