out and about with ff baby - how to heat milk?

[samnjack]

Seems like a silly question, but my DS is newly onto the bottle and I've only fed him out of the house with a ready made carton of milk in a sterile bottle. What's the best way to do it with the powder? Can I carry a sterile bottle with the right amount of water in and then heat after adding the powder, or should I take hot water in a flask and use that?

samnjack, current guidance on safety is that formula should be made up fresh each time, with water that is no less than 70 deg C. If your flask can maintain water at this temp then this should be safe. You can then add the powder at the time your baby is ready for it, cooling it down before he actually drinks it.

HTH

Any idea why the water needs to be 70 deg c? I thought as long as the water was not re boiled and the feed was made up fresh that was ok. Iv been using water at a temp ready to feed for both my girls and have never had a problem

tiktok is right with the current guidance.

However, when I was in hospital with DS2 (now 6wks) they made up formula and kept it in the fridge for 12 hours. Those of us using it (I bf with topups as he was so big) took our allotted amount out of the bottle and warmed that up.

DS1 didn't bf for long and we moved on to formula for reasons I won't bore you with. I used to make up the bottles with hot water and then add the powder when I wanted it. Used to do this at night too rather than head downstairs and make fresh.
Out and about I'd just ask cafe for hot water, or you could take a flask of hot water with you for warming.
I know other mums who always fed their babies with room temp milk to avoid having to heat it.

Just offering alternatives that have worked for me and many mum friends in case you want other options.

The reason for using water at no less than 70 deg C is to kill potentially lethal bacteria in the powder.

The risk is small but the scary thing is that if the infection is transmitted, the baby can become very seriously ill and more vulnerable, pre-term, younger babies in particular need to be protected.

Ready-to-feed temp water, even if used fresh, is not as safe.

All this is in current leaflets.

A maternity ward not following guidance (see scarlotti's post) is poor

tiktok out of interest, if the formula is made up with the right temp water, can it then be cooled and stored in the fridge? Maybe that's what the maternity unit were doing ...? I didn't know about the bacteria potentially being in the powder. Is that because it sits in the pot from production to use?

I'd forgotten how complicated it was when DS was small. Now he's older we take a bottle of cooled boiled water, and the powder in a sealed tub, and just tip it in. He drinks it at room temperature.

With a little baby, depending on finances and how often you go out, I'd be tempted to buy the cartons of ready made milk. Then you know it's safe.

Tiktok, do you know if you can make up concentrated formula with boiling water to kill bacteria, then water down with cooled water to the desired temperature, to save waiting around for it to cool down? i.e., if you want 6oz of milk, mix 6 scoops of powder with 2oz boiling water, then add 4oz cooled boiled water. Would that be safe?

You can buy pre-sterilised bottles from Boots, and you just add a carton of ready made milk. Its easier and less worrying.

I take out bottles with prepared (boiled and cooled) water and a little container with the measured amounts of powder in it, and I make it up and room temperature as and when I need it. For DS2 he has it at room temp.

DS1 was fussier however and would only take it heated, so I used to take out a wide thermos and heat the bottle in that.

I know it's against guidelines, but hey ho, you just do the best you can.

When I had DS1 (6) and DS2 (4), they told me that I could make 24 hours worth of bottles up. When I had DS3 (13 mo) the new guidelines were in, but I never followed them.

They also recommended sterilising bottles until 12 months back then, whereas now it is 6 months. I still done it until ds3 was 1.

I've always done the steri bottles and ready made milk though, as you're only really meant to have a bottle out for 1 hour after the water is boiled/bottle is out the fridge.

samnjack I don't think that it is a silly question.

What I did is only use ready made carton's of milk and a sterile bottle when outside the house.

The best way to do it with powder is to fill a flask with boiling water and take this with powder and a sterile bottle and then make up the feed and cool.

The reason for this is that the most important part of making up powdered formula is to use water which is at least 70 degrees C.

This is because fomula powder is not sterile - it may contain pathogens which can only be killed using water of at least 70 degrees C.

scarlotti - yes you are right the forumla can be contaminated during the production process.

tiktok the maternity ward is presumably using the advice for when it is not practical to make up feeds just before feeding - see leaflet for health professionals here.

