Making up formula feeds.

[srh96]

Why do people not understand that formula powder has to me mixed with boiling water (above 70 degrees celsius) in order to sterilise the formula powder?

Or do people know but choose not to do it because it's inconvenient?

Is it the NHS's fault for not discussing formula feeding enough?

I'm a midwife, any woman who I discharge from hospital who is formula feeding her baby leaves with this information (and other info around making up formula feeds and sterilising etc).

I'm just trying to understand. So many people don't seem to get it, I see it on mumsnet and in real life all the time. I say something like 'when preparing the formula you need to sterilise the formula powder by mixing it with boiling water, then allow the formula to cool to a drinkable temperature for baby' and am met my shock or surprise. They have usually done other research on formula feeding so aren't completely clueless, but it's the vital part of adding it to boiling water that comes as a shock.

It might just be me, but it's an almost daily occurrence. I don't mind educating, that's literally my job, I enjoy it, I just don't understand why it's not known about more.

Sorry unwilling was probably too harsh, I’m sure all midwives want to support their patients however they feed and I totally appreciate that it’s not your fault because you’re only allowed to say what you’re allowed to say. But how the hell does anyone think ‘feed on demand’ reconciles with ‘make every bottle from scratch using hot water’, a process that takes you roughly 45 minutes. And ready made at roughly £1 per small bottle just isn’t an option for most people to use at every feed. I don’t know what the solution is either but when you can’t actually suggest anything that is manageable for parents but also safe for baby according to NHS standards, you surely can’t actually be surprised that people aren’t following your advice.

[quote srh96]@LakeShoreD not unwilling, but somewhat unable. If you're wanting to breast feed, we won't discuss formula as we aren't allowed due to the unicef baby friendly initiative.

If you're wanting to artificially feed then you should be advised and supported of course! We can only advise what we're allowed to advise. So maybe you don't think the advice we can give is decent, I'm sure plenty of people would agree with you.

I don't really know what the answer is. We want feeding to be doable and manageable for parents but we also want what's best and safest for babies. [/quote]
Even the term "artificial feeding" is awful. Makes it sound like you're feeding your newborn some awful plastic concoction.

I don't know why I'm so upset by it still. It's been such a long time.

If you're wanting to artificially feed then you should be advised and supported of course

What is ‘artificial feeding’?
Are you referring to formula feeding?

@LakeShoreD I know, it doesn't match up does it? It doesn't make sense.

@Reachersloveinterest @FTEngineerM
This is the term used for formula feeding when speaking professionally, so in research and within medicine/the NHS. It's language we use in our written records and when communicating info amongst staff.

Apologies, I didn't mean to cause offence it's just what I'm used to calling it. When speaking directly to families I'd use 'formula feeding' or 'bottle feeding' but I didn't think when typing my reply.

The term artificial feeding has been used longer than I've been in midwifery, I can't shed any light on why it's used, but a google search of the term brings up mainly research articles and a few NHS/.GOV links.

Again, apologies, my intention wasn't to cause upset.

So my take home from this thread is that something isn't matching up.

I especially hear what pp said about us encouraging responsive feeding but the bottle taking 30-45 mins to make up as advised.

I don't know what to do about it mind you! I'm a tiny cog in a giant machine. I will talk to my colleagues about it later this week and see what they think. I'll then speak to the infant feeding team at my trust and see what they suggest and go from there.

This is interesting.

I had my children in France, they are school aged now. I have never heard of sterilising the powder. The Brit in me had heard of sterilising bottles and my Mum brought over some sterilising tablets as they pretty much don't exist in France. I was told by my pediatrician that washing bottles normally in the sink or dishwasher was enough and that I could make formula up straight from the Evian bottle/other brand of water that was low in minerals. However, when baby is constipated French pedis say that a few sips of magnesium infused water will help them go to the toilet.

I guess advice varies from country to country!

@CaMePlaitPas it is interesting! I just think the advice should be evidence based and that it shouldn't vary country to country without reason

Same as in France here where I live, last summer when Ds was born, midwife thought I was a crazy ott mother when I asked about sterilising and the whole water above 70 for powder.

Here are German aptimal milk powder guidelines for preparation of bottle

@Caspianberg

I have said on here before, it must be a country guideline thing though, not the milk manufacture.

If you go on to aptimal.de for example and look at the German guidelines for now to make a bottle it’s very different and it’s exactly the same product.
It basically says 40 degrees max. And that’s what they do in hospital

My understanding is that we are told to use boiling water because a kettle is a standard piece of kitchen equipment in the UK; in countries where it isn't (most of Europe and the US, among others) they feel the scalding risk of parents repeatedly handling boiling water without a kettle outweigh the risk of unsterilized powder. Which says something about how large the risk of unsterilized powder is.

@Hardbackwriter very interesting! I had never thought of it like this.

I’m not offended, just confused I suppose, artificial feeding in my mind would be something like NGT. Obviously I’m not a midwife or hcp in anyway so I wouldn’t even know.

I haven’t heard anyone call my oats and yogurt breakfast artificial feeding.

@Hardbackwriter - maybe. But I have lived all over ‘Europe’ and a kettle seems to be fairly standard. I think every home I have been in has one and it’s used just as often. Herbal tea is very popular and drunk a lot even if ‘English breakfast’ isn’t.

