The 2-Hour Rule, Part Deux: A Cautionary Tale

After reading the comments I received from my post on formula prep and handling, I felt like I did this one time in second grade when my favorite teacher caught me passing notes: Embarrassed, guilty and like I learned a really valuable lesson (yeah, I admit it, I was a total sycophant in school).

The embarrassment came from me realizing that while I may be the Fearless Formula Feeder, I am also in many ways the Completely Clueless Formula Feeder. The irony is that I know a good deal about breastfeeding – but not all that much about bottle feeding. Some of you guys know FAR more than I do.

The guilt came from me realizing that I have essentially been risking my child’s health for the past few months, due to a disbelief in the importance of proper formula etiquette.

The really valuable lesson came from me realizing that as an educated, research-savvy former editor of a parenting magazine, it is scary as hell that I knew as little as I did. Even scarier, practically all I do all day is study, write about, and discuss infant feeding issues.  I have now formula fed two infants, and at no point did a medical
professional tell me ANYTHING about what water to use, or why I wasn’t supposed to use a bottle after a certain amount of time.

I took several classes on breastfeeding; I read multiple books on breastfeeding; I had paid professionals helping me breastfeed; I had access to a free group, run by the same paid professionals, which would support me in my breastfeeding endeavors.

When I became a formula feeder, I had a few sentences on the back of a formula can, with the most prominent message being “use as directed by your doctor.” My doctor directed me to breastfeed, and when I couldn’t, had no advice to give about proper feeding. The underlying message there: Your baby is already a lost cause, so what’s the point?

There is NO excuse for us not to be given complete, thorough and factual information on infant formula preparation and usage. Neglecting to give useful information about formula feeding is not going to raise breastfeeding rates; it’s going to put babies at risk. It’s a dumb, juvenile and punitive move by the powers that be.

Sure, there are some “guidelines” printed on the back of the formula canister. But if in one breath, parenting gurus like Dr. Sears are telling us that formula companies are the devil, and that we shouldn’t believe anything these companies say; and then in the next they are dismissively suggesting we can get all the information we need from this same devil… well, that’s just obnoxious. Obnoxious and dangerous.

One of the consistently proven “risks” of formula feeding even in affluent nations with good water supplies is a increased risk of gastroenteritis. I wonder if this could possibly be due to improper formula use rather than the formula itself? For example, how many parents were doing what I was doing, and figuring that leaving formula out for a few extra minutes couldn’t hurt? Or what if they didn’t know they were supposed to boil the water first to kill any bacteria – even if they lived in a place with “safe” tap water? Or that purified water wasn’t necessarily good enough? I’m not even talking about major, life-threatening types of stomach illness, like the necrotizing enterocolitis so prevalent in NICU populations. I’m talking minor bouts of diarrhea that give formula fed babies the reputation for being more prone to gastrointestinal bugs.

This has got to stop. It’s not fair that formula feeding parents need to get their information online from either breastfeeding advocates with an axe to grind; formula companies primarily interested in profit; or misguided formula feeding bloggers who know far more about breastfeeding than they do about the “rules” which actually apply to their fan base.

So – that said, I’m implementing a new feature on the blog. Twice a month I will feature posts on the actual mechanics of formula feeding. I will be honest with you when I don’t know the answer to something, and we can do what we did with the post that started my little revolution… we can share our info, and piece together the real story. Feel free to email me (formulafeeders@gmail.com) with the specific things that are puzzling you, and I will do my best to crack the case.

And now, back to the subject at hand. The Two-Hour Rule, Redux. I made some misleading claims in my first post on this subject that I want to retract and/or clarify.

