preparing formula

[stapes]

I have just started topping up my baby's feeds with formula as my breast milk is struggling to keep up with her growth spurt. Is it acceptable to prepare the formula in advance? I know it is against dept of health guidelines but what do you do to avoid a long wait with a screaming hungry baby?

mears - Can you make up ready made formula in advance? I know that you don't really need to as its just a case of pouring it into the bottle, I'm just wondering as its something that we used to do with ds.

Ready formula is heat treated so is sterile till it is poured out. Better just to keep it in the carton till needed and pour into sterilised bottle. However, will be OK in bottle for a while before you use - defeats purpose of sterility though.

Thanks.

Also if your using a thicker formula like C&G Comfort or Aptamil Comfort then they need hot water to dissolve the starch which is the thickener in them.

Yes Mrs Poppins i used your method 20 yrs ago, but i have moved with the times given that i care for other peoples babies.

The fact that NCT classes and post natal ward midwifes won't even mention formuala prearation is not helpful to new parents, tho pnw midwives do instruct on the cleaning and sterilisation of breast pumps and associated equipment.

A close friend recently gave birth to a full term 5lb baby who had IUGR, amoungst the comments made to her on the pn ward were,

"you'd better hurry up and get your milk going else we'll tube fed her" that would be formula then

"you still trying to feed, do you want a bottle" umm formula again

"it would be much better for her to be tube fed you know" more formula

"if she doesn't put weight on each day we'll take her to the nursery and feed her ourselves" yet more formula

Now this amount of pressure to use formula could 'break' a uncertain new mother, my friend is a ex maternity nurse, but she still contacted me to check that she should continue to breast feed her new tiny daughter with colostrum and then her milk, this pressure is down right unacceptable IMVHO and makes me wonder how much dosh the formula companies 'give' to maternity units/hospitals, after all you can buy the same formula in the real worl, it isn;t a special hospital only liquid.

the 3rd comment was made by a doctor on the ward round!

That was a bit mean!!
I would like to see the stats. It isn't just 20yrs ago. I posted the NHS formula feeding leaflet on this thread form 2004 that still did it the way I do at present...

I am not going to retaliate to the accusation of neglect against me that is being flippantly remarked upon in various guises as there is little point and you don't know me so cannot judge with any sound basis the care I give the chidren.
cheeky beggers!!!!!

Flying duchess - do you know at what temperature the nutrients are destroyed as I sometimes don't cool the bottle down very much at all before putting the powder in and am worried that my baby may be harmed as a result? I thought the cool to 70 degrees thing was because of a perceived risk of scalding - didn't think of nutrients. Worried now.

The American Dietetic assoc says not to make up with very hot water for possible changes in physical stability of the formula (e.g., clumping or separation) and nutrient degradation though I don't know exact figures.Allowing the boiled water to cool slightly seems to fulfill all the criteria that you are worrying about so I would go with that. I don't think it is a huge compromise.

here is an updated NHS site that has lots of advice.

and this has great info for 0-5s

Thanks for posting that 2004 link, MrsPoppins, it means I no longer wonder if I imagined being advised to do it that way.

Not sure which way I'll do it this time if I can't BF successfully. I'd be intrigued to see the statistics of how many babies are ill (although I do appreciate it would be difficult to collate those who have a mild illness) and wonder whether the change in advice could be a knee jerk reaction to one incident although of course any baby suffering is a tragedy.

I guess I'd like to make up my own mind like I do about getting in a car or drinking the occasional glass of wine.

PS Not all hospitals provide formula these days. My local one doesn't although they will obviously produce bottles should you want to bring in your own. It's meant to encourage BF but I'm not convinced it can unless backed up in other ways.

'The fact that NCT classes and post natal ward midwifes won't even mention formuala preparation is not helpful to new parents.'

Totally agree. And why are formula companies not obliged to provide more detailed info along the lines of the NHS guidance?

I have obviously been doing things incorrectly, and was under the misapprehension that you only had to be wary of destroying the nutrients when using just-boiled water. Not being much of a science expert, and going along with the guidance on the formula box, has led to me probably quite often using water that is too cool to kill any bacteria. I am only glad that my DS is nearly 1 now and seems to survived!

same here undercovermutha!

and thanks mrs poppins for your support to us less informed mothers!

Post natal midwives should be covering making up feeds with mothers who are formula feeding. If breastfeeding mothers then change to formula feeding when midwife has stopped visiting, then the HV is there to advise.

Midwives to not teach mothers antenatally how to make up feeds. That information is best done postnatally on a 1 to 1 basis

undercovamutha - the formula companies do give the same guidance.

here is SMAs website

They don't on the formula box, Mears.

When you buy something with instructions, do you presume that the instructions are incomplete and then check for more detailed ones on the website? I don't!

When I switched to mix-feeding, the HV didn't give me any info. Just said to buy the formula and follow the instructions.

"I guess I'd like to make up my own mind like I do about getting in a car or drinking the occasional glass of wine."

I can totally see your point, but think you're correct that it would be very hard to get reliable information. There would be no real reason to investigate in great depth why a formula fed baby developed a stomach infection, etc, unless it had been life threatening or fatal. It would also be difficult to run a proper trial, what with the ethics of encouraging incorrect preparation, difficulties with accounting for other variables and, of course, the impossibility of blinding it (which I know is not the be all and end all...).

I actually thought that the guidance was on the side of the tin now. I'll need to go and investigate now next time I am shopping...

It is on the side of the tin. But it is not detailed - for example, it does not mention the need for ensuring the water is hot enough to kill the bacteria. It just states leave the water cool for 30 minutes. IMO, if the temperature of the water is so crucial that it can cause illness in babies, they need to be a lot more prescriptive. I know a lot of people (me included, plus a good few people on this thread) who thought this meant to cool the water for 30 minutes so it wouldn't be too hot for baby. Didn't realise that it was crucial to ensure the water is left to cool for NOT more than 30 minutes, to ensure that bacteria is killed, IYSWIM.

What I mean is, in the pamphlet you linked to Mears, it states:

'If the feed is not prepared safely, these bacteria can cause infections ? and even though these are extremely rare, when they do happen they can be life-threatening.
Therefore, it is important to make up the formula milk with water at a temperature of around 70ºC, which will kill these bacteria. In practice this means boiling the kettle and
leaving it to cool for no longer than 30 minutes. Very young babies are at most risk, and it is better to use commercially
sterile, liquid ready-to-feed products for premature or low birth weight baby'.

On my tin of formula, it merely states:
'Boil fresh tap water, and leave to cool for 30 minutes'.

I see what you are saying now. I agree with you. Perhaps a leaflet should attached to the lid, just in the same way that some medicines have a detachable leaflet that can be peeled off?

I know I like to undestand why I am being instructed to do something - not just told what to do.

i just moved DD2 onto formula and have been putting half the water for a feed into the bottles in advance at the beginning of the day, then when i need to prepare the feed, freshly boiling the kettle and adding the other half of the water quantity to the cooled water in the bottle and then adding the powder straight away, so adding to hot water but not having to wait for the freshly boiled kettle to cool.

agree the instructions are not very detailed at all and if it really is very wrong to make the formula up with cold water i think they should have a warning that you should not do this under any circumstances as it is could result in serious illness, even though everyone knows the dangers of smoking there is still the warning that smoking kills on the packet.....