There is A LOT of talk in the news, social media, blogs, everywhere, right now about the current recall on Similac, Alimentum and EleCare powdered infant formulas. Powdered formula from these brands manufactured by Abbott Nutrition in Sturgis, Michigan are related to Cronobacter sakazakii and Salmonella infections in infants who had consumed this formula. You can click the link above to learn more about the recall or go directly to the company’s website to see if any products you have purchased fall under the recall. I am not going to delve into that issue, it is covered widely everywhere, I want to address the safe handling and preparation of powdered infant formulas.

Powdered infant formulas ARE NOT sterile, none of them. (Liquid, pre-mixed formulas ARE made to be sterile.) It is not feasible with current manufacturing processes to prepare powdered formula free from all bacteria. Cronobacter is a naturally occurring bacteria that is occasionally found in the environment where formula is manufactured. Salmonella is a bacteria rarely found in formula, but can also be found in the preparation environment, such as on counter surfaces, spoons, bottles, etc. Neither of these pathogens grow in powdered formula, but they can survive for long periods of time in dry environments, and then when reconstituted in warm or room temperature water, it creates the ideal environment for the bacteria to grow. When the prepared bottles are then left out at room temperature, there is potential for the bacteria to thrive. For these reasons, safe preparation and handling of powdered formula is CRUCUIAL.

Preparation

These steps below outline the safest way to prepare powdered formula in the home for the bottle fed infant. These steps were developed from years of research, risk assessments and consultations from the Food and Agriculture Organization of the United Nations (FAO), the World Health Organization (WHO) and the International Food Safety Authorities Network (INFOSAN)

The World Health Organization recommends that water be boiled and cooled for handling to no less than 70°C or 158°F. Many people seem to think that the boiling of water is to ensure the safety of the water, but it is actually to kill the bacteria in the powdered formula!

Infants most at risk:

Infants under 3 months of age
Low birth-weight infants
Infants born prematurely
Infants who are immunocompromised

These infants should consume formula that is manufactured and sold pre-mixed as a liquid, when possible. When powdered formula must be used, ALWAYS follow these steps for these particularly at-risk infants.

Storage

Sanitizing, boiling, mixing, and cooling can take a bit of time, which is a precious commodity already with a newborn infant. Although it is best to prepare each bottle this way immediately before use, it can be unfeasible. It is acceptable to prepare multiple bottles at once. Bottles prepared this way are good in the fridge for up to 24 hours, so you could prepare a batch for each day at one time and take them out individually to use when baby is ready to eat.

How do I re-warm refrigerated bottle feeds?

Remove a bottle of feed from the refrigerator just before it is needed.
Re-warm for no more than 15 minutes. Feeds can be re-warmed by placing in a container of warm water, making sure the level of the water is below the top of the cup. Occasionally shake or swirl the bottle to make sure that it heats evenly.
Check the temperature of the feed by dropping a little onto the inside of your wrist. It should feel lukewarm, not hot.
Throw away any re-warmed feed that has not been consumed within two hours.

WARNING: Never use a microwave oven to re-warm feeds. Microwave ovens heat unevenly and may cause “hot spots” that can scald the infant’s mouth.

What about feeding your infant outside of the home?

You can transport the pre-made bottles with you in a cooler with ice. You want the bottles to stay below 5°C or 41°F to inhibit the growth of bacteria.

Can I bring pre-prepared feeds with me when I am traveling?

Yes - but make sure the feed is cold before it is transported and is kept cold during transport. This will slow down or stop the growth of harmful bacteria.

Prepare feeds as normal, cool quickly and place in the refrigerator (no warmer than 41° F)
Immediately before you leave home, remove the cold feeds from the refrigerator and place in a cool bag with ice packs.
You can then place the feeds in a refrigerator at your destination, or re-warm a feed when you need one.

If your trip is longer than two hours, you may not be able to keep the pre-prepared feeds cold. In this case, you should prepare feeds as you need them. Bring individual portions of powdered formula with you in a cleaned and sterilized container, and prepare feeds as normal using boiled water that has been cooled to no less than 158°F.

Other Concerns

There is debate over the use of boiling water to prepare formula, including risk of injury to the person preparing the formula and the possibility of damaging necessary nutrients in the products. These concerns caused the USDA to rescind the recommendation for healthcare providers in the US to use boiling water. Studies have concluded that any loss of nutrients was insignificant and nutrient levels were still above recommended levels. Experts also concluded that “risk of scalding can be addressed through educational messages on the label and training of those preparing and feeding.” You can read about this here in Appendix 3.