Making up formula - do you follow the rules??

[MumtoHarry]

We have just moved Harry onto formula and I am worrying about how I should make it up ... does everyone follow the new guidelines about making it up with boiled water cooled for less than 30 mins, and then let that cool enough for the baby to drink it (which seems a real faff - and a bit impossible to get the timing right if you are letting the baby demand-feed)... or do people make up the bottles of cooled boiled water in advance (and make up the feed with water at room temp)... or do people make the feed up in advance and keep in in the fridge?? I am probably over-thinking this, but it all seems SO much hassle to do it properly and yet if baby was ill because I couldn't be arsed to get it right I'd feel awful ....

god, from a food safety poiint of view putting bottles of boiling liquid is a nightmare, isn't it? i thought you were never supposed to put hot things into a fridge because it raised the temperature of the environment and put the other foods at risk of turning.
cbc's book is out of date, it must be.

i read the claire byam-book a year or so ago, when waiting for a client;s labour to get going.... i did Not Like It.

i think HVs , MWs and GPs should have access to teh NHS leaflet about making up feeds. I have a copy, it is clear, concise and easy to understand.

so that rather than getting info 2nd hand of t'interweb, you can look at the guidelines and read them yourself.

honestly, it is not that confusing, as i said earlier, what is confusing, is everyone else saying, ' i did it this way and it was fine'

The book I mentioned by Clare Byam-Cook was published in 2001, so it does pre-date the latest guidelines. My first baby also pre-dates them, and I hadn't realised new guidelines had been issued - no MW or HV has ever discussed with me the correct way to make up formula (in my experience these 'professionals' are so disapproving of bottle-feeding they won't discuss any aspect of it), so I got it out of a book myself. In other words I read a book that seemed trustworthy and followed its advice - I didn't go looking for something to back up my own dodgy practices.

Just out of curiosity - genuinely - does anyone know of a baby who has died as a result of badly prepared formula?

no, i'm sure none of us know anyone, the fatalities seem to have been in the netherlands, belgium and france. to be honest i fail to see the relevance. i don't know anyone who's fallen off a mountain but i wouldn't let dd hang out on the side of a cliff.
i've read an interview with the french father of a child who died and he was DEVASTATED that he had followed the old guidelines and killed his child. that's why the guidelines were changed. there's a link further down discussing the fatality rate.

here is the link again

i know. i remember when i stopped using the sterile packs of milk and went onto the big boxes and read the instructions - wtf?
they're not even written in a way to encourage you following them, tbh. you look and think 'well, there's no way i'm boiling the kettle and waiting half an hour every time i need to feed the baby...'
if they were more truthful (saying that it isn't sterile like hipp organic do) i think there would be more motivation. Not that i'm all about the sterilisation, the dishwasher was good enough for me, but this e salazakii thing is vile.

A bottlefed baby in the UK is 9 times more likely to be admitted into hospital than a breastfed baby.

Gastroenteritis is the most common reason for hospitalisation among bottlefed babies.

I may be remembering this incorrectly but around 9 babies per year, between the age of 2 and 12 months die in the UK because they were not breastfed.

Someone with the exact stats, and hopefully links, may come along soon - this is how I remember them when I first saw them over a year ago and it shocked me.

does a baby have to die from salmonella or E.Sazakaii to make the current guidlines more relevant?

On the hospitalisation issue - it's probably worth taking into account that many small babies who are bottle-fed may already have a medical condition or problem that has made breast-feeding difficult or impossible, and may end up in hospital as a result of that condition. That's the case with my own second baby, who has a serious heart defect, and who has been in hospital a couple of times since her birth. I guess that, statistically, she's a bottle-fed baby admitted to hospital - but admitted not because of infected milk but because of heart failure.

I asked about fatalities because of an earlier post asking how we would live with ourselves if something happened.

Very difficult to come up with UK figures - don't think I have seen any that postulate death as a result of formula feeding in the UK. Wd be interested in knowing more, kiski.

There's a big study in the US www.ncbi.nlm.nih.gov/pubmed/15121986?dopt=Abstract
which reckoned that "breastfeeding has the potential to save or delay approximately 720 postneonatal deaths in the United States each year" , ruling out congenital anomaly or malignant tumour, and they didn't look at deaths in the first month. Other commentators have taken the same data and extracted the exclusive breastfeeding figures from it, and found an even greater difference in mortality.

We have a number of studies in the UK that control for socio-economic factors and find that formula feeding has risks - seems to me sensible to work out how to reduce those risks, given that hygienic preparation is pretty simple (and not at all confusing!)

treeny, i did not mean to imply you read the book to back up what you were doing ...

i don;r know any babies who have died as a result of bottle feeding incorrectly, i don;t know any babies who have died thank god.

i was told about the change in guidelines by my HV ,but DD was almost one, so she was on cows milk

it is more that HVs etc are not passing on the information ..maybe they are to mothers of new borns, but not of older babies? mind you , a lot of parents stay away from teh HV except for immunisations ..

Treeny, good point. For decent stats, we need to separate out the babies who have some sort of anomaly (like your baby) and this was done in the US study on mortality.

There is a good study which looks at respiratory disease and diarrhoeal disease as hospital admissions only - and also controls for socio-economic variables. This one - done in the UK on 16000 babies - shows clearly that the more formula a baby has, the more at risk he is for hospitalisation for those conditions, whatever his background.

