making up formula

[JRmumma]

Does anyone abide by the instructions on the side of the carton? How can you possibly make your baby wait that long for a feed?!

I have a 4 week old and am half expressed breast and half formula feeding due to baby not being able to breast feed. Id never anticipated having to make up bottles and so never gave much thought to how it was supposed to be done.

I understand the rationale for using hot water to kill bacteria etc, but really, ive never heard of a baby getting ill through the misuse of formula so assume the risk is still pretty low. Ive been doing the water in advance and then just adding powder and slightly warming when i need the feed. Does anyone know if this is a better way than making up the feed with hot water (to kill bacteria) and then reheating again when needed?

Logically, making up with the correct temp water and flash cooling is safer. Your method, while not giving bacteria time to multiply, also doesn't have a bacteria killing step in it (Christ could I sound any more unscientific )

We use Hipp, which tells you to make up at 40-50 degrees. Which is drinking temp in our house (a little warmer than body temp).

What you don't need to do is use boiled water. There is an argument for sterilising bottles (we don't) - but that is the risk fom bacteria in the milk, again. Tap water in the UK is safe to give babies.

We used to make up several bottles with hot water, flash cool in a sink full of cold water and put in the fridge, then warm as required.
We did this because we put colief in ds' milk and that can only be put in warm milk, not hot, and then be left for 20 minutes. Imagine making a hungry baby wait that long for his milk?!

Here: Hipp says you can keep properly made feeds in the back of the fridge for 24 hours (they do also say to boil the water, my theory that you don't have to is mine, not official!)

www.hipp.co.uk/expert-advice/baby-0-to-4-months/bottle-feeding/making-up-a-bottle-feed

Interesting earlier thread

Thanks. Yeah i understand the bacterial implications and i also thought that making up the feed and cooling was the more logical way from a microbiological pov, but is there any other reason why you shouldn't have the powder in its reconstituted state for longer than 2hrs? I cant think of any possible reasons but in not an expert.

I make enough for 24 hours, kept in the fridge and reheated when i need one. I do sterilise bottles an i do boil the water.

I make them.all at 70deg plus in one go, flash cool.and put into fridge.

Took.them.out an hour before needed to get to room temp and fed as they were. Sometimes dd had thwm fridge cold. Never warmed a bottle for her.

Because bacteria breed much faster in warm, wet conditions. So you can have warm and dry, or wet and cold (for 24 hours), but they've capped warm and wet at 2 hours.

I have a tommee tippee perfect prep, it does a hot shot at 70 degrees then the rest cools it to the right temp, and only takes about a minute.

Thanks Rooty, yes i get the bacteria bit, im just wondering if there are any other reasons. Im sure im over thinking it and that the only reason is for bacteria control and in that case making up the feeds at 70 then cooling makes more sense, but im sure the risk in any case is extremely low.

I understand that using water that is too hot may damage the nutrients, and if its left to cool too long it wont kill any bacteria so in reality doesn't seem like a better way overall.

too.hot water doesnt kill the nutrients.

The powder is made in a factor and shoved in a tin which lord.knows what touching it throughout the process - they dont sterilise the powder.

Therefore whatever other steps you take you must mix the powder with water that is hot enough to sterilise.it. A full.kettle.boiled can sit for up to thirty mins and still.be a suitable temperature.

sorry if I was just echoing what you were thinking. I guess the answer is, the instructions are designed to reduce risk to really low levels. I've fed DD bottles made warm and used almost immediately as my preference, without sterilising, and she has been fine (from about 4 months old tho, at which point she was nomming objects far filthier than tap water, would prob have sterilised if she'd been tiny).

I think the claim that water that's too hot damages nutrients has been discounted (I read it here but can't remember when). When DD2 was on formula I used to make it up with half hot water, add the powder then top up with previously measured cooled water so it was at a drinkable temperature straight away. With such a young baby I'd follow the guidelines and make it with water above 70 at least until she's a bit older. Yes the risk is low, but it is a risk nevertheless (I know everything is but at least you have the option of minimising it).

The risk isn't low - the likelihood of it happening is low (although not that low) but don't confuse that with risk. Risk is the likelihood multiplied by the potential consequences. The most serious consequence is death, with severe disability from brain damage, damage to the digestive system, dehydration etc all featuring on that list. These infections are no joke for a newborn.

I personally know 1 baby who contracted a very severe bout of e. sakazakii from formula, 2 friends of friends whose children have ended up hospitalised with bad gastros and 1 MNer whose DS had salmonella. It's not just contamination during production - once the box is opened whatever lurks in your kitchen can get in, so an accidental droplet of raw chicken juice, mould spores, you name it and it probably goes in and finds he perfect place to breed.

If you understand the broad principles behind the microbiology then you should understand why 70C is recommended and why they limit warm, made up bottles at 2 hours. Bacteria are mostly killed at 70, inhibited from reproducing below 5 (but not halted completely which is why it's 24hrs and not indefinite) and reproduce fastest in nutrient rich, moist conditions between 30 and 40.

We make up as instructed and then flash cool - so there is always one bottle in the fridge but for no longer than 12 hrs so for example when DS was feeding in the night we would do 2 before we went to bed. One for in the night one in the morning.

BUT DO boil the water and let it cool a little. - we usually do 20 mins rather than 30 mins.

With all these things my view is if you cut corners e.g just use water straight out the tap and the bacteria in the formula powder is bad how devastated would you be. 2 babies died in europe! would you ever forgive yourself!

