The FFF Quick-and-Dirty Guide to Formula Feeding: Mixing bottles

Hola, FFFs. And holla, because here is the quick-and-dirty guide to formula feeding I’ve been promising for ages! Actually, this is just Part One, but I will be posting new parts every so often until the entire guide is finished – at which point I will make it available via a tab on the right-hand side of the blog. Sound good?

I hope that this guide will offer some simple, accurate info for prospective (and current) formula feeders, without the subtle guilt-mongering prevalent in most formula feeding info. I figure the least we deserve is some evidence-based advice that doesn’t come via the formula companies.

Since many readers of this blog are experienced, educated formula feeders, I’m sure they will be able to elaborate on what I write in this guide. Be sure to read the comment threads, as I hope that there will be even more helpful hints and tips offered by the FFF community.

And as always, if you have any specific questions, please feel free to email me at formulafeeders@gmail.com and I will try and find the answer for you.

Happy formula feeding, lovely ones!

– The FFF

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The FFF Quick-and-Dirty Guide to Formula Feeding:
Mixing Bottles

Mixing up a bottle of powdered formula isn’t rocket science, but it can be trickier than one might assume. First, always read the back of the can, because brands vary – some say to use an unpacked level scoop, others require a “packed” scoop. It’s important to have the proper ratio of formula and water because the wrong ratios can lead to stomach upset, which might make you think your baby is “intolerant” of the formula you’re using, when really it’s just that you’ve been using too much powder.

Finished reading the directions on your can? Cool. On to the next steps – and please note that I’ve broken this down into two categories, for newborns and babies older than three months. More precautions are necessary when your baby is a fragile newborn, since even the most insignificant illness can have a big impact on a human that tiny.You’ll notice that the instructions for older babies are much shorter. Like everything else about parenting, as the kid gets older, things get easier. If you can afford it, for the first month, use Ready-to-Feed formula rather than powdered. It’s safer (no chance of contamination from water, and less chance of contamination from your hands as all you have to do is pour it into a bottle or, in the case of those little nurser bottles some companies make, attach a pre-sterilized nipple. Easy-peasy, but pricey, so this is really just a short-term solution – but well worth it in the early days when the last thing you want to be worrying about is mixing formula the wrong way at 3am.)

Mixing Formula for Newborns

  • Measure the water. In terms of water, if you are mixing formula for a baby under three months old, the water source is pretty important. This is because if the water is contaminated with any bacteria, your baby can get sick. You know all those “facts” you hear about how formula fed babies get more gastrointestinal diseases? Most likely, it’s the water and not the formula which is causing these problems. (By the way, I’m sure you don’t need me to tell you this, but always wash your hands before you open the can and before you make up any formula. Duh, right?) Your best bet is distilled, bottled water (not all bottled waters are purified enough to reduce the chance of bacteria, and the distilling process helps gets rid of the little buggers), or simply boil a batch of water on your stove, let it cool, and keep it in the fridge. As long as you live in a community with a good water source, you’ll be able to use tap water (or tap water that’s been run through a home filtering system like a Brita pitcher) when your baby is a bit older.Pour the same amount of water into the bottle that you want to make of formula. So for example, if you are making a 4-oz bottle, pour 4 oz of water into the bottle.

(A little note about the “nursery water” that they sell at many grocery stores – this is usually fortified with fluoride, which may or may not be a good thing. Check out this post for more info.)

