Are you safely preparing your baby's formula?

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Studies have shown that more than half of the parents that bottle-feed their babies do not prepare their baby formula safely. This can result in babies being injured or becoming ill and, in extreme circumstances, can result in babies dying. This post aims to help you learn how to prepare your baby’s formula in the safest way possible.

Please note that the information included in this blog post is for informational purposes only. It should not be construed as medical advice.

Which formula should I use for my baby?

No matter where you live, you’ll likely find that there are a wide variety of baby formulas available on the market. ‘Infant formula’ is designed for babies of all ages and is suitable from birth, whereas ‘follow-on formula’ is only suitable for babies over 6 months of age (National Health and Medical Research Council (NHMRC) infant feeding guidelines). There is no evidence that using a ‘follow-on formula’ or ‘toddler formula’ is better than using an ‘infant formula’ regardless of your baby’s age (NHMRC infant feeding guidelines). Also, there is little evidence that any one formula is better than any other, provided your baby is a healthy, full-term baby (NHMRC infant feeding guidelines). As such, the exact formula you use for your baby is largely a matter of personal preference. The NHMRC, however, recommends that you choose a formula with a lower level of protein as elevated protein levels in baby formula have been linked to obesity and chronic disease in adulthood.

The exception is if your baby has one of a small number of medical conditions that require a specific formula. For instance, babies with phenylketonuria, galactosemia or maple syrup urine disease require specialized formulas that exclude the components that they cannot metabolize (NHMRC infant feeding guidelines). Similarly, babies that develop an allergy to any of the components of everyday baby formulas (such as cow’s milk protein) will need to be fed a formula that excludes the relevant component.

Premature babies may also require a specific formula initially.

You should consult a medical professional if you think your baby may require a special baby formula.

What’s in baby formula anyway?

Baby formulas are usually made to resemble human breast milk as much as possible. They contain protein, fat, amino acids, electrolytes, vitamins, minerals and other nutrients and are usually partially comprised of cow’s milk (though goat’s milk is also a relatively common inclusion). They don’t, however, contain some of the components of breast milk such as living cells, cholesterol, polyamines, free amino acids, enzymes and other biologically active compounds.

Baby formulas are generally regulated by food regulation bodies. For instance, in the US they’re regulated by the Food and Drug Administration, and in Australia and New Zealand, they’re regulated by Food Standards Australia New Zealand.

How to prepare baby formula safely

Safely feeding your baby with any baby formula relies on a number of key actions:

  1. You must carefully wash all parts of your baby bottles and teats in hot soapy water
  2. You should sterilize your baby bottles and any accessories you use to mix your baby’s formula [link to sterilization post]
  3. You must clean and should ideally disinfect the surface on which you will prepare your baby’s formula
  4. You must wash your hands before you prepare your baby’s formula
  5. You must make up your chosen formula using a safe water supply
  6. You must mix formula according to the manufacturer’s instructions (and you should pay extra attention to the instructions if you change to a different type of formula at any point as the instructions may be different)
  7. Whenever possible, you should prepare one bottle of formula at a time and do so just before the feed

The water you use to prepare your baby’s formula can be bottled water or tap water provided you live in an area where tap water is considered safe for drinking. If you’re using tap water, you should first boil it. The World Health Organisation guidelines state that the hot water should be used to prepare the formula (the water should be no less than 70ºC) to avoid the risk of infection by a particular bacterium (Cronobacter sakazakii). There is a lower risk of this in developed nations and so guidelines relating to water temperature vary. For instance, in Australia, the guidelines state to allow the boiling water to cool to a lukewarm temperature. If you are unsure what to do in your area, consult the instructions on your chosen formula.

I cannot emphasize enough how important it is to read the instructions on your baby formula every time you make up a batch. This is particularly vital if you switch to a different formula as the instructions may vary.

To prepare the formula, you should add the required amount of water to your baby bottle first and then add the powder. You must always measure the required amount of powder using the scoop provided in the can as different formulas may use a different size scoop. Make sure the scoop is full. Don’t use half scoops or add additional scoops. Never add less formula than is stipulated in the instructions (for instance to save money or because you think Bub needs more water in warm weather). Doing so may be harmful to your baby.