Although I'd prefer to see hospitals only using ready to feed cartons.

scarlotti you may be interested in the advice in the above leaflet or in this one.

If you find it impractical to make up feeds as you go then the safest way is to make up with the water which is at least 70 degrees and then cool rapidly and keep in the fridge and minimise the time stored. This is what I did.

CuppaTeaJanice I understand that if you use boiling water and add to formula you can actually destroy some of the nutrients in the formula (however I have no evidence to link to for you) but it seems to make sense from a logic point of view.

MakkaPakkasWilly - I totally understand that it is not always practical to make up fresh feeds but there are easier routes as mentioned above which are less risky than what you are doing.

Why don't they sell little sachets of sterile formula powder to make 1 bottle? It must be possible.

I know when my baby wanted milk he wouldn't have been happy waiting around for 20 minutes while I boil water, wait for it to drop to about 80 degrees so it doesn't destroy the nutrients but does destroy the bacteria, mix it with the powder, wait for it to cool some more so he can drink it without burning his mouth...

It is not possible - there is no such thing as sterile formula powder. They cannot guarantee that it is sterile due to its manufacturing process.

Ready to feed formula however has been pasteurised (something which can be done to liquids but not powders).

If you don't want to make it fresh and make your baby wait then you can make it in advance provided you follow the guidelines for rapid cooling/check your fridge temperature and minimise the time between making up and feeding.

This is safer than making with cool water.

Please can people read the links which I posted above.

I think that this is a very important issue.

Fine if people decide not to follow the guidelines once they have

a) read them in full

b) understood all the alternatives and

c) understood the reasons for the guidelines

but not fine to just "do as everyone does" and feed their babies a non-sterile product.

It makes absolutely no difference if you friends did this and their babies were fine.

This is like saying - my friend ran across the motorway and was fine - so I am going to do it! (Disclaimer - I know the risk of death from this is higher than the risk from death from incorrectly preparing formula). I am just trying to get this information out to people as health care professionals certainly don't seem to be doing so.

Janice then the advice would be to make it up in advance using water above 70 degrees, cool in in the fridge and then take it out and about in a cool bag.

It IS a pain, for all the reasons given above, but my understanding is that they changed it after a sharp rise in the number of babies being admitted to hospital with gastroenteritis.

I primarily breastfed, but on the odd occasion later on when I was feeding out and about and couldn't breastfeed I used a carton; just couldn't face the stress and faff of the preparation method - understand tho that might be expensive if you did it all the time.

How about doing the prepare hot, cool in fridge method whenever possible and saving cartons for times when that just isn't feasible?

Sorry to jump in.

I didn' t relise ANY of this! I have exc bf till now (DD1 is 18wks) and am trying to introduce a bottle feed a day (need to go onto complete ff before return to work).

Thanks for the leaflets tabouleh. Afraid I still have the following questions:

1. How to make sure you have a bottle fairly readily available when baby is hungry? In the house/ out and about you then have virtually boiling water that you need to cool down

1. How come they recommend making up feed and storing it in the fridge for up to 4 hours? I thought you were especially NOT supposed to make up ahead of time.

1. If you do make up ahead of time is it ok to reheat it then?

4.How do you ensure the flask you' r e carrying the water in is sterile?

1. Till when do you need to sterilise bottles?

1. Till when(what age) do you need to follow these guidelines?

FWIW I remember a bf thread making the point that it is hard finding any advice re ff. I agree with that sentiment. Although bf is seen as best, ff is a real and sometimes only alternative for some women. Not having this info more readily availabe is dangerous in itself.

In short- thanks for the leaflets.

I look forward to getting some more advice!

HerMomminess - I'm glad my post has been useful - I was a little worried that I may get flamed for going against the majority views on this subject...

I will try and answer your questions:

1. Unfortunately - to have a bottle fairly readily available then unless you can predict when baby will want one you are only left with making in advance or using ready to feed.