First….I was somewhat correct in my original post; breastmilk is subject to similar laws of nature and without a doubt, can be contaminated if left out too long. The difference between the two substances is that breastmilk at least begins as a sterile substance. Reconstituted formula is NOT sterile, and in fact there have been cases where  Enterobacter sakazakii has been found in unopened cans of formula. Once the bacteria is in there, it can easily grow and thrive. For example, this bacteria is of primary concern in the NICU, because it can cling to surfaces like feeding tubes; if these tubes are not properly cleaned, babies become infected. But even at-home devices like formula pitchers are breeding grounds for bacteria. I never used one of these for FC (seemed like an annoying extra step) but our formula pitcher has been a lifesaver with Fearlette, who needs a strange brew of thickened hypoallergenic requiring insane measurements that would be difficult to do at a moment’s notice – especially a moment around 3am when I’m half awake, and naturally clumsy.

It’s nothing to stress over too much, but for younger babies, I do think it’s important to clean all formula-related equipment carefully. I swear by those microwave sterilization bags sold by a really famous breastpump maker who rhymes with Shmedela…you can just throw all your bottles/disks/rings/caps in there, stick it in the NukeBox, and zap. You’re done.

Water-wise, to be totally safe, you should boil all your water, whether it be from tap or bottle; let it cool, and then mix with formula. However, this isn’t very practical, and I can tell you that a few pediatricians I’ve spoken with say that it is perfectly okay to use that Nursery Water stuff (the flouride is a different issue, but we dealt with that in another post) or distilled water, as long as your baby is full term, and healthy; eventually, depending on where you live, tap is kosher, too. But as much as I hate to say this, if you can afford it  – spring for the ready-to-feed infant nursers for those first few weeks. I know they are pricey (another reason I hope that they don’t outlaw the hospital sample bags, because this is usually what is in them) but those tiny disposable bottles truly are your safest option. After the first few weeks, you can switch to powder and use boiled tap water or bottled, distilled water.

As for leaving formula out, I did read a study (thanks to Becky, who gets the promised gold star) that found that the longer formula was left at room temp, the more bacteria grew. This does not mean that the bacteria level found would necessarily be enough to make your 6-month-old sick from one crusty bottle of formula milk, but there are facts, and then there are real-world applications. We pick and choose our battles, but we should be informed enough to be able to decide which fights to wage.

I will tell you that since I started researching these things a few days ago I have become super anal about not allowing Fearlette to snack on an older bottle. I just use my (well-cleaned) formula pitcher so I can pour small amounts at a time; this way we don’t waste much of her liquid gold (aka Alimentum), but she’s also not nursing a bottle potentially full of microscopic bugs. Do I honestly believe that she is going to get sick from doing this? Probably not. But I know the inconvenience is worth avoiding the risk, which is apparently a documented risk…. and I also wish someone had given me more evidence-based advice on these things, because it would have at least made me understand why we have to follow these terribly annoying rules.

Some other interesting things I learned from FFF readers over on the Facebook page:

Jennifer suggested mixing formula “with boiled water that is still hot. That will not only kill bacteria that might be in the water but also ones that might be in the formula. Of course, then you have to let it cool before feeding it or refrigerating it, at which point it can be contaminated with bacteria just like any other food.” But then  Ella pointed out that “recommendation in the UK is to NEVER mix formula and water and then refrigerate,” but rather to “boil water, keep in fridge, then mix with powder when needed”, she then mused that “in France…you mix the powder with bottled water- Volvic or Evian, the others being to high in I can’t remember what- at room temperature, so no boiling involved at all. No one seems to agree on what to do…” 

Methinks I have my first homework assignment…

About the Author:

Suzanne Barston is a blogger and author of BOTTLED UP. Fearless Formula Feeder is a blog – and community – dedicated to infant feeding choice, and committed to providing non-judgmental support for all new parents. It exists to protect women from misleading or misrepresented “facts”; essentialist ideals about what mothers should think, feel, or do; government and health authorities who form policy statements based on ambivalent research; and the insidious beast known as Internetus Trolliamus, Mommy Blog Varietal.

Suzanne Barston – who has written posts on Fearless Formula Feeder.


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47 thoughts on “The 2-Hour Rule, Part Deux: A Cautionary Tale

  1. My Paranoid Husband (TM) looks up these things on the CDC and food safety sites and I *think* it's 3 lb of meat or more but don't quote me on that. He made me throw out the remains of our 14 lb turkey, which I can tell you made me sore because it took me a while to cook the darn thing.