When you’ve finished adding the powder to your bottle, put the scoop back inside the tin and close the lid. Do this before you mix the formula to minimize the chance liquid will get inside the tin. It’s best not to wash the scoop in order to avoid accidentally introducing moisture to the tin of formula if the scoop doesn’t dry properly. If the scoop gets dirty you’ll obviously have to wash it, and ideally sterilize it, so it pays to take care not to allow it to become dirty.

To mix the formula, it’s a good idea to gently swirl the bottle rather than shaking it vigorously. The latter method is much more likely to introduce air bubbles into the mix that can give your baby gas. If your baby is uncomfortable after a feed and you suspect gas is the culprit, be vigilant to burp your baby. Minbie bottles come with a seal that you can use to mix formula without spilling it. If your chosen baby bottles don’t have a seal or cap to use for this purpose then mix the formula with the teat attached to the bottle. You may spill some formula but not as much as if you don’t cover the bottle opening.

Always test the temperature of the prepared formula by dripping a few drops on the inside of your wrist. Most babies will prefer their formula to be warm but cool or cold is much better than too hot.

Once you’ve done all that, you can then go ahead and feed your baby.

Safely storing formula

Any formula left over at the end of a feed must be thrown out. If a feed happens to go longer than 1 hour, you should also throw out the remaining formula. This is because the powdered formula isn’t sterile and keeping it at room temperature for more than an hour could allow pathogens to multiply to a level that might make your baby sick.

Formula that has been sitting at room temperature for less than 1 hour can be refrigerated for up to 24 hours provided it’s stored in a sterile container. It’s a good idea to label the outside of the container with the time the formula was placed in the fridge so you can be sure of the length of time it was refrigerated for. Any formula that hasn’t been used within 24 hours should be thrown out.

When you’ve finished a tin of formula, it’s a good idea to dispose of the scoop that came with it so there is no chance that the wrong scoop will be used when you open your next tin.

Safely using pre-prepared formula

If you happen to be using a pre-prepared ‘ready-to-drink’ formula, similar guidelines apply. This means you should sterilize your baby bottles before use and if you’re heating the formula, you must make sure it’s not too hot for Bub before each feed commences. Once opened, these formulas can be stored in a sterile container in the fridge for up to 24 hours. Any formula that you don’t use within that time frame must be thrown out.

The risks of not preparing baby formula properly

To reiterate, baby formula is not sterile. As a result, it contains all sorts of microorganisms. Some, or even most, of them are likely to be harmless but there is always the possibility that your tin of baby formula may contain a harmful microorganism. If you don’t prepare (and store and/or transport if required) your baby formula correctly, you risk creating an environment that is perfect for such pathogens to grow and rapidly multiply. This could make your baby very sick. While the risks are relatively low in developed countries, some harmful microorganisms are still associated with a high mortality rate in babies, especially those with a low birth weight.

If you don’t mix your baby’s formula according to the manufacturer’s instructions, your baby might ingest:

  • too little water, resulting in dehydration
  • too much protein or other formula constituents, risking short- and/or long-term health issues
  • too little food, resulting in malnutrition and poor weight gain

Transporting formula

As noted above, it is best to prepare formula right before you feed it to Bub. If that’s not possible, however, it needs to be stored in the fridge in a sterile container and used within 24 hours.

Keep the prepared formula in the fridge until immediately before transporting it. When transporting it, keep it in a cool bag, cool box or other insulated container and put ice packs in the container to help keep it cool. Containers specifically designed to insulate baby bottles for transport are available in some areas.

Formula transported in this way should ideally be used within 2 hours of removal from the fridge. Formula can, however, be transferred to a fridge after transportation if it arrives within that 2-hour window. It can then be kept in the fridge for up to 24 hours from the time it was prepared.

If all that sounds like too much effort (or too much of a risk), consider taking a sterilized baby bottle filled with the required volume of water (previously boiled) and a sterilized container containing the required amount of formula. Some manufacturers even produce single-serve sachets of baby formula that you might consider using.

Stay safe

Some of these guidelines may seem onerous. They are, however, vital to keeping your formula-fed baby safe and healthy. Bub will be formula-fed for such a short period of time in the overall scheme of things so take heart that you won’t have to do all this forever!

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