  • Measure the formula. Again, check if you’re supposed to use an unpacked or packed level scoop. Always use the scoop that the formula company provides, because they vary. The ratio for all formulas is one scoop to 2 oz of water (the exception to this is prescription Neocate, which uses a ratio of one formula scoop to one oz – thanks to FFF Perfesser for alerting me to this), so if you are making a 4-oz bottled, you’ll use 2 scoops; a 6-oz bottle, 3 scoops, and so on. Now, if you want to make an odd number of oz, things get trickier. You can eyeball a half-scoop, but this is obviously not an exact science, and I wouldn’t recommend it for a newborn. Instead, I’d suggest making more formula than you need, and pouring the remainder into another bottle which you can refrigerate and use at the next feeding. So for example, to make a 3-oz bottle, just make 6 oz of formula (6 oz of water/3 scoops of formula), shake up the bottle, and then pour 3 oz into another clean bottle to save for later. Cap that extra bottle and stick it in the fridge, and serve the other 3 oz immediately to your baby. When the time comes for the next feeding, warm the refrigerated bottle to room temp, and serve.
  • Insert any rings/discs that your bottle needs (for example, Avent bottles have little circular rings that need to be inserted before putting on the nipple; Dr. Brown’s use a whole elaborate contraption, and Born Free use a two-part disc. Other bottles don’t need anything but the nipple. I’ll leave figuring out the particular mechanics of your bottle of choice to the manufacturer’s website, because those things confuse the hell out of me. Took me like 3 weeks to figure out how to get the Dr. Brown’s system to work…) and then attach the nipple.
  • Mix or shake. Once everything is attached correctly, cap the bottle (or just place your finger over the hole in the nipple) and shake it vigorously. Then place the bottle on a flat surface and let it settle before serving. Check the nipple to make sure there are no clumps of formula stuck up in there, because it happens. A lot. Your other option is to use a formula mixer. Some folks swear by the little hand-held ones; they are supposed to mix the formula more smoothly and prevent air bubbles from forming. Personally, they didn’t work for me; the formula seemed more clumpy than when I shook the bottles by hand. I preferred using a formula pitcher, or even a salad dressing mixer (a heck of a lot cheaper than the commercial formula pitchers, and they do the trick). With these, you mix batches of formula and then pour the desired amount into bottles. Now, some warn against using these, as it is recommended that you make each bottle separately right before feeding. This is done, once again, to protect against bacterial contamination. Bacteria breeds the longer it is left out, so the theory is that if you have formula lying around – even in the fridge – it gives the bacteria a chance to grow and multiply. But if you are using pre-boiled or distilled water refrigerate the formula immediately and use it within a few hours, your chance of this happening is pretty tiny. You can also be extra-cautious and mix only the amount of formula that you need in the pitcher. One more caveat to using a separate pitcher/mixer – make sure you clean it after every use. And I’ll say it again – duh, right?
  • Make sure you feed your baby the bottle within 2 hours of mixing it up, unless you refrigerate it for later use. I used to be skeptical of this rule, but I’ve recently changed my mind. Just to clarify (thank to FFF Becky05 for this one), if you refrigerate the bottle, it stays good for 24 hours. But at room temp, you need to use it within 120 minutes, and once your babe has put it’s mouth to the nipple, it’s only good for 2 hours regardless of whether you stick it back in the fridge (although I still stick to my original belief that for an older baby, nursing a bottle for a little longer than 2 hours probably won’t hurt him/her, with a newborn, it’s better safe than sorry.)

 

Mixing formula for an older baby (3+ months)

  • Pour the water. At this point, you can use whatever water you personally drink. Bottled or tap (as long as it is from a safe water source – check with your city’s health department if you’re not sure) or filtered.
  • Scoop the formula. If you’ve recently switched formulas, double check that you are using the right amount – packed or unpacked – and make sure to use the scooper provided by the manufacturer. A hint for those of you as absent-minded as me – don’t try and have a conversation while mixing formula. You may find you suddenly have no idea if you’ve put in two scoops or three, at which point the whole batch might be ruined. It sucks. Pay attention and count aloud when you’re doing it. Seriously… or you’ll be crying over (unusable) milk.
  • Shake or mix. As long as there isn’t formula clumped in the nipple, you’re good to go. If you are worried about air bubbles, or your baby has an issue with excess gas, you can add a few of those infant gas drops (like Mylicon) to each bottle. But there’s really no need unless your baby is particularly gassy or spits up a lot. You can also just mix up the formula 15 minutes or so before a feed and let it settle – this will allow the air bubbles to subside.
  • Feel free to mix the day’s amount of formula in a formula pitcher (or even just a 32-oz Tupperware container), refrigerate, and use within 24 hours. If you’re using thickened feeds for a reflux baby, this is a total lifesaver – you can mix your batch to your baby’s specifications and not have to measure everything out for each bottle.