The phrase head, beating, brick wall comes to mind when I look back at this thread. People won't listen to what they don't want to hear. IMHO the baby milk manufacturers are deliberately confusing the issue for their own ends (ie profit).
I wish the media would publicise this, I don't think the NCT press release has been taken up by any of the newspapers.
There are clear explanations in the NHS bottle feeding leaflet and the Birth-to-5-Book which are given to all parents of new babies, at least in the area I work in. But we can't force people to read them. Midwives give out the bottle feeding leaflet antenatally and the HV checks parents have got it at the new birth visit. But there is so much potential for misunderstanding and offence-taking, its a minefield, look back at this thread and try to imagine how it must be for HVs trying to get the message across with limited time and doing their best to try not to make new mothers feel guilty for not breastfeeding.
We can give out leaflets and try to explain but can't force people to take any notice.
So we have to cover ourselves in case the baby gets ill, and make sure we write in the records that the parents were given the information.

How patronising to say that people won't listen to what they don't want to hear - totally discounts people's real experiences.

I do hope that my MWs and HVs haven't written in the records that they gave me information about bottle-feeding, because they certainly didn't. And the HV I had with DD1 clearly believed it was part of her job to make new mothers feel guilty for not breast-feeding - she couldn't have made it any clearer. When I was in hospital having DD2 and she was just out of SCBU, one of the midwives told me I was 'on my own' if I intended to bottle-feed DD2, and she wouldn't get involved.

i don't think that anyone's directing that at you, Treeny, but you have to admit if you look at the whole thread that there are quite a few people saying that it's so confusing etc when it's not. it's written on the side of every single pack.
true, it's not written in a particularly helpful or encouraging manner and i do think that it obfuscates the actual reason for the method (with the honourable exception of Hipp Organic) but it is there, every time you pick up the box, in black and white.

I had ds2 in November and although I was breastfeeding my HV still talked to me about the new guidelines in case I wanted to top up with formula. I've just finished combined feeding and switched to ff. I follow the guidelines, I admit it's a bit of a pain, there is alot of wasted milk as the baby changes his mind and wants mini-feeds etc and he cries for 5 mins while I make the feeds at night. BUT I follow the rules because my HV is a health professional and I am not. My ds1 survived the old method but I survived being weaned at 12 weeks (got IBS now though boo hiss). I think that's a bit of a weak arguement tbh. It's not confusing, the guidelines are a bit of a pain, yes, but not confusing.

Hi - sorry, no idea among the many messages here if this has been said already but I contacted the people who make Aptamil formula about making up bottles and they said - sterilise your bottles, add the required amount of just boiled water and then you can leave them on the side until needed, no need to put them in the fridge (which makes warming them later quicker). You add the milk powder when you need it and I warm it a bit in the bottle-warmer, takes about 2-3 mins...

hang on. did they tell you what temperature to warm it to?

Am feeling slightly horrified reading this thread as I have never heard of this before and having been bottle feeding my 5 month old baby since she was 1 week old using the old method (keep boiled water in sterilised bottles in fridge till needed, add powder to cold water and warm up to feeding temp). My baby has special needs so have been inundated first by midwives and then hvs - and none has ever mentioned this. Anyone else in the same boat?

well the good thing, mg, is that she really hasn't come to any harm so that's great and no sense worrying about it as it's in the past.

what you could do now is just change your practice to making sure you're heating up the cold water to 70 degs before adding the milk powder. or not, because the risk is low, technically, but if you get that sakazakii (or whatever it's called, i don't think i've spelled it right twice) thing it is very bad news.

as i say, the way i did it was in the microwave until it got to 70 degs (you only have to check the timings once with a thermometer).
they don't recommend heating liquids in the micro because of hot spots, but i always figured that adding the powder and shaking it vigorously distributed any hot spots.

you then have to cool the milk down a bit to make it drinkable, i kept the powder in the fridge so that helped.

To a poster below. It seems like Aptamil's 'careline' is advising people to do it the alternatibe way, which is what the World Health Organisation sets out as a way to make up formula if there is no or limited access to gas and/or electricity. Erm, 3rd world countries and disaster zones.

Except that the WHO doesn't say anything about heating it up after mixing up. They added that bit in.

I guess that Aptamil did not tell you that formula powder is not sterile on their Careline or on the packaging. Funny thing these 'carelines'.

The Aptamil instructions here say you can store pre-boiled cooled water for 24 hours. This is dangerously wrong advice, from what I can gather from the NCT site and the DoH. Frightening stuff...

just one thing i don't understand, so forgive me for being stupid, but...

if you add powder formula to >70oC water to kill the bacteria, and then store it at room temp or in the fridge, and then warm it again, why would the bacteria multiple?
wouldn't they all be dead from being added to the boiling water?

following this thread, i (and DH) now make my ds's feeds according to the guidlines.

use a flask for nights, and half frozen water to cool the baby bottle down quickly.

used to add powder to room temp cooled boiled water.

reason being, that i wouldn't want to risk illness (and any concequences), hopitalisation, or fatality because i was too lazy to do it he right way.

you could feed formula the old way, but its about risk. do you wish to take the risk that the old way could make baby ill?
i don't.

yes, my LO does cry, but he's crying less, hopefully he is learning that it IS coming. also while it cools i change his nappy.
Plus i'm getting quicker and better at making his feeds.
also at recognising what times he'll be hungry and when he's about to wake up.

hope this will encourage others to make up the feed by new guidelines.