  2. That may be the show I'm thinking of, I tend to watch TV in such short segments that it's hard to keep it all straight. Can't remember if he said something about pathogen growth or if I read/watched that elsewhere, now that I think of it…

  3. I was watching Kitchen Nightmares a few weeks back and Gordon Ramsay was screaming at the chef because he had put a pasta sauce in the fridge straight after making it, which apparently made it taste bad. It confused the hell out of me, because of the safety issues of leaving food out (I have to admit that I often leave these things out till they cool, for instance when I make pasta sauces in bulk and use some of it for supper and only get round to putting the rest of it away later.) I suppose the fact that I reheat pasta sauces well makes up for any possible bacterial growth.

  4. FWIW the reheating doesn't get rid of bacteria that might develop in meat, that's what I was told by docs during pregnancy. That may just have been for toxo and the other preg-related germs though.

  5. I wondered about the pockets of heat too, when I heard about that (ears ago) but a formula feeding friend or relative that I mentioned it to said that she shook the bottle after microwaving it and that apparently dealt with the issue.

  6. Hi, I'm new here but I was soooo happy to find you site.

    My daughter has been formula-fed since she was 5 weeks old and I figured I could add in what her pediatrician told me to do:

    1. Make sure everything that is used to construct the bottle is cleaned with hot, soapy water and then sterilized before use/re-use.
    2. Use only boiled or properly filtered water.
    3. Wash your hands with hot water and soap every time you are going to prepare a bottle.
    4. Before you open a new can of formula, wash the lid as well the top of can itself to remove any possible dirt.
    5. Make very sure to measure the proper amount of water and formula via the can's directions; too much water + too little formula can lead to lessened nutrition/nutrients and too much formula + too little water can lead to dehydration and kidney issues.
    6. Never leave a prepared bottle in room temperature for longer than 1 hour. If the child has still not finished the bottle within that time and is still hungry, make a fresh bottle.

  7. Teri, the danger zone for bacteria breeding is room temperature and when food stays at it for over an hour (or closer to two hours actually per recent studies on safe meat defrosting) there is an increased risk of food poisoning. But putting hot food in a fridge right away cuts down the time that it will be in the danger zone, as it were. The only exception is a whole cooked turkey, which doesn't cool fast enough because of its mass (so you are supposed to cut it up before refrigerating). I have a food safety paranoid husband and am pretty paranoid myself and read all the studies ;)

  8. One thing to think about is what your goal is in buying organic formula. No formula, whether organic or not, will have a significant amount of pesticide residues. Contaminants tend to be carried in animal fats, and formulas are all made with non-fat milk and added vegetable oils. Moreover, formulas are screened for contaminants, breastmilk is more likely to have pesticide residue than any formula. So there's really no reason to think organic is healthier or safer for your child. If you prefer organic for ecological reasons, someone else will have to address that. I'm skeptical of any and all eco claims.

    All formulas have roughly the same amount of sugars, the difference is in what kind of sugars they contain. The basic formulas usually contain added lactose, or the sugar naturally in milk. Many organic formulas contain sucrose, or table sugar, because it is less expensive. Other formulas, like gentle or sensitive formulas, contain different sugars believed to be easier to digest. Lactose is the sugar in breastmilk, so some prefer it for that reason.

  9. Many formulas are now BPA free. Gerber Good Start and Similac now have both ready to feed and concentrated liquid formulas that are in BPA free packaging as well.

  10. Hmmm I've read that if you put hot food straight into the fridge or freezer, you have pockets of warmth that can breed bacteria while the rest of the food cools…then again this was on a cooking show.

  11. I am absolutely horrified as I look back on how I fed my oldest child when he was an infant. He was FFd from about 2.5 months on and I was taught NOTHING about how to properly handle bottles, formula, water, etc – not even by my mother who FFd two children. At the age of 20 (turned 20 2 weeks after my son was born, actually), I knew nothing about how to care for an infant and I received zero information about infant feeding (of either variety) from the hospital where my son was born. The only thing they told me was that I should only nurse him for 10 minutes on each side – no more! Any more than that was pacifying him and would turn him into a spoiled brat! That, btw, is what ultimately led to our BFing failure.

