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?

WHO guidelines

flyingcloud thanks for that link I like that leaflet as it shows the alternative methods - i.e. yes you can make in advance and rapidly cool and store in a fridge

• provided you've made the formula up with water which is > 70 degrees

• of course the best way is to make fresh each time but I hate the fact that when people decide not to do this they then don't go to the 2nd or 3rd less risky option they go straight to an awful option!

I think that the guidelines are the same in the UK and Europe but are not understood by HCPs or parents.

Thanks Claire - im going to do it like you, after all it worked for DS1 (now 4) with no problems .
Other suggestions have been to use ready made formula but that is so much more expensive & a newborn will only take 2/3 ounces at a time anyway not a whole carton.

I don't know tabouleh - my tin of HiPP certainly doesn't have these guidelines on them.

I don't think it's the temperature that's the issue so much as the time formula is kept for (and i have a phd in microbiology). Any bacteria in the milk powder will basically be quiescent until rehydrated. Therefore while hot water may help kill them, it's leaving the formula around that gives them time to multiply and grow (slower at 4 degrees but still happens).

Therefore, when using formula i sterilise a batch of bottles all at once and make them up - they will be ok for 24hrs. I then either do all the water in one go and only add powder when needed, or do water and powder when needed. You can aliquot the powder dry into one of those sectioned tubs to make it quicker when needed.

DrDoobs as you have a phd in microbiology I'd love you to have a look at the recent report commissioned by the FSA:

This report here - just the exec summary will give you the key facts

and also

p14 and p15 of this this summary of the WHO research

I agree that the time formula is kept is an issue which is why it is better in an ideal world to make it fresh and if storing it to rapidly cool and ensure refridgeration at 4 deg C etc.

However the guidelines state that it is very important to make formula with water which is at least 70 degrees C This is because the powder itself is not sterile

I would really really like you to have a look at my links as I feel that it is rather unfortunate that people may look at your qualification and your statement that "I don't think it's the temperature that's the issue" and be misled.

If you read/have read the guidelines and research and you still disagree with them then I would be very happy to have my mind changed.

This is a topic which I feel very strongly about and I am so mad that what I feel is the correct info and rationale isn't making it out there.

I feel quite strongly about this too as it seems to be an issue which is surrounded by mis-information.

But honestly my tin of HiPP says to make it with water no hotter than 40 degrees!

I am now a bit worried that the way I make it is a bit dodgy - I leave the kettle cool for ten minutes and then make up the bottle which I then cool to drinking temperature under a cold tap or in a bowl of cold water.

Didn't mean to mislead anyone - just stating my opinion and that it is based on a relevant scientific background - but apologies if misleading. I haven't read up on all the research, so take it back if not the case but you've got to think that the bacterial load dry must be much lower than that after it's sat around in a fridge for a day. Will read your links (but may not be for a few days) - do they have info on how much of an issue infection from bottles actually is?

I guess what I'm trying to say is that in a pratical world, where you don't want to make up each feed with ex-boiling water each time, personally I prefer to risk cooler water (and not killing any bugs) rather than leave made up formula in the fridge (and risk growing any bugs not killed). Does that make sense?

Of course if you have the time, doing it all the right way each time is preferable.

I think I see what DrDoobs is getting at.

That if the bacteria in the powder is dormant ie not multiplying and then you make it up with cool water and give it to the baby straight away then there is no time for it to multiply to pathogenic (illness causing) levels before you actually feed it to the baby and it's destroyed by the babys digestive system.

However if you make it up and all the bacteria are not killed then you leave it in fridge for upto 24hrs, there is time for it to multiply to pathogenic levels and cause illness to the baby.

If that's not what you mean DrDoobs - sorry.

I'll still use the hot and store method myself because i'm happy i'm cooling and storing it cold and preventing any growth if i haven't killed it all when preparing it.

flyingcloud the NCT issued a press release 2 years ago noting that the formula packets were misleading - see here.

I've had a look at the HIPP website and they state:

" Boil freshly run tap water and leave to cool for less than 30 minutes. "

So no mention of the 70 degress but they have the correct info from the guidelines all be it in a brief way.

It sounds as if the website is different to the packets .

DrDoobs the WHO document I linked to is a summary of research which showed that there was far far less bacteria growth when water of 70 degrees was used even when the feed was made in advance.

In terms of how much of an issue rates of infections are etc - well there have been deaths. I don't have full info on this but it is mentioned in my links.

It is due to the enterobacter sakazakii bacteria which seems to have been renamed to
cronobacter.

I'm going to ask Mumsnet to have a re-think of their bottlefeeding section to see if they can include all the main points from the leaflets regarding using hot water and the best alternatives after the making up fresh.

I think we need to campaign to spread the message and get the correct info onto the packaging.