A few other hints:

  • For night time feedings: pre-measure water into bottles. Buy a formula dispenser, and measure out your formula into the dispenser. Bring all the stuff into your bedroom or master bath, and when you need to feed your baby in the middle of the night, all you need to do is pour the formula from the dispenser into the bottle. No fumbling around or measuring half-asleep.
  • The formula dispenser is also a great tool for outings. They have 3 little compartments, so you can measure out the amount of scoops you need for each bottle; bring bottles filled with water, and this way you don’t need to bring a cooler or anything when you’re out and about.
  • These instructions make it look like formula feeding is a massive undertaking. I promise you, it’s not. But I also strongly believe that most of the “dangers” of formula that are so widely discussed are due to improper formula handling. The older babies get, the lower the risk for major problems with bacteria and dehydration, and you can get more lax about things. But most of this stuff becomes pretty rote, anyway. Using ready-to-feed formula takes a lot of the stress out in the beginning, and as things get more chill in general, the less scary everything becomes. Just like breastfeeding has a learning curve, there’s a learning curve with formula feeding. You’ll get good at it and figure out what works best for you. As long as you have safe water, clean bottles, and accurately measured formula, you’ll be fine.

 

   Suzanne Barston (me) on KidsInTheHouse.com:

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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58 thoughts on “The FFF Quick-and-Dirty Guide to Formula Feeding: Mixing bottles

  1. Thank you for this! If I could add just a few suggestions: one, Neocate is the exception to the 1 scoop =2 oz rule (it's one scoop = one oz which makes it scary pricey but at least easier to remember); two; the powder tends to clump less in the nipple if you swing the bottle like a pendulum to mix it (instead of pumping up and down) OR use the screw-on plain cap for mixing and then attach the nipple part (these parts are available via Amazon for the Dr. Brown's bottles we used and it was worth it to avoid wasted bottles due to clumping with pricey Neocate); three; the ice-pack bags made by various companies (Munchkin I think makes one that fits Dr. Brown's bottles) are great for taking pre-mixed bottles out and about so you don't have to stop to wash your hands and mix when you are on the road.

  2. Great suggestions! And thanks for the correction on the Neocate thing – I will go change that right now.

    I second the idea for ice packs on the go. We used this system for Fearlette since her bottles required such extensive prep (she needed specific amounts of cereal mixed in b/c of extreme reflux) and we ended up making the whole day's worth in the pitcher. It worked great. With FC, I just used the formula dispenser and pre-filled bottles of water. I also brought antibacterial stuff around with me so I didn't have to worry about hand-washing…

  3. This is awesome! Exactly what I was looking for when I started feeding my older daughter formula when she was 8 days old. I was CLUELESS about all of this stuff and only had a stack of breastfeeding information to reference! Hopefully this will help other moms in the same situation – help without judgement! :)

  4. Thank you so much for pointing out the “Duh!” things! I've seen formula feeding moms, even of very young babies, do things that baby books wouldn't even think to warn against. For instance, I've seen a mom of a baby around 3 months old bring one bottle and a small tin of powder to a family gathering and use the same bottle all day, without ever actually washing the bottle. She'd just rinse it out with cool tap water, if it was rinsed at all, then refill it with water to mix more formula. Not thoroughly washing the bottle has the same safety issues — risk of bacterial growth — that leaving the bottle out at room temp does. If someone is very laid-back about food safety, it probably won't occur to them that there could be safety issues with formula mixing and storage.

    One comment. You write, “Make sure you feed your baby the bottle within 2 hours of mixing it up. ” I know what you mean, but it isn't clear from context that this applies only if it is left out at room temp. You say in a previous point that formula can be refrigerated for later, but I thought you might want to clarify this particular bullet.

  5. You could mention that you shouldn't use hot water from the tap because of the bacteria that can be found in a water heater. I know you mentioned tap water should be boiled anyway, but it might be nice to mention this. I only recently learned that one technically shouldn't EVER drink hot tap water because of the possibility of bacteria lurking in the bottom of the water heater!

  6. One tip I figured out a bit later on pertains to snacky babies and those who want a little bit more after they've finished the bottle. My formula was a 1 scoop to 2oz type and often mine would only want an extra ounce. People told me to just put a half scoop in, duh, but measuring can be fiddly even with a whole scoop, so I'd make up the whole 2 oz, pour 1 of them back in the bottle/container (we didn't use bottles for feeding but I made up formula in the bottles) we had been feeding out of (observing the 2 hour rule for the container) and keep the other bottle in the fridge-subject to the 24 hour refrigerated once made up rule- until another 1 oz top up was necessary.

