AIBU nursery not using bottles for breastmilk

[quesadillasaurus]

My breastfed 10-month old started nursery a couple of months ago. I have been sending her to nursery with expressed breastmilk (EBM) and bottles, which DH cleans at home and I bring back the next day. Last week the nursery staff told me that they do not want the bottles anymore because she does not drink well out the bottle, and that they have been transferring it to a lidded cup for her. When we asked more about this, they said that they run it through the dishwasher after, but it is just one of their normal cups, not specifically for my daughter, and not specifically for EBM.

My question is, is this normal practice for nursery EBM container handling in your experience? I do not consider myself a germophobe, but I did some reading before buying a breastpump and decided to buy a new breastpump based on the recommendation from the American CDC that breastpumps should not be shared between users because of the risk of infectious disease transfer. I assume that the rule would be the same with bottles used for EBM, but I can not find it listed specifically anywhere. Surely it is not best practice to use normal nursery cups for EBM which will then be used for other children? Especially if not sterilized after use.

I'm not sure if I'm being too germophobic and/or how to bring it up with them. I'm pretty new to the nursery and I don't want to make a bad impression, but I'm also a worrier and I always try to do things 'the right way'. Any advice is appreciated!

Your daughter should be coming off bottles soon anyway so her learning to use a cup is a good thing.

Yes, no need to sterilise for breast milk. This was new advice from NHS when I had DD in 2019. It's been updated on the Scottish parentclub website but not on the general NHS one yet. I imagine the info is taking time to filter down.

www.parentclub.scot/articles/breast-milk-storage-and-bottle-hygiene

'Make sure whatever you're collecting your milk in is very clean and dry (you don't need to sterilise it though – this is new advice in Scotland)'

@WaterBottle123

OP You numpty

Breast milk IS sterile and CANNOT transmit infectious diseases.

Washing any cup used for EBM with soap and water is completely and utterly fine, chill

Breast milk is NOT sterile and CAN transmit disease. CMV, HIV, Hep B and C and West Nile virus among others can all be passed through breastmilk. Breast milk is a living substance and contains live cells. Having said that so long as the mother doesn't have any of these viruses washing a breaker in a dishwasher will be fine. While we're talking about dishwashers, in the UK dishwashers do not reach temperatures high enough for sterilization. Steam sterilization is at 121-129oC or in boiling water. Dishwashers do not get this hot and the NHS website states that dishwashers will clean but NOT Steriliser.

Ach she'll lick every piece of blocks and toys in there OP
Yes they should've asked before switching, and gave you the option of bringing your own cup , but at least the previous ,precious milk isn't being wasted.

@lookingforjobinspiration

There are natural sugars in breastmilk it contains 7% lactose.

🤦‍♀️

So my understanding is the pump thing is because some home pumps aren’t closed systems, so milk can get in the pump system occasionally and can’t be cleaned back out. If someone with a transmittable disease used the pump and then you did there’s a chance the disease could transfer to you or your baby.

The key fact being that there are parts tthat can’t adequately be cleaned (so I chose a closed pump system for myself)

Breast milk is different to formula in that it can grow bacteria but it has many bacteria killing properties of its own so it stays fresh a lot longer than formula would. Anything containing formula should always be sterilised.

I would want nursery to use my own cup for milk and I would want to be the one to clean it thoroughly (spouts/straws harbour all sorts) but I’d feel like that about water or cows milk in a sippy cup and I’m only happy for my kids to use open cups that the nursery have cleaned.

Thank you for your thoughts. I was mostly curious what other nurseries do -- do they transfer breastmilk to their own bottles and how do they clean them/ are those bottles specifically used for one child or shared between children?