    I digress, it's honestly terrifying to look back on those days. It's amazing that he didn't get very sick from all of the old bottles, unsterilized bottles, tap water, etc that he consumed. It's ridiculous and shameful that in this day and age, women aren't well equipped and given access to the information needed to safely feed their babies. The infant feeding pissing contest has got to end so that the health and well being of moms and babies can take center stage.

  12. They recommend the microwave? Around here they tell you that's a real no-no because of the potential for pockets of heat. This is so needlessly confusing…

  13. I can't tell you how much I love the idea of regular posts on the mechanics of formula feeding. I'm giving birth in December and already know that I will be formula feeding. I've tried so hard to find unbiased information related to formula options and have come up short. One question that I have – and there is clearly some debate surrounding – is the benefit of organic formula. I've read that there is a lot more sugar in organic formula and so its not good to use… but I'm not sure that I trust the information I've found since it dates back to 2008.

    Regardless, I'm thrilled that you are going to start focusing on this… there are so many instructions on how to best address breast feeding and NOTHING on formula. This is wonderful.

  14. We didn't use ready-to-feed formula 1) because we couldn't afford it and 2) because of the BPA in the canisters, which leaches into the liquid formula. While most powdered formula cans have BPA as well, it's less likely to leach into powder. Our ped said that our (big east coast city) tap water was perfectly fine, and never said anything about boiling. We just measured the powder into the bottled, then filled with tap water to the appropriate water level, shook it and fed. My kid preferred cold bottled, and wouldn't so much as touch a warm bottle. We also never sterilized bottles or nipples – don't have a dishwasher or microwave, just washed the bottled and such in hot water and let air dry, and were told that was fine. I should be grateful that we were so lucky – my now three year old has never even had a single bout of tummy trouble.

  15. I don't know about boiling water killing probiotics and other nutrients found in formula, but according to health code, any hot food or beverage should be put into the fridge without letting it cool down at room temperature first. Many people think you should let it cool off first before putting it into the fridge, because it might bring up the temperature of the fridge. But I took a blood-bourne pathogen class at Red Cross, and the teacher there was food safety certified and she mentioned that you should never let hot food/drink cool off before putting it in the fridge. Your fridge will sense the temperature increase and it will begin cooling down to compensate. Leaving it out at room temperature lets more bacteria grow.

    Also, mixing formula with boiling hot water kind of helps it to mix better. The clumps dissolve much easier. But yeah, it's probably not good to add boiling water to powdered formula for the reason that it probably messes with the nutrients.

  16. Jenny, just ask your pediatrician. In most places in the US it is totally fine to use tap, especially as the baby gets older. I just use the water from my Brita filter. I think we used distilled for the first 5-6 months, but after that, we're completely on filtered tap…

  17. We were told the water in our area was safe but then we live in a sort of countryside-ish area with very good water. When I used to live in a Large City on the East Coast, I didn't even drink the tap water myself and it would have sucked to have to boil it for bottles. Do you get distilled water in bottles in the US? You do where I'm from and that would have been a very good thing. Or you get a reverse osmosis water purifying machine which gives you pretty much the same thing.

  18. When my girls were in the NICU they obviously got the pre-made bottles – they never use powdered formula in the NICU. However, once we got home we switched to powdered formula.

    I asked my pediatrician if I should boil the tap water and he said we didn't have to. Tap water is very safe and highly regulated in the US – I can't imagine that it's necessary to boil the water. I did always make bottles fresh and never let the formula sit for more than an hour. This seemed much more important to me than boiling the tap water.

  19. We used ready-to-feed formula. While it eliminated a lot of “risk” associated with what water to use, using powdered formula, etc. – it was also horribly expensive… oh my goodness, was it ever. But it was only for one year of her life and it was worth it to us. Thankfully both of our families and a ton of our friends all signed up for Similac coupons and mailed them to us (and we occasionally bought/swapped on Ebay or mom message boards) and we never really paid full price for the formula.