  7. My comments: bottle feeding parents need to worry about BPA and other chemicals:
    1) It's in ready to feed formula in higher concentrations than powdered formula, and I'd be really wary of exposing a newborn to that much BPA. I would never use ready to feed formula that comes in metal cans.
    2) Plastic bottle liners can also leach toxic chemicals.
    3) If you put plastic bottles, especially those with BPA, in the dishwasher or microwave, the chemicals will leach into the formula.

    We used glass bottles, never used ready to feed formula, and later, used BPA-free sippy cups. The Environmental Working Group is a good source of information.

  8. Time to doubling, or log phase, of something with a quick generation time, like e. coli, is 15-20 minutes (this is one of the faster ones). So that's when 1 cell becomes 2 etc. So after that 15-20 minute lag from introduction of the cells to appropriate growth conditions (nutrients, fluid and temperature) the growth is now exponential. The generation times are different (often longer) inside the body, and this is all assuming that infant formula at room temperature (pathogens tend to like body temperature) is an optimal growth medium for whatever bacteria might have come in contact with it. True times are likely to be much longer. Of course on top of that you're rarely going to be concerned about 1 cell. Usual inoculation levels might be in excess of 10,000 cells. So for the e. coli example in 2 hours you might go from 10,000 to 1,000,000 cells in 2 hours.
    Thing is you never know the cell load contamination, the bacterial type (they have different generation times) etc if any, so 2 hours is a reasonable enough guideline assuming oral bacterial contamination. I tried to shoot for an hour myself.

  9. Going to make another comment while wearing my microbiologist hat. While this is true, the bacteria most likely to be in your water heater are more grody than pathogenic. That reddish or brownish slime you might see around your shower taps? That's what that is. And your hot water heater is probably full of it. Gross, but not really going to hurt you. Also sometimes bacteria can make your water heater smelly. The exception to this is if you have your water heater too low (below 50-55C/125-131F) then Legionella can survive in there (though technically those are considered an inhalation hazard). One thing to worry about from the hot water tap is lead. So says the EPA anyhow. http://water.epa.gov/drink/info/lead/leadfactsheet.cfm I personally don't drink hot water from the tap because of the grody factor.

  10. If your baby will take cold formula (I swear ours prefers it that way!), you can premix the nighttime bottles and store in a small cooler. This was a complete sanity saver for us and we still do it. (that's right, my son is 9 mos old and still wakes for a feeding in the night! I'm horrible! 😉 )

  11. I read something recently about a study that showed the BPA risk had been overblown. I was pretty finicky about using BPA free bottles and cups but didn't go down the glass bottle path because we are a clumsy couple (coughDHcough) and I was worried about glass fragments. Anyone know the scientific dirt (as it were) on this?

  12. I don't want to push a specific brand, but Similac has published that it does not use bottles with BPA for its ready-to-feed formula. http://abbottnutrition.com/news/pressReleaseDetail.aspx?ContentTitle=abbott-leads-by-achieving-bpa-free-status-for-its-infant-formulas&year=2011

    I'm not sure about other brands, but I think it's important to do research before making a blanket statement like “BPA… is in ready to feed formula in higher concentrations than powdered formula”.

  13. I kinda wonder how most of us survived drinking from BPA bottles when we were younger. I'm a baby of the 80s and my mom used plastic bottles. I'm gonna bet those had all the BPA we're so worried about now :p

    Anyway thanks for posting this!

  14. Whats this 'oz' stuff!? Weirdo Americans 😉

    I know its 'duh' stuff but I'm, surprised at how many smart smart people do silly things with formula. Adding powder first for example and not using boiled water for newborns, leaving the bottle sitting aorund for hours and reusing it without washing properly etc etc.

    I think we will end up having so many safety issues with formula feeding here in NZ because NO ONE is willing to give you advice (or do they actually know correct procedures anymore!?) on formula or bottle feeding here becuase of this 'baby friendly' crap. My nurses at hospital all had varying opinions if any at all on the 'correct method' my midwives wouldn't speak of formula and when you go to the formula websites it just says 'breast is best'. Oh, thanks!