I think a lot of you have misunderstood my question (5zeds seems to have got it). I do not sterilise her bottles at home anymore and indeed she licks the floor. The question is not about avoiding day-to-day contact with germs and bacteria. The issue is that breastmilk, a body fluid, is specifically a potential carrier of certain infectious diseases, including HIV, HTLV, and possibly hepatitis. brochures.mater.org.au/brochures/mater-mothers-hospital/breastfeeding-with-infectious-diseases
www.gov.uk/guidance/human-t-cell-lymphotropic-virus-htlv-types-1-and-2

If you were a mother with HIV or HTLV, hopefully you would know about it and not breastfeed. I'm sure that the frequency of undiagnosed mothers with these diseases in the population is low, so it is unlikely that infectious breastmilk is present at the nursery. But, isn't it technically possible and so shouldn't nurseries be using a designated bottle for each child's breastmilk and/or sterilising them after use?

Note that these comments do not apply to any other kitchenware such as plates, cups for water, etc. It is not a question about everyday germs, specifically about breastmilk.

@SleepingStandingUp yes from birth , well from when they could take expressed milk from a bottle rather than a tube. So around 36/37 weeks. It’s a leading maternity hospital and they do not use sterilisers at all, (nutriprem is given via tube or from disposable bottles)

If you were a mother with HIV or HTLV, hopefully you would know about it and not breastfeed. I'm sure that the frequency of undiagnosed mothers with these diseases in the population is low, so it is unlikely that infectious breastmilk is present at the nursery. But, isn't it technically possible and so shouldn't nurseries be using a designated bottle for each child's breastmilk and/or sterilising them after use?

A lot of people on this thread have misunderstood what you meant - maybe the nursery did too? I would explain this to them again.

A breast pump can’t be washed and sterilized the same way a cup or bottle can. It’s an apples and oranges comparison. There is absolutely no risk to your daughter or the other children from her using shared cups to drink her milk. If it makes you more comfortable, send in your own lidded cups.

My own dd wouldn’t take a bottle, but drank breastmilk from a lidded cup at that age.

I think you’re correct OP
I think you could explain to nursery again.

Anyway, buy a couple of sippy cups, and label them prominently in dds name.
Send a message IN WRITING saying specifically to please use only that cup for ebm.

@quesadillasaurus

Thank you for your thoughts. I was mostly curious what other nurseries do -- do they transfer breastmilk to their own bottles and how do they clean them/ are those bottles specifically used for one child or shared between children?

I think a lot of you have misunderstood my question (5zeds seems to have got it). I do not sterilise her bottles at home anymore and indeed she licks the floor. The question is not about avoiding day-to-day contact with germs and bacteria. The issue is that breastmilk, a body fluid, is specifically a potential carrier of certain infectious diseases, including HIV, HTLV, and possibly hepatitis. brochures.mater.org.au/brochures/mater-mothers-hospital/breastfeeding-with-infectious-diseases
www.gov.uk/guidance/human-t-cell-lymphotropic-virus-htlv-types-1-and-2

If you were a mother with HIV or HTLV, hopefully you would know about it and not breastfeed. I'm sure that the frequency of undiagnosed mothers with these diseases in the population is low, so it is unlikely that infectious breastmilk is present at the nursery. But, isn't it technically possible and so shouldn't nurseries be using a designated bottle for each child's breastmilk and/or sterilising them after use?

Note that these comments do not apply to any other kitchenware such as plates, cups for water, etc. It is not a question about everyday germs, specifically about breastmilk.

OP, HIV would absolutely not survive a standard wash. And THINK. The amount of HIV present in breast milk is very small. And you're talking about MILK RESIDUE.

Seriously, transmitting a virus this way is literally impossible.

The second you slap partially decomposed meat on their plates.. you can stop sterilising.

HIV is a very fragile virus and dies very quickly once exposed to air. Hepatitis C can survive longer but there are no cases of it being spread through breast milk. There is basically no risk. It is standard practice for nurseries to put breast milk in soppy cups and for those cups to be shared amongst other children after being thoroughly cleaned.