It is a French tin (I live in France). I feel like I'm on my own little crusade here too - to convince people that there is a method to my madness!

The WHO document says that a small number of premature babies died, so the risk to a full-term, healthy baby is probably small. Nonetheless it's a small risk I am not prepared to take (and I'm pretty relaxed about most things baby-related).

Thank god for tabouleh

This is my "pet peeve" too, every month or so you get a thread asking how to make formula, someone comes on with the correct way, a dozen others come on spouting what they did/do, which is incorrect, but its always followed by " it never did me or my 17 childred/grandchildren/whatever any harm"

Unfortunately this is not the point. As children it was not the law for us to wear seatbelts - many of us will remember lying down in the back of estate cars sleeping on the way to family holidays. It never did us any harm right? You wouldnt do it now though would you?

There is a right way to make up formula - by adding the powder to water that has been boiled for less than 30 minutes. You can add powder to a smaller amount of hot water, and mix, then add the correct amount of cold (previously boiled) water - ie 7 scoops of powder into 4oz of hot water, mix, then add 3oz of cold water.

There are hundreds of wrong ways to make up formula - including adding formula to cold water, adding powder to mineral water, making up feeds 24 hours in advance etc etc.

At the end of the day it is your decision how you choose to feed your baby - you can pick the right way, and deal with the slight inconveniances, or you can pick the wrong way, and deal with any consequences of your actions. There have been babies that have died as a result of making up formula incorrectly. It doesnt matter how many babies, or where these babies lived, they died.

There is right way and a wrong way - it is that black and white.

I think I might copy my post and yours, save them somewhere, and then I can just paste it onto every thread

Would you like to "second" my request to Mumsnet Towers that they improve their bottlefeeding section and start a campaign?

done.

Hopefully Lulu/Tiktok will give it their backing too as I know its something they both feel strongly about.

I think deaths are thankfully rare, but formula fed babies are at greater risk of gastro-enteritis, including the serious sort that means they end up in hospital (not something they will die of in the UK but what a miserable experience), and one of the reasons for this higher incidence is bottle/formula hygiene. Most ff parents would want to know, surely, if they could avoid this?

icantbelieveimnotbitter - that was what i meant but it's clear from the WHO slides tabouleh posted that my assumption was wrong and i am talking rubbish. (can't get the fsa report to open for some reason known only to acrobat).

Many apologies. Am off to hide my head in shame.

DrDoobs I really appreciate you taking time to look at the WHO report and post back on the thread.

Thanks !

If you have any ideas as to how you think it would be best to communiate this information to HCPs and parents I would be very interested. I started a thread in site stuff to ask Mumsnet to update their bottlefeeding section and I think that this will be the start of my campaign!

I always look out for threads such as this as I was left to get on with FF when DS was 12 days old (again whole other story) with no information from HV MW or really anybody apart from what my mum did years ago!!!

I have friends who make up bottles cold and others who use cartons all the time!!

I make mine up fresh each time at home but I do make up his next feed just before I leave the house if I am going out and then take a flask of boiling water and power in a little dispenser.

I am confused that the cartons say that once opened they can be stored in the fridge for up to 24 hours - surely this would lead to the bacteria growing as with making up bottles and it won't be cooled rapidly??

I might be being a bit thick but I don't understand why they can advise this for the cartons and discourage it for made up bottles surely once the carton has been opened it is no longer sterile????Hmmm

newmummy2lucas i think all have left this thread.

i agree that its a bit baffling that the cartons can be stored but from previous threads i gather that they are sterile because the way they are made up is different in the first place. bit like those longlife dairy milks you get i guess.

with ds i always made up in advance. water boiled, 10 mins later add the powder, cool in water and either use or bung in the fridge for upto 24 hrs

i did plan on doing exactly the same again when dd is born but i find these threads and all the links completely confusing and it worries me to death.

it seems to me that as long as you put the powder in when hot enough you are safe. i think the way i use to make in advance is ok, ds is still alive! equally. i knew plenty first time round that added the powder to previously fridged boiled water they're all fine too

the whole subject is down right confusing when the formula companies only put enough info on the tin to cover their backs and the government do not like to plug ff so you find direct advise on from birth formulas impossible to get

ahh!!! i also hate that we ff feel that we have to apologise or be shamed because we cannot (1st time) or will not (this time) breast feed

Hear hear!

I know this is an old thread but I am really confused.

I live in Belgium and will be using Nestle NAN formula for my almost three month old DS. On the packet it says to boil water, let it cool to 40 degrees then add formula. It says that it is really important to let the water cool to 40 degrees before adding the powder. Now this seems crazy as it means the bacteria won't be killed.

What on earth should I do??? When DS starts creche he will be fed the formula at 40 degrees which is the norm here in Belgium but I am really worried.