What the experts say about preparing baby formula safely

Millions of babies around the world get 100 percent of their daily nutrition from reconstituted formula milk powder. However, experts differ on the level of precaution needed to prepare it safely.

To eliminate pathogens such as Cronobacter sakazakii, the World Health Organization (WHO) says to boil water, then cool it to no less than 158 degrees Fahrenheit (70 Celsius) in a sterilized cup or bottle, and then add the exact amount of formula according to the manufacturer’s instructions. the formula label. The American Association of Pediatrics (AEP) advises that water should be boiled and chilled for about 5 minutes before mixing with formula milk when feeding infants younger than 3 months, those born prematurely, and others with weakened immune systems . The Centers for Disease Control and Prevention (CDC) states that formula “does not need to be heated before feeding,” but suggests boiling and chilling the water if contamination is a concern for infants. babies with weak immune systems or are younger than 2 months.

The reason for these discrepancies, according to David Berger, medical director of Wholistic Pediatrics & Family Care in Tampa and a member of the American Pediatric Association, is often a matter of geography.

“Part of this conversation is that WHO and UNICEF are dealing with people in developing countries where there are not always clean water supplies,” he said. In the United States, pediatricians and nutrition experts are more concerned about scalding accidents or boiling water destroying some of the nutritional value of added vitamins or probiotics in a formula.

But the presence of chronobacteria in formula milk has occasionally sickened and killed babies in the United States. For this reason, many pediatricians and food safety experts say that the safest options for young and vulnerable babies are breastfeeding or sterile liquid formulas that come from the factory in pre-sealed, ready-to-feed bottles.

If powdered formula is used, “the key point is this: For infants less than three months old, those born prematurely, and those with weakened immune systems, hot water should be used to prepare the formula in order to to kill any microbes,” says Steven Abrams, a physician and professor in the Department of Pediatrics at the University of Texas Dell School of Medicine at Austin.

“Some groups, including the WHO, tend to choose to keep the water still hot rather than cold. This helps kill any bacteria, such as chronobacteria, in the dust, but both the Food and Drug Administration (FDA) and the CDC does not routinely consider it necessary and allow the water to cool to decrease the risk of burns,” Abrams said.

Experts agree on other good practices to keep formula – and any product given to babies – safe.

Wash your hands before preparing a bottle, recommends Melissa Glassman, medical director of New York Presbyterian’s Newborn Clinic and its Outpatient Breastfeeding Support Program. She suggests washing bottles and nipples with hot, soapy water each time, leaving them on the counter to air dry in a clean space or on a dedicated drying rack for infant feeding items, and making sure the water does not collect at the bottom of bottles.

It says that for vulnerable babies, extra precautions can be taken, and bottles and equipment can be boiled on the stove top or run through the dishwasher on the top rack.

The Mayo Clinic maintains that any type of clean water can be used, either tap or bottled. If you are concerned about the purity of your water supply or the condition of your pipes, many public water systems will test your drinking water upon request. If you use tap water, the Mayo Clinic suggests boiling it for about a minute and cooling it to body temperature (ie, 98.6 degrees Fahrenheit or 37 degrees Celsius).

Glassman explained that parents are sometimes confused and think that bottled water eliminates the possibility of harboring pathogens such as chronobacter.

“Parents think it’s the water, not a possible pathogen in the formula itself, so if they use bottled water, they think there won’t be a problem,” he said.

The Mayo Clinic points out that you have to discard the remaining formula milk at the end of each feeding if more than an hour has passed since the start of this. Resist the urge to refrigerate the bottle once you’ve fed your baby, as bacteria from the baby’s mouth can continue to multiply in the refrigerator.

On the other hand, Berger said, freshly brewed bottles keep well in the refrigerator for 24 hours.

“Don’t mix bottles at 3 a.m.,” he recommended, when caregivers can be sleepy and more prone to mistakes. “You can make eight at a time and keep them refrigerated, then let each one come to room temperature.” One way to gently warm the prepared bottle is to place it in a cup or saucer of hot water.

The CDC advises that unopened containers of infant formula should be stored in a cool, dry place indoors, not in vehicles, garages, or outdoors. Don’t store them in the refrigerator or anywhere that has significant temperature fluctuations, such as near a window or above a microwave, Berger said.

Most infant formulas should be used within a month of opening the container, although caregivers should check what it says on the label. The CDC suggests that when you first open a container, write the date on the cap to help you remember.

Washington PostLaura Reiley

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What the experts say about preparing baby formula safely