  20. In a past life, I was an official science nerd, and I still have access to science-nerdy things through my science teacher husband and other science nerd friends. And one thing I have promised myself is that whenever I have kid #2, I will do a nice, controlled experiment. I will get myself some petri plates and mix up some agar, and then I will go to town. I'll pump milk under my regular conditions (bottles and pump parts cleaned in hot soapy water but not sterilized) and under as sterile conditions as I can get in my kitchen and under the conditions sometimes suggested on breastfeeding websites (just pop the parts in the fridge between pumpings or use those wipes made by that same company that rhymes with Shmedela). If I can manage to hand express, I'll just squirt some straight onto a petri dish. I'll use RTF formula that's just opened and some that's almost at the end of its 3 days in the fridge. I'll make up a bunch of batches of powdered formula — with tap water, boiled water, cooled boiled water, filtered tap water, and bottled water. I'll let milk samples and formula samples sit out at room temperature for various lengths of time, and in the fridge. I'll take samples after my baby has drunk from the bottle, and I'll enlist my son to help me create some “saliva-contaminated” samples. My fridge will be so full of petri dishes and formula and pumped milk that we'll have no room for food. But I will see just what kinds of bacteria grow and just how long it takes for milk and formula to go bad.

    And, because deep down inside it's pretty clear that I'm still a science nerd at heart, this, more than all the benefits of breastfeeding in the world, this is what makes me want to breastfeed my next child. If anyone asks how long I plan to breastfeed for, my answer will not be “at least a year” or “I made it 7 weeks last time, so I'm going to try for at least 8 this time” or even “as long as I can.” No, my answer will be “as long as it takes me to complete my experiments, and then we'll go from there.”

    I think maybe I should go to bed before I start with the mad scientist laugh….

  21. “in France…you mix the powder with bottled water- Volvic or Evian, the others being to high in I can't remember what- at room temperature, so no boiling involved at all.” Yup, I confirm, that's what many people do there. What other waters are too high in is probably nitrates. Or perhaps sodium.
    /OT rant on/Anyway, MY problem is to get my breastfed son to accept a bottle of either breast milk or formula, sighs (I've been a bit paranoid about nipple confusion and proposed the bottle too late. Now I'm stuck with a frequent nurser who won't accept any substitute)./OT rant off/

  22. I'm also in the UK and follow a similar approach to that described by Lynne: sterilising bottles and teats before each use and making up bottles in advance a couple at a time. I was directed by a parenting forum to this government guidance:

    http://www.food.gov.uk/multimedia/pdfs/formulaguidance.pdf

    I read this, particularly where it says “if you must make up formula in advance, then do so like this…”. I then choose to take the risks I was prepared to (keeping made up bottles for up to 24 hours in the fridge, and cold bottles up to 8 in a cool bag with an ice brick which is actually colder than some parts of my fridge) and minimise others by being scrupulous on hygiene with surface, hands and bottles during preparation. We actually needed to replace our kettle soon after my son was born and so got one where we can heat water to 80 degrees celsius, sterilisation point, and so make up bottles instantly.

    I agree it is madness that we have to seek out this information and it is handed round like forbidden sweeties by the naughty kids at the back of the class. When I was taught to “top up” my son by bottle before leaving SCBU, I had 5 mins with a nurse who showed me how to hold him, and a bottle. No one talked about making up the formula and indeed my husband and I had some fraught conversations where I had to get him on side re accuracy and hygiene, as no one had spoken to him either.