    Which brings me to another rant, WHY do formula companies not give formula feeders support and guidance?
    But I will save that for another day 😉

  15. I've actually found the Plunketline to be not bad in regards to formula advice. I've called them a few times with formula related questions and they've been helpful with no unwanted commentary. I imagine it's somewhat pot luck though. My actual plunket nurse is a beast and I still have near vomit inducing panic attacks over weight checks, but I got worthwhile formula advice from a lactation consultant plunket nurse at a family centre as well.

  16. Yeah you are right, Plunketline have been awesome. I did call them once about a formula related question when my second baby was quite refluxy and we were unsure what to do. We never really got an answer but we had a long chat to the person on the phone and I definitely felt better afterwards!

    Plunket nurses though? Ergh. Nothing but nasty interactions with all of them. My first with my first child I remember being so excited to have continued support (my first midwife was pretty great) after my midwives had finished there 6 week visits but the first thing that came out of her mouth when she stepped in my door was 'oh there is a bottle on the table, you are expressing?' 'uhh no, its formula' *queue disgusted disappointed look* 'do you want to tell me why!?'. I cried for about 3 hours – you know how it is, first baby, outrageous hormones etc plus the actual reason that I wasn't breastfeeding which was personal as all hell and i had to regurgitate it all over again.

    I stopped going to plunket appointments with my second, I have been so much more confident and ..well, lax about it all that when they call I usually just say 'shes doing great – we wont be coming'. The doctor sees her before her immunizations anyway.

  17. I probably come across as finicky, as it should be obvious to most that FFF is USA-based, but is it worth putting something that states this in there somewhere? Reason I say this is that it seems things are really different in the UK! For example I've used all the major brands here (apart from SMA Staydown or any prescription-only formula) and they have all been 1 scoop to 1oz (or 30mls) of water.

    I appreciate things are different everywhere around the world, so you can hardly write a post which will take into account EVERYTHING. But that's why I think it could be worth to specify that this is based on what's available in the USA?

    I'm not usually a finicky cowbag, honest /blush.

  18. The 2oz nursette bottles you get in the hospital (and can buy in some stores) are BPA-free. The metal cans are what you have to worry about. Enfamil and Good start still sell their RTF formula in metal cans w/ BPA lining whereas Similac uses BPA-free plastic bottles. Baby bottles are all BPA-free now, although I still used glass because I just feel better about glass in general. I find it strange that there was such an outcry about BPA that manufacturers stopped making bottles with it yet the formula companies still put it in their cans. Annoying.

    I have to admit, I haven't really dug into the BPA research but every day seem to read something bad about it. I have an endocrine disorder so I'm quite paranoid about it. I use glass bottles and I never heat food in plastic containers. The sippy cup thing is annoying because while I can find BPA free ones, they are all plastic and I hate plastic.

  19. Well I have an endocrine disorder that made it very hard to get pregnant so I'm sure it did have an effect on many of us, some more than others.

  20. Using boiling water is not common in the US and I don't think there's a medical consensus on this. I was never told to do so and I never did. The basic mixing instructions and how long you can keep the formula out is on the can but it says “ask your doctor if you need to use boiling water.” I was under the impression that I didn't need to if I had city water. My daughter did have one minor GI upset when she was 2 months.

  21. I wouldn't know if on average people do it here or not, I didn't know any other formula feeders at the newborn stage, but the formula can specifically says to use boiled water so I figured you had to?
    I also felt, what was the point of sterilizing everything after I washed stuff if I was just going to use the same tap water I washed with to fill the bottle.

    Works the other way too, when my babies were old enough to eat dust bunnies, leaves and lick the fridge I stopped bothering to sterilize or use boiled water.

    Never had any stomach issues here except for a virus that went through all the males in the house. That was fun.

  22. I concur. Thanks for doing this series, Fearless Formula Feeder. It's not easy to get straight answers on how to FF, particularly without at least some BFing comments. You even answered the water question! I'll look forward to more “quick and dirty” posts :-)

  23. We never boiled water and our pediatrician said it wasn't necessary. And she also said it wasn't necessary to sterilize the bottles – just wash with hot soapy water and air dry (we didn't have a dishwasher or microwave so couldn't wash/sterilize that way). My kid just had his first tummy upset – at three and a half.

