Cool boiled water for bottles - apparently ok cold!!

[MaverickSnoopy]

I've seen it a million times on here and when making up bottles in the past (mix fed first 2 children) I always followed the instructions on the box which match the WHO guidelines - use freshly boiled water and leave for no longer than 30 mins. It's the hot water that sterilises the powder and kills the germs. It's not that you need the water sterilising.

My newborn is in hospital very poorly with suspected CMPA so although I was breastfeeding, for now she's been moved to a dairy free formula. The hospital provide this but imagine my surprise when they very kindly brought me a box of powder, sterilised bottles and some little bottles of cold sterilised water. I queried this with them in line with the WHO guidelines and they looked at me like I had 2 heads. They said they had never heard of needing to sterilise the powder and that this is standard (for all babies) in hospital - regardless of the type of powder. For clarity the instructions on the box are the same as any other.

Weirdly the bottles of sterilised water are made by Cow and Gate. So tell me, what exactly is the purpose of the bottles of sterilised water? I mean, they're for sale so they can't be that bad right (as if companies never sell things that are bad)...but hospitals are using them! What would one use them for if not for formula?! They come with measurements on the side for easily making up formula.

The only thing that I can think of is that as the water is already sterile they think that if you heat it up it would be sufficient. However they're not being heated up and no one said anything about this and even if they did do that, the water isn't hitting the powder at a certain temperature. We've moved to another ward now and they're making the bottles up freshly.....but it's bothering me and I want to understand why it's "ok" (see relevant bit about staff not having a clue and looking at me like I'm mad).

Contact pals...this is incorrect guidance and needs challenging

As above - they are wrong. When I was in hospital they provided ready made formula to avoid this issue but made sure everyone was aware how to make up bottles properly when they went home.

No idea, but my logic is the same as yours and I’d be interested to find out the answer. We’ve been given the little cow and gate sterilised water bottles in the past but to mix with other medication that was soluble

I also thought the purpose of boiled water was to kill bacteria in the powder, rather than sterilise the water.

I'm surprised by that - DS has been FF since birth, and all HCPs have been on the same page re: powder needing to hit hot water. We took the little bottles of ready-made into the hospital (FF was planned), but we noticed when we were there that the hospital also kept those in to give to babies who needed supplementing or where BF wasn't working etc, to avoid the faff/impracticality of having to make hot fresh bottles on busy wards.
I'd definitely check again.

Ok good I'm glad I haven't got 2 heads and that I'm correct. Interesting to know how the bottles of sterilised water can be used.

I will certainly raise it (although I'm going to need a thick skin and it's going to have to wait until LO is better as I'm already planning on writing to pals about the appalling after care I received last week - tbf midwives asked me to write too as it's linked to how stretched they are - and I also had to write to them a couple of weeks before giving birth as I had encountered some difficulties so needed some advice and support - it wasn't a complaint).

In their defence if they don't know the WHO guidelines whuxh they absolutely should, then I can see why they might think they're suitable. They look like they're made specifically for making up bottles of formula.

Some specialised formulas should be made with cold water. Check with the hospital.

My son is on nutramigen formula for CMPA and the instructions to make it up are different to regular formula. It has to be made by mixing into cool water, not hot. It could be that this is why they have given you the sterile water to use x

Yes the difference is that it's a specialised prescription formula that needs to be made with cool water. Regular formula needs to be made with hit to kill any bacteria present.

Check the instructions with the manufacturer that makes the formula. If it’s made with the cold water they’ll have done a risk assessment to be able to supply it

Bottles of sterile water have a lot of uses for medical purposes. I know they're made by a "baby food" company but they're not just for babies. (We have them prescribed for an adult).
Otoh I assume that wards have them because mixing formula with recently boiled water isn't practical. My son was on a "special feed" and in the childrens hospital these were made up in a milk kitchen where they made up a while days supply at one go for storage in the ward fridge

The milk that she's on is Aptimil Pepti 1 (I think they'll be using trial and error to see which formula works best for her) and the box has the same instructions as regular formula. It was the first thing I checked and it clearly saying to not leave longer than 30 mins, same as any other. I do know that some can be made with cold water but this isn't one of them.

I'm going to ask the doctor about it today though as dd has been pooing and unusual amount (around 25-30 times in 24 hours) and we need to know if it's the cmpa or incorrectly made formula (because she had 1, possibly 2 made with the sterile water from the bottle).

Disclaimer I have never made up a bottle of formula, I'm not going to go against anything WHO say however, boiling water is not going to sterilise either the water or the powder.

Hot water will kill bacteria very effectively, but it will kill all bacteria, including what the TV ads call 'good bacteria'.

The manufacturers guidelines state that if there’s no tap water and if there no electricity or gas available to boil the water bottled water can be used.

This is probably why they are giving you the sterile water. There will be some risk as stated in the WHO guidelines about the power not being sterile, but I’m guessing they might give sterlie water as there’s no facilities available to boil a kettle/make up bottles.

The manufacturers guidelines also advise when not using boiled water to use the formula immediately and don’t keep it.

www.aptaclub.co.uk/article/aptamil-pepti-1-safe-preparation

From the WHO guidelines for making formula in cars settings where no boiling water is avilable.

What if boiling water is not available?
The safest way to prepare a feed is using water that has been boiled and cooled to no less than 70oC. If you do not have access to boiling water you may wish to use sterile liquid infant formula. Alternatively, you can prepare feeds using fresh, safe water at room temperature and consume immediately. Feeds prepared with water cooler than 70oC should be consumed immediately - they should not be stored for use later. Throw away any left-over feed after two hours.

www.who.int/foodsafety/document_centre/PIF_Care_en.pdf?ua=1

My ds was on pepti and the advice was to make it up with boiled water

Some hydrolysed formulas are supposed to be made up with cold water, but that isn’t one of them. This should be challenged.

Just to update - I have emailed pals at our local hospital to highlight this.

The woman said that all formula is made up this way - not just some specialist formula and they did have facilities to boil a kettle so I do feel that should be the default option. Most babies in hospital are already poorly or brand new and therefore I feel that extra care should be taken where possible and it was possible. It also concerned me that two people that I came into contact with had no idea what I was talking about.