Bottle-feeding: making in advance v. making each time

[Meandacat]

I tried to BF but it just didn't work - that's a whole other story.

So now I'm bottle-feeding and am confused about the practicality of making a feed using formula from scratch each time. So far, I've been making up a bottle with boiled water cooled, chilling it in the fridge, then taking it out, adding formula and heating by standing in more (slightly) cooled boiling water while I change DD.

But I am worried about the sterility of this and know that making a feed each time is recommended. I've read suggestions that you can get over the annoying 1/2 hour wait for the boiled water to cool by running your made up bottle under the cold water tap. But what about the bottle itself? Surely I'd still have to sterilise a bottle for every single feed? I have a microwave steriliser which takes 4 bottles and this seems a ridiculous waste of its capacity and energy (though, ok, I 'fess, I have no idea how much energy a 6 minute pop in the microwave is). What are the options?

I'll tell you how I do it. First of all, we got a separate kettle for the baby, with a built-in filter thingy. I'll boil it every morning and leave to stand. Every time i need to make a bottle, I'll fill it with water from the kettle, pop it into microwave for 40 sec, then add formula and shake well to avoid hot spots. Now wit the steriliser, mine also holds 4 bottles, but I actually manage to squeeze 6 in, by first sorting the bottles, then adding nipples on top. Worked with both babies.

By the way I leave the bottles in steriliser till they all run out, so wash them all together once a day.

I used to wash all the bottles and sterilise the lot in the morning. I would then make them up so teats in place etc but empty. Then make up formula as and when needed.

TBH, I think so long as the bottle is very carefully washed up, sterilising isn't strictly necessary and there are threads on it. It is far more important to use 70+ degree water in the bottle to sterilise the formula as that can have very nasty bacteria in.

I posted a thread the same as this about 2 months ago.

Make up a days worth of formula in the morning using hot water at 70 degrees (i.e. boiled and left to cool for no more than 30 minutes) and stick it in the fridge until needed. In the evening, make some more for the last feed of the day and the following days breakfast feed and put those in the fridge too. Warm when needed.

Use cartons of ready made stuff overnight - your baby will probably guzzle these quite happily at room temp.

I don't think adding formula powder to cooled water is the right thing to do since as tummytime said, you need to use hot water to kill off the bacteria, since formula powder isn't sterile.

Can somebody explain the science behind the water that was cooled for 30 min killing bacteria? From what I remember, to kill bacteria you actually have to boil something for a considerable time (like bottles in steriliser), unless this cooled water kills bacteria by drowning it or something, I am not sure how it works. On the pack and the Aptamil site it says "Let it cool down for 30 min to avoid scalding". Also, if it so important to use the "30 min water", why they recommend to fill a bottle with boiled water, then re-heat it with a water from thermos, bottle-warmer, etc, and top it up with formula when out and about? It does not have any time limit on it...

Also, formula contains special enzymes that help digestion, that?s why it is recommended to discard any formula after 2 hours because it is actually starting to ?digest itself?. I am sure the process in the fridge slows down, but I still prefer to make a fresh bottle from scratch. And don?t forget all the nasty things that can be lurking in the fridge, with meat, eggs, cheese etc being stored there?

Water which has been cooled for 30 minutes is still hot enough to kill the bacteria which may be lurking in powdered formula. Boiling water is better for killing off bacteria but also kills off some of the nutrients in the formula and you have to wait longer for it to cool down.

But if I'll take cooled water, and microwaved it to the same 70 degrees, it should work the same? You are not supposed to re-boil water because it will cause higher mineral concentration, but microwave does not evaporate water, so it should work the same as the just-boiled thing?

Why would you want to take cooled water and microwave it again?? Microwaving is meant to cause hot spots and you wouldn't know when it was 70 degrees.

I think the new guidelines for preparing formula are a load of bollocks myself. They were drawn up by the DOH and formula companies have adopted them probably as an arse covering exercise so that they don't get sued if there is any problem with the baby.

But if you think how many babies are fed formula each day in the world (i.e. millions) without ill effect then the risk of them being ill from formula are really minute. I'm sure the vast majority of these babies have not had every dose of formula prepared by the DOH method.

There seems to be two common methods that people have been doing for years.

People either seem to use water at 70 degrees, make a batch in advance and store in the fridge until needed, or they boil the water, leave it to cool to room temperature and then add formula to the cooled water as and when needed. People have been using one or other of these methods for years, long before the new DOH guidelines came in in 2005. The old DOH guidelines prior to that suggested the latter method. I think these guidelines were changed after there was a case of a few (which I believe affected no more than a handful of babies) cases of problems in Belgium (I think it was there).

Personally, since I would quite like the bacteria in the formula to be killed off I prefer the hot water method. I think it is important to realise that the powder is not sterile and therefore needs hot water to sterilise it. I'm sure someone in the DOH has atleast tested that the relevant bacteria are killed by water that is at least 70 degrees, otherwise they wouldn't suggest using hot water.

However for the guidelines to suggest doing it fresh for every feed is ridiculous and impractical and seems to cause no end of confusion.

