Mumsnet please can you update your bottlefeeding info section?

[tabouleh]

Hello Mumsnet Team!

Following on from this thread about the correct guidelines for preparing formula I'd like to ask you to consider updating/expanding the bottlefeeding info section.

I am unleashing my inner interfering bossy feminist/activist part!

It is clear to me that:

• many people do not know that formula is not sterile and that it needs to be made with water which is hotter than 70 degrees C

• many people do not know what the guidelines are at all or just follow what they/their mother etc did

• people who know what they are don't know the research or reason behind the guidelines and therefore dismiss them

• people don't realise that there are some pretty good alternatives to making fresh each time and that THIS DOESN'T INVOLVE ADDING FORMULA TO COLD WATER AND HEATING UP!

• the formula manufacturers need a kick up the arse to be pressurised to provide fuller explanations on their packaging and websites

• the midwives/doctors and HVs also need to know

If you'd like me to have ago at drafting something then I am happy to.

Do you think we could start a Mumsnet campaign? Could we get someone on from the FSA or something.

You know what? I think I'm done, because it is obvious I am not typing in a language any of you read or understand.

Go ahead. Make a MN campaign to push the 'correct' way to make formula. But do nothing to push manufactures to make formula in such a way that it doesn't make babies sick, no matter how its made.

That obviously makes the most sense to you people.

Now where's the hide button?

ah fgs get ober yourself

Did you not read MrsBadgers post?

"1. Formula cannot be made sterile-ly using the spray-drying method. Some bacteria, including E.sakazakii, can survive the heat and dessication, but most other bacteria cannot"

Fool

i was a shit sterliser
used the dw after 6 months
kids all alive

I didnt sterilise after 6 months either Su, its the nasty little germs in formula that need to be zapped. After 6 months they usually eating cat fur/soil/shoes anyways

She isnt reading the posts. People are giving her the information, and the reasons behind it.

I have no idea why things are done differently in USA, but I know how things should be done over here - if formula is made properly then any risk is irradicated. Its not rocket science.

Oh and she was the one who threw her toys out of the cot.

Tee2072 I hope you haven't hidden the thread. I find it very useful to get all points of view as it draws out questions and helps me think of how best to communicate this issue.

Is powder sterile & what about the USA?

In order to address your question about the powder not being sterile and what happens in the USA.

Yes it is shocking that formula powder is not sterile. Lots and lots of people don't know about this.

I understand as Mrs Badger has said that it is unfortunately impossible to make the powder 100% guaranteed sterile, whereas cartons of liquid have been subject to the UHT process (ultra high temp).

You ask about the USA. Well formula is not sterile in the USA either. The WHO information and guidelines apply across the whole world. I don't know why the US guidelines are not in accordance with the international WHO guidelines. (It may well have something to do with the US paeds being influenced by the formula manufacturers).

The International Formula Council whose members are predominately based in the US admit on their website that "Powdered formulas are not sterile"!

What are the guidelines?

I think that the message about making the formula with hot water which is > than 70 degrees C has become confused into "do not make your feeds in advance".

Now this is because this is what the formula tins say and what some of the basic leaflets say and what HCPs incorrectly say.

What they should be saying is:

Formula powder is not sterile. In fact it sometimes contains a very very nasty bacteria called E.sakazakii. As has been mentioned above this is not your common or garden everyday household bacteria.

Scientific tests have shown that the best way to manage this risk is to make up the formula with water which is at least 70 degrees C.

See results of the WHO study here.

As most of us are aware, bacteria multiply with time and more quickly at room temperature. We can inadvertantly introduce bacteria into the milk by: unwashed hands, surfaces, incorrect sterilisation the fact that the powder has been open for a few weeks etc etc.

Thus you put these 2 points above together and you come up with the Gold Standard for preparation:

• make each feed fresh using water which is > 70 degrees C.

Now it is at this point where lots of people panic and say "I can't do that - it's impossible".

I agree that it is very very difficult but you have options:

Using liquid ready to feed cartons. (This is what I did when DS was very young and did when out and about).

Then you have the option of boiling the kettle and storing water in a flask. This cuts down on time to boil and slightly cool the water.

Then you have the option of making in advance - YES MAKING IN ADVANCE! Fancy that - the very thing which people think is the big no no. This is actually recommended as the option when you can't do one of the above.

This is what I did when at home when DS was a bit older. I used to make a max of 3 bottles but the key thing is that I made it with water which was at least 70 degrees. I rapidly cooled and refridgerated.

I have not made these options up - they are the guidelines.

Here is the NHS leaflet.