  23. Haha, I've got my hands full with this one right now. Probably about a year before we start trying for another, unless there's a surprise before then… :-)

  24. Nope, was definitely told by English GP and child nutritionist that ” what matters is that the water has been boiled at some point, and most people store cooled boiled water in fridge, then add powder when needed”. All the FF mums I know in the UK do it this way. Like FFF pointed out, in my home-country they just use bottled water and don't worry about boiling it. So yes you do wonder…why can't anyone agree on this? It sounds that even in the same country they contradict each other, so who are we supposed to believe exactly? I think what you have been advised to do ( mix formula with hot water to make sure bacteria is killed, then store in fridge) makes a lot more sense that what I've been told- how is sterile water making the powder safe if it's cool? I'm not a scientific person but even I know it doesn't work like that. We really need some proper, consistent guidance on this, but Heaven forbid it should happen, that would undermine breastfeeding apparently :-(

  25. Our ped told us to boil the bottles the first time and thereafter the dishwasher was adequate to keep them bacteria free, but we did also boil all the Dr Brown's nipple parts every few weeks (after thrush, baby illnesses, etc). As for mixing up the formula, we were told to make it fresh each time, which is also the recommendation from Babycentre.co.uk (which I find much more balanced and sensible than the US version) and the Mayo clinic baby book. After baby weaned completely we did start to make up an extra bottle for the night and keep it in the fridge because one doesn't want to be mixing things up while half asleep. Once baby started daycare at 9 months however we did have to pre-mix bottles and keep them cold because they would not mix them up over there, and occasionally they would leave the bottle out and re-use it which made me nervous but I wasn't sure I wanted to pick a fight about that.

  26. I have to say that the advice I've been given (Also in the UK) is different to the advice Ella was told. Here, the official line is to make every bottle fresh. So boil kettle, leave to stand for between 20 and 30 minutes, add water to bottle, add formula to water. Cool the bottle under a running tap, and serve. Most parents realise very quickly that this is not practical. What I've been told (and what I know others have been recommended in the UK) is that if you want to pre-make bottles, you pre-make the whole thing. So you boil kettle, add water to bottle, add formula to water. Fast cool the whole batch (ie sit them in a sink of cold water) then when they are cold enough, put the bottles in the fridge and use within 24 hours. The method of keeping bottles of cooled, boiled water (in the fridge or otherwise) is not recommended. Unless, of course, you are using SMA Stay Down which absolutely requires to be made with fridge-temperature water. So apparently, the guidelines can be flaunted for kids with reflux (including my friend's daughter who was born at 26 weeks!), but everyone else should be making the bottle from scratch.

    The amount of misinformation is terrifying, and endlessly frustrating for me. The midwives in some NHS areas are actually forbidden from discussing formula at all, lest us ignorant women be lured from breastfeeding by the mere mention of the F word. It at least got a page in one of the books I was given, but again, all that was mentioned was the “make each bottle fresh” rule. It's no wonder that other mothers treat those who use formula as second class citizens, when the problem starts with the so-called “professionals”.

  27. The WHO has definite reasons for recommending hot water, although some may think they are being overly cautious, and there are good reasons for recommending boiled water even if it has been cooled, but I've also heard arguments against it, such as the fact that it can concentrate minerals or impurities. Neither Gerber water nor Nursery water is sterile, although they may be less likely to be contaminated than tap water. The WHO cites evidence suggesting that using hot water doesn't significantly degrade nutrients, but yes it would kill probiotics but so far only a couple of formulas (Nutramigen and Good Start Protect) in the US have those. I do think the older bottle at room temperature thing is more clear, and if there *is* bacterial contamination in the water using the formula quickly will help avoid its growth. Making sure all bottles and equipment are thoroughly cleaned in hot water between all uses will help with safety, too.

    A midwife I know from the UK said that their recommendations just changed to match the WHO, so that the official recs are now to boil water new at each feed and then use it while still hot.

    Thanks for the gold star! :)

  28. Ellyn Satter has a full chapter devoted to the mechanics of formula feeding in her book Child of Mine: Feeding with Love and Good Sense. A brilliant book for every stage up to teens, it has a nonjudgmental attitude towards feeding, however that may be. On a side note, the thing that drives me batsh!t crazy about the antagonism towards formula feeding is that it puts added stress on adoptive families, and just seems so exclusionary all around for families that are outside the narrow definition of “traditional”.