When I fed DD 10 years ago I remember the panic of not being able to breastfeed (traumatic delivery, in terrible pain and incorrect advice led to bleeding nipples after 24 hours), and trying to find instructions as to how to make up a feed. The formula tub simply told you how much powder to add, how much water to use. I asked both midwife and health visitor what I should do and they both said to use cooled boiled water, and NOT to pour boiling water onto the formula powder as it would destroy some of the nutrients. Was told to sterilise bottles, and then fill them with boiled water, allow to cool and then store in fridge until ready to use. Then add formula powder and heat up when needed.

I checked with friends and there was no consistency with guidance. I was obsessed with doing the best thing for my baby so was not setting out to cut corners. It seemed back then that formula was frowned on and there was little information or support for mothers who either chose or needed to FF.

[quote Caspianberg]@Hardbackwriter - maybe. But I have lived all over ‘Europe’ and a kettle seems to be fairly standard. I think every home I have been in has one and it’s used just as often. Herbal tea is very popular and drunk a lot even if ‘English breakfast’ isn’t.[/quote]
That hasn't been my experience - in Italy I ended up bringing one from the UK and just using it with an adaptor plug. But 'most European countries' was probably too sweeping (they're definitely quite rare in the US, but that's a voltage thing). I have read that the boiling risk is why other countries don't recommend 70° water like the UK does, though, whether or not it's specifically kettles that are why we are deemed safe with boiling water!

Is it the NHS's fault for not discussing formula feeding enough?

A little bit, yes.
Obviously there are instructions on the box - but they are very badly written. Imagine how much fucking water we’d waste if we seriously ran every bottle me made up under a tap to cool down to the right temperature. Perhaps because of that people think the rest is bullshit too?
That and the ‘old’ way of doing it so much easier - lots of people will have relatives and friends tell them they made all the bottles up with warm water or stored them until needed in the fridge, their kids were fine, many will prefer to follow that advice.
As you say the NHS isn’t doing much to counteract it. They offer one NCT class on feeding and formula is a forbidden word. I think many still think you use boiling water because the water needs to be sterilised, not the powder.

NOT to pour boiling water onto the formula powder as it would destroy some of the nutrients

I’ve heard this a few times and it really doesn’t ring true - water that is 70 degrees is just as likely to do that surely, hence why it is hot enough to kill germs. The reason you don’t use boiling is because when you shake it to mix the formula you risk some volcanic formula activity - it will bubble a lot more and can shoot out the top, leaving you with a nasty burn - the companies tell you to let the water cool a bit so it is hot enough to kill bacteria but not hot enough to put you in peril while making up the bottle.

There was a thread on formula preparation today, and I learned for the first time that it's not advised to make up formula with room-temp bottled water. This is the advice we received here in Spain a few months ago.

The instructions on the side of our tin of Nutriben say to boil water then let it cool to 45°c, so it's not actually sterilising the milk at all.

I think a few things contribute to this…

Before I had mine, I had no idea that a product made for newborn babies could be unsterile and unsafe. I suppose I just assumed that manufacturing guidelines would mean this wasn’t an issue?! Whenever I’d heard/thought about sterilising, I’d assumed we just needed to ensure the bottles and teats etc were sterile, not the formula itself. And (I say this without meaning to cause offence) I am a mother who did all the classes, read all the books etc. so if I didn’t know, then there are so many others who don’t stand a chance.

Then there’s the whole feeding on demand/making each bottle fresh, which is just not achievable without the perfect prep!!

And finally the confusion around what’s the ‘right way’ to do it/ NHS guidance/ influence from previous generations etc. It changes all the time! With my first in 2017 there was no mention at all on the NHS website of any other way to make a feed other than to make it fresh with the kettle, by 2020 with my second there was info on pre-making bottles and cooling quickly to keep in the fridge (I assume because so many were doing it regardless, so they at least had to say how to do it safely!)

The NHS should be discussing it more. Absolutely. I wonder how many gastro illnesses are caused by incorrect formula use. It’s not like they collect data on it. I’m always amazed that other EU countries (France in particular) allow instructions for making bottle with cold water. An open tin of formula is basically a Petri dish, and there have been plenty of batches that have contained known pathogens from the factory (there was a scandal only a few years ago in France and lots of babies were very very sick). Surely the EU would follow WHO advise? Obviously people don’t always follow the advise because it’s a massive faff to make up formula correctly and people think if they got away with doing it for so long it must be fine.

I think it’s because it’s such a faff to do and nobody gives any sensible short cuts. I was told by my midwife to make every feed up from fresh and use 2 oz of boiling water to mix the milk with and use already cooled sterile water (kettle water stays sterile for 8 hours) to top it up to the right temp to save the waiting around. I used to make a bottle up before bed and then refill a sterile flask with the nights/ days water.

Before I had mine, I had no idea that a product made for newborn babies could be unsterile and unsafe. I suppose I just assumed that manufacturing guidelines would mean this wasn’t an issue?!

I think the chances of a box of formula not being safe is fairly small - but the chance is there and so the very health and safety conscious UK will jump on that and drive new parents who are trying to manage emotional night feeds even more loopy. Manufacturers, fearing that tiny chance will then result in some kind of lawsuit will create the most impractical instructions to put on their product to cover their arses as effectively as they can, letting babies scream in hunger while they wait for parents wasting gallons of water cooling their 70 degree exactly feed down under a running tap…