On another note just wanted to say ds had feeding problems and i ended up half p[umping half formula feeding. I actual found stored breast milk can stay in fridge longer and can last longer in a cool bag out and about so only really made up formula at home in the day time.

goodluck pumping is a tough road

Mejon's method sounds good, mixing with hot water, adding cooler water.

Nom thanks for correcting my terminology. Out of interest, what's your view on tap water? The NHS says tap water is suitable for babies over 6 months.

Thanks everyone for your views. I never thought of making up with half cooled water, that sounds the most sensible way to me. Although maybe not when out and about. I do try to take bm out with me though as its able to be stored at room temp for longer.

trotts off to sort the cooled water

andcake yes im finding it tough but ive given myself a goal of 3 months. IM hoping i can keep going another 8 weeks and then if its too much ill stop or reduce to a couple of times a day if possible.

I'm mix feeding in the same way too and wrt pumping what I do is one pump a day goes in the freezer so I'm building up a stockpile for when it gets too hard, then there will still be breastmilk to give her one or so a day when I want to stop. I'm at 3 months now and it's not too bad, you get used to it I think. With the formula I make them up with boiled water in the morning and at night and put in the fridge, it's really not worth the risk of using cold water just to save time. Baby might have to whinge for half hour if you're unprepared but better that than getting seriously ill. I have found as my DD gets older she's much easier to distract while the bottle is being made or warmed up anyway, she doesn't really cry about it anymore.

In the UK in most places the tap water is perfectly safe. The rare locations where it isn't you'd know about it on a local level. I would boil tap water if the water wasn't run through frequently though (in a holiday cottage at the beginning of a season for example). Abroad it depends. Some parts of France have lead pipes still... In those cases I'd tend to use Evian rather than boil and even though that's not sterile I've never boiled it. I've never given tap water personally or professionally under 6m but I'm not 100% convinced I'd boil it for my own. If working I'd have to follow the guidelines. It's not sterile but DS tried to drink bath water before then.... Maybe under 3m? But then I don't sterilise toys unless they've been dropped in the street either.

The problem is with the milk, not the water - that's why you should always heat treat it (with hot water) and continue sterilising bottles until you stop using formula, although your dishwasher is usually adequate in conjunction with a good scrub after 6 months once baby has started weaning and licking the floor because it probably gets hot enough.

It's interesting looking at different perceptions of risk around baby rearing practices. Some countries say the risk of scalding yourself is greater (higher likelihood, less severe consequence) than the low likelihood, severe consequence of an infection. That all comes down to how you quantify consequences, and what data you have on infant admissions to hospital/visits to the doctor resulting from contaminated formula to accurately quantify likelihood.

I thought you weren't allowed to use bottled water?

Thanks for the reply, Nom, that is all really interesting. I suppose I am one of the 'worry about the high likelihood events' people that you describe. Though the serious risks you have described have given me pause. I felt as I was following Hipp guidelines using 40-50 degree water, it was ok. I think for another baby I would be more cautious.

There is such a lack of understanding about it all though. I have a friend, bright and well educated, who religiously boils and cools water for her 11mo's feeds, sterilises his dummies, washes his toys if they hit the floor.......and makes up his bottles with cold water. It drives me bonkers.

I didn't ever sterilise but should clarify and say that was bottles from 4mo she was already licking the floor and I do wash her bottles incredibly thoroughly in very hot water with an antibacterial soap. That was just my choice and it's up to everyone - just didn't want to give the impression I wasn't doing what I consider equivalent, iyswim.

Bottled water can be high in sodium and sulphates, which put strain on baby's kidneys. Evian has 6.5mg/l of sodium and 12.6 of sulphates which is actually less than breast milk. In contrast the tap water where my parents live exceeds that measure - Buckinghamshire if anyone wants to check their local water. Similarly bottled water is advised in many European countries because of the mineral composition, but they are much better at labelling. Evian is my preference because it's available virtually everywhere. Don't, however, use Vittel - it has a high concentration of sulphates despite being fairly low sodium.

Boiling tap water is mostly down to chlorine content anyway, which bottled water doesn't have. In some areas you can smell the chlorine as it comes out the tap, so faced with that I probably would boil.

the Hipp Formula is still not sticking to the department of health guidlines

If that's not clear the sodium in Evian is less than the sodium in Bucks. The tap water there is still lower in sodium that breast milk :) Excessive levels of sodium or sulphates in your tap water should be one of those local reasons not to use tap water I mentioned before.

NomDeClavier Yy to all. The whole point is to try and kill the bacteria in the formula. Enterobacter sakazakii is serious, and there are recorded cases - in Europe and the US - of children being hospitalised or even, sadly, dying, as a result of inadequately prepared formula. Whilst statistically it might be less common, the safety of not preparing formula correctly is a game of odds and not a guarantee.

To make things easier, we got a good quality flask and filled it with freshly boiled water about 2-3x a day. This meant whenever we needed to make a bottle we had 70C+ water ready, we just mixed up the formula and cooled the bottle in a jug of cold water. Probably took us a couple of minutes so not too long and gave us peace of mind. Within the first week or two of ff'ing we got used to how often DS would feed and so would make it as we were approaching the next feed, so it would be ready as soon as he wanted it and would be only about 10mins 'old'.

It is sad and frustrating that formula companies do not print adequate guidance on formula tins (we use Hipp and I was at the 40-50C recommendation on the packaging). The government are also a bit useless at communicating this information - we had to switch to formula unexpectedly and literally spent over an hour (maybe at least two?) trying to find out what we should do.