The BIG NO NO - is do not make up formula with cool water!

Now other people have mentioned microwaves. Personally I never used them and bought into the "hot-spot" risk.

Other people have mentioned using hot water for say 4oz adding powder and then adding 3oz. I'd like to see some evidence or be persuaded that the formula can all dissolve in the smaller volume of liquid. Also if people use this method they need the cooler water to be measured accurately in order to end up with exactly 7oz liquid with 7 scoops of powder.

Additional recent info

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.

I think it is important that people understand the reason behind the guidelines and the different risks involved in different methods.

I would love for Tee2072 to let me know if I have in any way persuaded her to change her opinion based on the above.

as far as I can see, US, NZ, Aus and Canadian guidelines are all similar to the UK ones

whether the population chooses to follow them is another matter

Just to throw another spanner in the works if you are going to go for the make a whole feed with boiling water then cool it down to drinking temp route via jug of icy water then you should also make sure you are using BPA free bottles.

It's apparently not safe to heat and cool bottles containing BPA in the way outlined above.

Tee I am understanding the language you are typing in just fine, what I don't really understand is why you want the manufacturers to do more.
There are many things on this earth that will harm or kill our children if not used properly, and formula is one of them.
Most grown-ups are capable of following simple instruction and is capable of preparing a bottle to the guidelines, it's just a case of whether or not we choose to.

I'm sure that if my ds drank a bottle of bleach, it would do some damage, but it says on the bottle to keep it away from children, so you just do it and no one talks of banning it.
The formula tin states how to prepare a feed safely and I really don't feel any more needs to be done.

If powders are much more difficult to sterilise than liquids, why do none of the formula manufacturers make concentrated sterile liquid formula? So you'd pour, say, 1oz of concentrate into a bottle per 4oz cooled boiled water (or whatever ratio). The concentrate could come in a screw top bottle, with enough for a whole day's feeds (or maybe 2), so would be less open to contamination than a big tub of powder, and less bulky and expensive than liquid.

Tee
I do understand your point, and it something that I have wondered myself. That is why I asked if anyone knew if there was a reason for powdered formula not being sterile.

MrsB gave us an answer.

Why the US recommendations are not the same as the rest of the world is a mystery.

At the end of the day, we can take up arms and campaign to get the companies to make the formula safer - if there is indeed any technical way of making that.

While that is happening, it is incredibly important to ensure that the formula we have at the moment is being prepared properly.

Salmonella poisoning is for an adult unpleasant. For a 5mth old baby it can be fatal. We were very lucky that DS recovered well.

I don't understand why anyone who has been given the information laid out on this thread would continue to endanger their baby's life by making up the formula in a way that certain bacteria may not be killed off.

hopefully this clip will inform Tee that formula, no where, is not sterile.

foxytocin thanks for finding that and posting it - I think it is important and I think that clip says it more clearly than words.

Interesting that they did not extend it to talk about the risks for babies who were not premature/specifically immune compromised and to quote the WHO guidelines on preparing with water which is at least 70 degrees C.

bump! Hello MNTowers - have you started looking at your bottlefeeding section yet?

Your link doesn't work - there are loads of links in my post or you can email me for them.

Also the write up is not accurate and therefore it undermines those of us posting the correct info.

This is wrong:

"Most crucially, you now have to make up each feed as you need it, rather than making up a day's (or a night's) batch and keeping in the fridge till your baby hollers for it."

Actually what is most crucial is to use water which is at least 70 degrees C. The guidelines and leaflets do explain how a feed can be made in advance (although pointing out that this is not the absolute best advice).

I have read the whole thread an am still confused as to what you are supposed to do.

I used readymade cartons mostly, but when not, I would make up 4 or 5 bottles with cooled (not cool, just not boiling hot) boiled water and keep in fridge for up to 24 hours. is that safe?

SambuccaKelly you are probably better off posting in Breastfeeding/bottlefeeding.

I recommend that you read this and this.

If you are boiling a litre of water and leaving it to cool for less than 30 minutes (but not using it as boiling water) then you should be killing any bacteria which was already in the sterile formula.

(The reason it is less risky to make in advance is that you can introduce bacteria whilst making the feeds. Bacteria grows most quickly at room temperature and it grows over time.) So provided you are cooling rapidly and you've checked your fridge temperature then your method is one of the options - as per my second link above.

Thanks tabouleh. Yes, I have always done as you describe. Good to know! It is confusing, though!

Hello. Yes, updating that section is on our Very Long List of Things to Do - but thanks for reminding us

Great !

bumping!

Ooh thanks for reminder. I'll see what's going on here.