  29. My friend started a discussion on Facebook about FFing a few days ago and one of the conclusions that we came to is that we're often left in the dark. Our Public Health unit will barely discuss formula feeding and doctors don't necessarily know anymore than we do about the mechanics of it.

    In North America where the majority of women do or will formula feed to sone degree the lack of information is irresponsible quite honestly.

    Suzanne – even if you were “schooled” it was still a very valuable discussion to have and to see the true lack of good information that is out there.

  30. Here in the Netherlands using bottled water is a real no-no unless on the road, due to the added minerals.

    We are also allowed to use cold tap water, add the powder then heat in the microwave until of drinking temp.

    In the UK a kettle should be boiled, allowed to cool until 70, then formula added.

    Some say you can make up a batch at a time this way.

    Nothing is perfect.

  31. Wouldn't adding boiling water to formula pretty much kill any probiotics, if formula starts going that way? There's indication that formula will, and there's some vitamins that degrade when cooked right? The levels of bacteria when water is added is low enough that most babies shouldn't have a problem… if the water is sterile anyway. (And if you want to use bought water, the Gerber water is sterile and fluroide free! Cheaper too…)

    My doctor actually asked where I lived and explained that 1) the water where we lived was very clean and good as far as reports went and 2) we should always use cold water and heat it up if we want it warm because of the dangers of hot water heaters and the pipes. See, the hot water heater is apparently a hotbed of bacteria, and a lot of the pipes have lead in them, so you should use cold water and heat it up if you're going to consume it (that goes for adults as well as babies though.)

    So basically the cold water from our faucet anyway is considered good for formula mixing, heat it up for warm, and hot water is off-limits to everyone unless you boil it yourself. But it does make me wonder about those warm baths my kids always got as babies.

    http://www.sciencenews.org/view/generic/id/37933/title/Science_%2B_the_Public__The_Case_for_Very_Hot_Water

  32. Interesting read. I actually didn't realize that wasn't common knowledge. I guess if there's any benefit to spending so much effing time in the NICU is that this topic actually gets a lot of time.

    One of the reasons I hated having to add formula to my pumped milk is because it shortened its halflife so much.

    Though to be clear, there are actually different rules for milk handling (whether that milk be from a can or a boob) for preemies pre-term. It's actually pretty standard that most NICUs just don't use powdered formula AT ALL because of the bacteria risk to their immature guts.

    I think it's probably wise to be extra strict with either breastmilk or formula for the first month or so postpartum, even for termies.

    We were actually told to sterilize bottles & nipples after each use for the first 4 weeks after we came home (Robbie came home on his due date, so until 4 weeks adjusted.)

    Anyway, my solution really was just to only put 2 oz of whatever into the bottle at a time and if he finished that, add more.

    As one of the posters on the other post mentioned, it was primarily the saliva that was the issue. As long as he hadn't contaminated my formula-breastmilk concoction, it was good for 24 hours. Robbie's eating was extremely sporadic, so I never felt like I could make up a day's worth, but I would often make up 8 or 10 oz in a large bottle, but then pour from that into a smaller (4oz) bottle and go from there.

  33. It was a sad situation all the way around. Thankfully, he thrived well on formula and I was so young and naive that I had no idea people were silently judging me for popping a bottle in his mouth in public.

    I went on to breastfeed my middle child for 3 years and my youngest is still breastfeeding at 15 months old with no end in sight. It really wasn't until I successfully breastfed a child that I truly understood how awful the info was that the hospital nurses gave me re:limiting feedings. And it wasn't until I read this and the previous “2-hour rule” posts that I realized how horrible my ff'ing practices were. Live and learn!

  34. I'm really sad you got that info about limiting his time on the breast. Cluster feeding is no fun, and slow, langorous eaters are their own challenge, but breastfeeding is hard enough that bad information like that makes it so much more difficult. Plus my heart breaks for both of you, him possibly still being hungry and you perhaps feeling like you were doing the right thing but likely sensing that it didn't seem to be working.

  35. “Tap water is very safe and highly regulated in the US – I can't imagine that it's necessary to boil the water.”