  24. Good Start and PBM (store brands and Earths Best) both just introduced BPA free containwrs for ready to feed. Enfamil is the one holdout.

  25. That is great info, thanks. Do you know if PBM still uses BPA in their powder formula cans? I always planned to switch to generic but the BPA thing gave me pause. Oh well we're only going to be on formula 2 more months anyway.

  26. Thanks for posting this with instructions for Newborns. Last time I nursed until 3 months so I've never done it for that age group and my family are all breastfeeders that didn't even know that there was more then one kind of formula before me.
    Thank-you thank-you thank-you for all of the little answers without having to ask WIC or ever trying to ask on cafemom again. FYI I don't recommend either one of those sources.

  27. Glad to be of help! Feel free to email me with any questions, too. I can only imagine how craptastic the resources you mentioned must be…

  28. Sometimes I have a hard time buying it too. Mostly because it seems like everything is supposed to cause endocrine problems(that and cancer) now. But I guess some people might be sensitive to anything.

  29. Re: BPA – a lot of the “debunking” efforts I've seen around BPA have come directly from the chemical industry – in fact, I've seen that in person, when I was testifying before a state legislature regarding environmental regulations. BPA is accepted as a chemical of significant concern in many countries, and the lack of concern here has been driven by chemical industry trade groups. In fact, regulation of harmful toxins and chemicals is woefully lacking in the US, compared to Europe. But endocrine distruptor chemicals, including BPA, are clearly linked to numerous heath issues – including primary lactation failure (relevant to this discussion); behavioral and developmental issues in children born to mothers with high BPA levels during pregnancy; early puberty; cancer, etc. And in conjunction with the growing body burdens of chemicals that we are all carrying…well. I will say that it keeps me up at night.

  30. I don't know about the powder formula cans. It is unlikely that much if any BPA will leach into a powder from whichever container, so I haven't been concerned about that.

  31. Another comment, that I *have* read elsewhere but should be repeated — don't trust disposable bottle liners, even the pre-formed Drop-ins, to be accurate in measuring. We're using these, at least while we transition to formula since the Drop-ins latex nipples are the only ones my son will take, and I've done testing myself and agree that it is not accurate enough to use for mixing.

  32. Thanks for posting that link, Katie. Our little guy needs Alimentum, it's the only thing he tolerates and in Canada (or at least our area), it only comes in ready-to-feed cans.

  33. Hi, thanks Lynne for adding the comment about the major differences in the UK. The boiling water/sterilising bottles protocol is such a cultural difference it would have taken me ages to explain but you did so succinctly!

    If this post/comments are intended as a resource for those lost in the ff wilderness (yay, thanks FFF!) then I'd like to post a link to this:

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

    This is the current (2011) UK government guidance for health professionals on making up formula. It includes guidance of safe storage of formula if it *must* be made up in advance (in my case, because my sanity insists it is safer for my child if there is a bottle ready in the fridge when he needs it, so I make them up a couple at a time). I have used this guidance (together with info from here, and other enlightened parenting sites) to make my own choices about the risks I'm willing to take in storing formula.

    This is what all those baby-friendly midwives, health visitors and nurses are offered to help advise those of us who make the choice to ff for whatever reason. Of course, they have far too much to do to digest all of this and I believe are measured on bf successes so not really incentivised to do so.

  34. This is fascinating, and i really appreciate that all of you are willing to share your experiences with the whole world! I nursed both my kids for quite a long time, but had to avoid the top 9 allergens while I did it, and more than that in the figuring-it-out phase.

    My mom called me in a panic when my sister in her early days as a new mom, was feeding her premie powdered formula mixed with hot tap water. i don't know if no one told her or if she was just too exhausted, so I printed out for her the WHO guidelines which say no powdered formula for the first month adjusted, whether premies or full-term, because of the enterobacter sakazakii that survive the powdering process. And then I sent my mom to the store for ready-to-feed!

    I wish there were better instructions on the cans and that the formula companies were more open about some of the risks and how to avoid them. I know it's a business to them, but still.