1. This is where the most confusion lies I think. There is wide spread confusion as to where the risk lies re bacteria and milk. The main risk is that the powder itself is not sterile. Mixing with water at 70 degrees should kill these bacteria. However if they are not killed or if any bacteria gets in whilst the bottle is being made then it will start to multiply. The more bacteria the more problem. Bacteria multiply over time and more quickly at room temperature.

Therefore cooling and storing in a cold fridge will limit bacteria growth and limiting the time between making the bottle and feeding will minimise the amount.

I used to make bottles twice a day - so max time in fridge was 12 hours. Out and about used ready to feed. This was a level of risk I felt okay(ish) with.

1. Yes you can reheat to feed - it is best to do so as close to giving the feed and as rapidly as possible. I used to sit the bottle in a jug of boiling water.

1. I believe guidelines are to sterilise until they are 1 (however see other mumsnet threads - some say 6 months). There is a mumsnet thread here where someone explains that you don't need to sterilise at all. If you think that you've completely cleaned the bottle then in theory there should be no bacteria - however I was worried that my cleaning wasn't 100% scrupulous and I knew that I was making bottles in advance - therefore allowing time for any bacteria to multiply.

1. There is no "end date" on the guidelines.

To be honest the way I see it - you have to use the hot water for as long as you continue to use powdered formula.

I do not know of any ready to eat packaged food which we as adults eat which is not sterile (obviously excluding meat dishes etc which need heating). If there were then surely we would make sure we zapped them to kill any possible bacteria?

I think that we need to somehow try to make sure that health visitors have this info. Any ideas how this could be done?

This is what I used to do
Boil water
pour required amount in sterile bottle
add required scoops to water
put on teat and cap
shake well
stand in cold water to cool
when cool put in fridge
take out of fridge when required.
warm using a bottle warmer mine was an avent.
I used to make up a whole days feeds in this way. if going out pop one in a bottle carrier mine was an avent insulated one that took two bottles most cafes will give hot water to stand in to warm at required temp or places like boots and mothercare have bottle warmers.
have had 3 kids all bottlefed using above method none ever had any tummy upsets or any other problems. hope this helps

I used to just take the little ready made cartons out with me and give it at room temperature.

Hi.

Well it's been a long time since I have done this, my LO is 3yrs now.

I am struggling to take in all this new info! What I used to do when I went out was take boiling water in a sterile bottle and in an insultated slieve and take a seperate pot of powder, by th time she needed a feed the water was the right temp.

But this is obviosuly the wrong way now, my LO never got ill though.

Thanks for the links to the informaton - have learnt a lot tonight.

Is it really not possible to sterilise powders? You'd think they could zap it in a microwave or use uv light or something. Surely there are some powder medicines that need to be sterile.

I'm sure between us we can come up with a safe and practical way of making up formula when out. How about making up concentrated formula as normal at home with 70 degree + water, say 2oz water with 6oz powder. Cool and store in fridge. Then take out the bottle and also a flask of boiling water, adding 4oz of hot water to the bottle when required, thus bringing the temperature back up to 70 degrees + and killing any bacteria that may have remained in the formula mixture. This would require taking out only 2 items, and less waiting around with a hungry baby.

Sorry, a final question: how do you actually ensure the 'flask' is sterile (ie the flask you are taking the boiling water in)

I have changed my practice and also ordered some ready made for out&about. Still have the booby when we need it though

I made it by adding the full amount of powder to 1/3 boiling water, mixing and topping up with cooled boiled water. Can anyone clarify whether this is acceptable under the most recent guidelines?

What I do is take a small flask of boilng water with me, a bottle with cold bolied water, clean empty bottles and the formula pre measured out into little pots. (This sounds alot of trouble but is so easy once you are used to it)

Say you are making a 6oz bottle, I would add 2oz of boiling water to the empty bottle, add the formula and shake (thus killing the bacteria) then add 4oz of cool boiled water and it's ready to drink It literally takes 30 seconds to produce a safe, drinkable bottle which doesn't need cooling or heating (you can experiement with hot/cold water quantites depending on what temp your baby likes it at) HTH

Is there an echo in here?

Oops sorry but it really is the best way