I think it would be so so unlikely for HIV to be transmitted to your child through shared use of a cup that has been through the dishwasher between uses.

But to put your mind at ease label a cup for her and send it in.

www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/sterilising-baby-bottles/#:~:text=Cold%20water%20sterilising%20solution,-Follow%20the%20manufacturer's&text=Leave%20feeding%20equipment%20in%20the,them%20in%20the%20sterilising%20solution.
NHS advice is to sterilize until they are at least 12 months old.

[quote MyDcAreMarvel]@SleepingStandingUp yes from birth , well from when they could take expressed milk from a bottle rather than a tube. So around 36/37 weeks. It’s a leading maternity hospital and they do not use sterilisers at all, (nutriprem is given via tube or from disposable bottles)[/quote]
I know special milk doesn't have sterilised but it does tent to largely be single use. I'd have been a bit 🤨 at them giving expressed milk or standard formula from a bottle that's been given a casual wash in the kitchen sink tho

@SleepingStandingUp my twins were given breast milk from bottles washed thoroughly in hot soapy water as were the breast pumps. I am sure NICU staff know what they are doing. I did the same at home afterwards.

I'm not saying they don't and obv your twins are fine. I'm saying I'd be 🤨 having always been provided with sterilising equipment in all the hospitals I've expressed best milk in

Yes thank you I'm aware of lactose. A PP seemed to say that she thought sterilising breast milk receptacles was needed due to added sugar.

They never said added sugars @lookingforjobinspiration

I thought you had to sterilise anything with Milk -formula or Breast - up until 12 months because of the sugars in milk

I sort of get what you are saying but I think the risks are extremely extremely low. And I am not so sure that breastmilk is a special case. The kids will have plenty of other bodily fluids that they will share in all kinds of ways - e.g. they will lick the cups and there could be a child in the nursery with something like hepatitis c (unlikely but then it's pretty unlikely that there is a breastfeeding mother with it too)

@lookingforjobinspiration

Yes thank you I'm aware of lactose. A PP seemed to say that she thought sterilising breast milk receptacles was needed due to added sugar.

No one said or implied anything about added sugars hun - it's ok to admit you were wrong

Thank you for all your thoughts and reassurance. Yes, it is difficult with the first child -- you worry about everything.

It was very useful to hear from many of you that sharing cups and using a dishwasher (rather than sterilizer) is standard nursery practice. I didn't know if it was standard or just something that my nursery did. So, I have decided to let it go. It seems that she drinks well from the cups and the nursery has a lot of them. I think that sending her in with her own cups for breastmilk would be a little bit annoying for them and it wouldn't fully address my original concerns anyway (because hypothetical viruses from another woman's breastmilk in their general-use cups could still be used by my daughter later, so unless I wanted to be really, really annoying and demand that she only use my cups for ALL liquids....).

About the dishwasher, as a PP commented it does not meet the standards for sterilization (www.hse.gov.uk/biosafety/blood-borne-viruses/methods-of-decontamination.htm), but it is still pretty hot. I asked the nursery today and they said that they run a 60C cycle. In case you are interested, I found a scientific article summarizing temperatures needed to inactivate various viruses in breastmilk: cdnsciencepub.com/doi/10.1139/apnm-2020-0388. Basically the standard method is to heat the milk to 62.5C for 30 min. This is pretty close to dishwasher temperature and the soap will obviously be bad for viruses too. After reading this I think there is basically very little or hopefully no risk of transmission after dishwashing.

This reading really leaves me scratching my head about all the "new breastpump only" recommendations, including the need to replace any part that comes into contact with milk between users even if using a closed-system pump (e.g. pumpables.co/blogs/tips/your-complete-guide-for-buying-a-used-breast-pump).

In conclusion, I guess I still do think it would be better if all cups at the nursery used for breastmilk went through a steam sterilizer at the end of the day, but it sounds like most nurseries don't do this and it will probably be fine.