  35. As a breastfeeding counselor and having only breastfeed my three little ones, I am a moron about these things. This is so helpful. I have it bookmarked, and now when a parent I'm working with wants to switch to formula for whatever reason I will ask if she or he would like info about how to safely formula feed before I am done working with them.

  36. Those recommendations in this link are basically the WHO guidelines. The thing is I have looked alittle into using boiled water at no less than 70 degrees Celsius part as recommended by WHO and this guideline and there seems to be some concern with it. Some of the concerns are small but important such as parents pouring boiling water into bottles and risking burns but some are big concerns. The biggest concern is that placing the formula into water at this temp could kill some nutrients and vitamins. Several organizations including the FDA (2002), ESPGHAN (2004) and AFSSA (2005) have warned that reconstituting formula at over 70°C risks losing certain nutrients. Nutrients most destructible by heat are the vitamins; thiamin, folate, pantothenic acid and vitamin C. Reconstitution at over 70°C may also affect essential micronutrients such as amino acids, polyunsaturated fatty acids and other active ingredients. It may also lead to reactions causing blockage of lysine, precipitation of mineral salts or proteins, fat separation or the formation of unwanted components. Now obviously this recommendation is too kill off any nasties that may be in the powdered formula which could cause E. sakazakii infection but this has a very low incidence rate of 0.001% in infants (which is probably alot more to do with unsafe storage practices then formula itself)
    So I guess the question that needs to be asked is: Is there more risk of an infant getting E. sakazakii from using cooled boiled water instead of boiled water no less then 70 degrees or is their more risk of an infant not receiving the correct amounts of nutrients and vitamins (which could led to all sorts of problems) when the water you use is burning off all those ingredients?
    All I know is the more I look into all these things the more confused I get!

  37. I know it's a bit late to be commenting on this but as a scientist can I point out that I've seen many mothers measure water inaccurately. Few people take the meniscus into account. This is the curve that water takes on, sometimes going up on the sides of the container, sometimes going down. Also people tend to eyeball the level of water by holding it in their hands, which tends to tilt the container and make the measurement inaccurate (depending on which way you tilt.) It may not seem like much, but over time the consistent cheating of 1/4oz of water can cause constipation.

    For measuring the most accurately, swish a little bit of water in the bottle first to moisten the sides (so that the water won't climb as high up the sides.) Then put the bottle on a flat level surface (your cupboard or table for instance) and pour water into it and read it looking directly at the line (not from above looking down at an angle.) As you get close to the level, use something smaller to pour in smaller amounts (I find the bottle's nipple/cap works VERY well for this, and you know it's clean.)

    Maybe it's just a pet peeve left over from having to do liquid measurement tests in University every year to prove we weren't going to be fooled by holding the container in our hand or the meniscus. That I even remember the word meniscus should point out how important it was to the professors. But I've seen moms lose as much as half an oz through just not knowing how to accurately measure water.

  38. THANK YOU, THANK YOU, THANK YOU for this. Especially the newborn section. I don’t plan to BF at all, but its so hard to find info on how to prepare bottles for newborns on the net. Cheers

  39. Pingback: Getting started with formula | Mommy Jessie

    • I’ve seen that as well. There are concerns that using boiling water will negatively impact the nutrition of the formula, though, so this is a case of “Find a competent professional and ask their advice”.

  40. The WHO recommends that water used for making formula be at least 158 degrees Fahrenheit. This is because powdered formula is not sterile and can contain Cronobacter (formerly known as Enterobacter sakazakii), a bacterium that can cause illness and death. Your instructions should include this recommendation from the WHO.

  41. I grew up in France in the 80s and was bottlefed using Evian water (not boiled water) and decided, even though being frowned upon by health visitors and GPs in the UK, to use Evian water exclusively for my daughter’s bottles. It saved me lots of time when baby was crying of hunger – instead of boiling the water and then letting it cool down for 20 minutes before using, just pour the water and warm it for 1-2 minute in a hot bain-marie. All my friends who also bottlefed didn’t trust my technique preferring to continue using boiled tap water. Found this extremely surprising.

  42. Pingback: Infant Feeding Today Pt. 4: Help With Mixed Feedings | Mama's Milk, No Chaser

  43. Pingback: Troubleshooting the scary first night home – I Support You

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