I wouldn't worry too much about how you do it, just make sure the bottles etc are properly cleaned and use whatever method you feel comfortable with. After all in many countries they don't even bother to sterilise the bottles like we are told to here.

But sterilising the bottles isn't the issue.

Killing the bacteria, and specifically the very dangerous e.sakazakii bacteria, which has been found in formula, is the issue.

The main thing is that the water has to be over 70 degrees. Any bacteria that is not destroyed, could multiply rapidly in stored formula - which is why it is not recommended to store a days worth in the fridge.

It is an easy thing to test how long it takes for your microwave to heat cooled boiled water to 70 degrees with a food thermometer (it only needs to be tested once to get timings right), any hot spots would disappear when formula is added and shaken to dissolve - also milk at 70 degrees is too hot to drink straight away so bottle would have to be held under cold tap for a couple of minutes anyway.

Hi Meandacat
I was in the same situation as you and tried to BF without success, now reluctantly bottle feeding.
I have been making up fresh feeds each time with hot water. My kettle only needs to be left for 10 minutes to get the water to just above 70 degrees. Then once mixed it takes about 7 minutes to cool in a jug of cold water. I would really recommend that you get a probe thermometer to do some tests for yourself & find a method that you are happy with.

I don't know why the manufacturers can't give more comprehensive instructions on what you can and can't do with making up feeds. I think the instructions they give are flawed anyway for 2 main reasons:

1. The water left in most kettles left to cool for half an hour will have fallen below 70 degrees. Why don't the manufacturers specify a temperature on their instructions? Or if they really want to cover their backs and the temp. is so crucial, why don't they say that you need to test your own kettle.

1. If you have water at 70 degrees, after you have added the first two scoops say, that will have dropped the temp. to below 70, so the bacteria might not be killed in the rest of the powder you add iyswim.

Re cleaning bottles. Personally I think it is important to sterilise for a young baby. I think it's just too dodgy unless you have the luxury of a seperate sink that you can use.

I have to agree with zebedeethezebra - there is too much unhelpful advice about bottle feeding, and yet do we ever hear of any child that has suffered from whichever method is used? I haven't changed my routine in five years of feeding children. I tend to wash the bottles in batches of about five, boil up the kettle, let it cool a bit (because there is an issue with boiling water and plastic bottles), make up all the bottles and put them in the fridge. I try to use them all within a day. I gave up on the bottle warmer very quickly and went for the microwave option, heating for about 20 seconds just to take the chill off the bottle and giving it a shake. Having said that, my youngest will take the milk straight from the fridge. There is no point making work for yourself....

was just wondering...I didn't use formula powder until ds was about 8 months but have often witnessed the above conversation and confusion.

Could you use a smaller amount of fairly newly boiled water to add to powder (and kill any nasties) and then mix with cool boiled water (stored in fridge or wherever) to get the right temperature - am sure that it wouldn't take long to get the quantities of hot and cold and temperature down to a fine art!

But i've never seen this suggested or mentioned so there must be a reason as to why it wouldn't work?

Not bottle feeding anymore but I like to post on these threads as I get so annoyed at the confusing information and the fact that HCPs don't seem to know/understand the guidelines.

As people have mentioned the key risk with the formula is that it is not sterile.

Therefore it must be made up with water which is at least 70 degrees C.

It appears that using water which has just boiled i.e. is just under 100 degrees C is not the best thing although info I can find on this seems to anecdotal and includes:

• water that hot can destroy nutrients
• water that hot can cause chemicals to leech out of the plastic bottles
• there is a risk of scalding yourself

A very good leaftlet which was designed for HCP is here.

What I like about this leaflet is that it acknowledges that there are time where it is not practical/possible to make feeds as you go.

Rob1n I totally agree with you about water being left in kettles for 30 mins may be at less than 70 degrees.

We also used thermometers etc but seriously a lot of Mums are not going to do this.

The FSA issued a press release last month stating that:

"The Agency is reminding parents and childcarers who use powdered infant formula to use hot water to make up a feed. Formula powder isn?t sterile, so occasionally it could contain harmful bacteria, which could make babies ill. Using water that is 70°C, or higher, will kill any harmful bacteria in the powder.

In practice, this means boiling at least 1 litre of water in a kettle and leaving it to cool for no more than half an hour.

Recent research funded by the Agency has confirmed the importance of using hot water to make up powdered formula. But some parents aren?t aware of this advice and may use cold water, or boiled water that has been cooled for longer than half an hour."

The research report can be read here.

Their more important finding is that "it is not feasible for caregivers to easily judge the temperature of reconstitution water in order to meet the > 70 deg C guideline ... boiling 1 litre of water gives temperatures on average > 70deg C after 30 minutes".

I'd be very interested to hear what happens in nurseries. Does anyone know what they do when preparing formula??

I'm having the same question in my mind. The formula milk guidelines never tell me about at least 70 degrees hot. But I personally prefer to give my baby the fresh made milk so every morning I boiled the fresh tap water then I put them into the thermo bottle. I left them for about two hours then I used them to make the formula milk(At the meanwhile, I fed her with breastmilk).

