Anti reflux milk needs cooler water?

[Boo2400]

My 3 week old has started anti reflux milk. But the instructions say to boil water, cool it to lukewarm and then add the powder or it doesn't mix and just clumps up. And it does.. I tried using hot water.
But I thought you couldn't add formula powder to cooled water? I thought it needed the hot shot to kill bacteria. So how can you do that with reflux milk?
I've been using the prep machine hot shot and cold shot first to get lukewarm water and then adding the powder but it's making me anxious that it's not right and will cause a problem. The formula will not mix with hot water though.

I suppose you need to weigh up the risk/benefit ratio for your baby. There is less risk if you are preparing the milk and using it straight away than if you make it up and then store it for later use.

My baby has a dairy allergy and this question comes up in support groups from formula mums. I read that with some of the prescription formulas, the hot water would kill the nutrients, and you should always follow the manufacturer's instructions. Prescription formula is different to normal formula.

When my dc were little we were worried about this and the HV told us the reflux milks were just with added thickener and to get normal formula and make up with hot water to eradicate the risk but to add something called carobel powder

Yes you have to make it according to the instructions otherwise you’ll lose valuable nutrients.

There is a risk from all formula but it is quite a small risk. Just take the usual precautions like washing your hands thoroughly before preparing the formula, using a airtight container and not offering a botyle more than 2 hours old.