    Well, except that there are occasional breaches in the system, which are caught and corrected but not until after some people drink the water, and because there is the possibility for the water to become contaminated on its way from the treatment center to your tap, as in the case in the cited article where bacteria were frequently found growing in water heaters. So the argument I've heard, which Ellyn Satter articulated well in Child of Mine, is that due to neonate's small size and underdeveloped immune system, a GI illness due to water contamination that wouldn't effect an adult can be catastrophic, and it is better to be safe than sorry.

    I do agree that not allowing the formula to sit is likely far more important than boiled water.

  36. Lisa, I used to wash the pump parts in hot water and soap and lay them out to dry on a paper towel, and once a week boil everything in a large pot of water. Doc said hot dishwasher was adequate for bottles. Perhaps we were too cavalier but I checked with the friend who gave me her pump and that's what she did too.

  37. Hi guys

    It is a real pain that the guidelines differ so completely. I'm in the UK and this is what I do – it meets the guidelines here and is fairly quick and easy. BUT it does mean pouring boiling, or almost boiling water directly onto formula, and I don't know what that does. (No one seems to know but I have heard what Coura said) But anyway…

    I add however much formula I need directly onto the bottle (say four scoops).

    Then I pour on boiling or just past boiling water BUT ONLY around 1/4 of the FULL quantity of water required (say 1 ml).

    Shake vigorously for as long as it's fun.

    THEN add the remaining water from a measuring jug stored in the fridge, that already contains cooled boiled water, not longer than say 6 hours old). I.E, the final 3 mls. You will need to measure it from the jug, not in the bottle, because obv the formula bunks up the content.

    And that's it! Warm but not too warm formula instantly!

    NB it sound fiddly; it also sounds like I'm teaching you guys to suck eggs – but it works for us, and it IS pretty safe.

  38. My daughter didn't care for ready-to-feed formula. It seemed to have a different texture, kind of reminded me of evaporated milk.

    We used a Dr. Brown's formula pitcher. I would sterilize it and the bottles, mix up a pitcher of formula with bottled nursery water, then pour it into sterilized bottles and straight into the fridge. About 4 months or so, I started just keeping the pitcher in the fridge and using clean bottles that had been through the sani-rinse cycle in the dishwasher (before I'd been using the dishwasher and microwave sterilizer). This made it easy for frequent feedings, or to give her a little more if she was still hungry, and it also kept her from swallowing a lot of air from a just-shaken bottle. At 6 months, I started using regular tap water from the refrigerator filter to make formula.

    I know nursery water isn't “sterile” but it is steam distilled, so I felt comfortable not boiling it, and my pediatrician agreed.

    Interesting note…My first mother/baby room in the hospital didn't have a microwave, so I wasn't able to sterilize pump parts. I was told to just wash them with hand soap, that I only needed to sterilize them once a day. I'm really curious whether this is the norm for full-term babies, or all babies. It seems odd to be told not to sterilize pump parts for a 32-weeker in the NICU.

  39. “”One of the consistently proven “risks” of formula feeding even in affluent nations with good water supplies is a increased risk of gastroenteritis. I wonder if this could possibly be due to improper formula use rather than the formula itself? For example, how many parents were doing what I was doing, and figuring that leaving formula out for a few extra minutes couldn’t hurt? Or what if they didn’t know they were supposed to boil the water first to kill any bacteria – even if they lived in a place with “safe” tap water? Or that purified water wasn’t necessarily good enough? I’m not even talking about major, life-threatening types of stomach illness, like the necrotizing enterocolitis so prevalent in NICU populations. I’m talking minor bouts of diarrhea that give formula fed babies the reputation for being more prone to gastrointestinal bugs.”"

    If you make dinner and prepare a raw chicken/ or go to the toilet and don’t wash your hands thoroughly enough then handle your breast to get it in your babies mouth to breastfeed you can just as easily give a BF baby salmonella or ecoli.

  40. Pingback: Is donor milk dangerous? Not as dangerous as hypocrisy. - Fearless Formula Feeder

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