Of course, I will test the temp before give it to my baby, if it's too hot then I will dip the bottle in the cold water for while.

Now it does make me wonder whether I do it correctly or not.

zebedeethezebra at most nurseries (including my DS's) they ask you to make the formula up and bring it with you and then they keep it refrigerated.

The main thing is to make the forumla up with water which is > 70 deg C. Then cool rapidly, transport in a cool bad and refrigerate.

You will see from pages 4 and 5 of this FSA leaflet the advice for safely making up formula in advance (where it is impratical to make it from fresh).

That's a really helpful leaflet tabouleh and that research paper is interesting too.

Meandacat and others concerned about it being impractical to make up feeds in advance.

Yes - it is often difficult and impractical. You need to be aware of the reasons for the guidelines and the risks.

There are alternative methods to making each feed fresh. These are presented in order of decreasing risk and can be see here in this FSA leaflet.

Adding formula to cool water is really really bad practice. It doesn't matter that lots of people do it/did it and have been ok. The fact is that formula is not sterile and research has shown that making it up with water which it at least 70 degrees C should kill the bacteria.

There is a risk that formula contains really really really nasty bacteria. These are more serious than the everyday around the house bacteria which your DCs may pick up from licking the floor etc. See here for example .

Personally I believe that a lot of babies stomach bugs are caused by formula being incorrectly prepared. However luckily most of these illnesses are not major.

I don't have evidence to link to but I have seen discussions about this on the internet.

scully77 not sure about microwaves. Unfortunately there has not been any research done on using them I don't think.
The standard advice to not use is based on hot-spots. Personally I wouldn't want to use for preparing formula. I would recommend you test with a thermometer to see if it is the right temp.

zebedeethezebra thanks for reading my links. The guidelines I think originated with the World Health Organisation. They are evidence based.

Lousymumdotcom sadly there is evidence to show that babies have died from these serious bacterial infections. You however are following the guideline to make up with hot water and therefore should be killing any bacteria within the formula. As long as you are rapidly cooling and refridgerating then you are following the alternative guidelines.

happy2bme I would like to see some research done on that method. I would like to be convinced that a smaller volume of hot water can still dissolve all the formula and therefore kill the bacteria. If you use that method it is important to separately measure out the cooler water and not do it by eye as you will then have the wrong proportions of formula and water. (This is because 4oz water plus 4oz water = slighty more than 4oz formula).

The instuctions given on the formula are absolutely crap.

This is so confusing
So I am better making 2/3 bottles at a time with hot water & storing in the fridge than using cooled boiled water & adding formula as I make them up? Thats my plan gone out the window & am due in 3 days!!

Tabouleh - thanks for the really useful post. I've always made up in advance with v.hot water (less than 30 mins cooling) and then rapidly cooled in a bowl of v cold water before putting in fridge and using within 24hrs.

I was always under the impression that if my bottles were sterile and I killed the bacteria by using hot water then there was no problem storing in the fridge because whats not there can't grow iykwim.

have had people question my method though, so its good to know it's okay.

I don't know why there hasn't been media coverage about baby deaths associated with enterobacter sakazakii, the bacteria found in powdered formula. But it causes meningitis in very small babies. See [url=www.enterobactersakazakiiblog.com/promo/about/]here[/url]

I sterilise 4 bottles at a time (ds2 has bottle every 3 hours) make them up with water cooled for about 30 mins cool them in cold water in the sink & refrigerate. I read all the evidence & am happy with what I'm doing. I've got a friend who sterilises bottles puts hot water in them then puts formula in as & when which I wouldn't be happy doing as the whole point is that the hot water kills the harmful bacteria.

I find the guidelines confusing as obv water cools quicker depending on your kettle & how much water you've boiled. I do around a litre at a time which is still pretty hot after 30 mins but if you made one bottle at a time as the guidelines suggest then that small an amount of water would surely be cold after 30 mins.

ohnelly - imo the most important thing is to make bottles up using hot water.

Claire236 yes you're right - it's the hot water killing the harmful bacteria which is the most important thing.

The water being at least 70 degrees C is important. You've picked up on a really really important point which is that the water will cool down at different rates depending on what volume there is.

This is why the FSA issued a press release in Feb 2010 to say that at least 1 litre of water should be boiled if being left to cool for 30 mins.

Here is the press release.

You can always use a thermometer if you like doing science experiments!

I have been watching this thread.

I live in France, which is where, iirc, some of the baby deaths occurred. However I am looked at like a slight loon as I follow the new formula feeding guidelines (which I got from the WHO website to back up my argument to DH.)

I don't understand why the guidelines are so different. Here people make up their bottles with cold mineral water and heat in a bottle warmer or in the microwave. Everything we are advised not to do in the UK. DD was a bit constipated and the pharmicist told me to use a certain brand of mineral water in the bottle. He looked slightly confused when I asked him if I should boil it first.

I really don't understand why the guidelines are so different from country to country.

Here my childminder will make up feeds for the baby (she prefers it that way) and is willing to do it my way - but she must think I am being a major pita by insisting on a completely different, more time-consuming way than other parents.