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Thoughts on infant formula prep study
- Thread starter chrissie0555
- Start date
notworthconsideration
New member
@chrissie0555 My pediatrician said to use boiling water to make formula for my son up until 4 months old (he was a premie). He actually recommended the pre-made stuff as it's more sterile and properly mixed.
Once the 4 month mark rolled around, he was big enough and had no underlying immune issues that the cronobacter infection became less of a concern.
Once the 4 month mark rolled around, he was big enough and had no underlying immune issues that the cronobacter infection became less of a concern.
chrissie0555
New member
@notworthconsideration You see, I've heard of boiling water first but not water + formula.
Like, I assumed that meant the WATER was the issue, not the formula. So I assumed it was boiling water, cooling, then adding formula to cooled water. I'm guessing that wasn't the case for you, though?
Like, I assumed that meant the WATER was the issue, not the formula. So I assumed it was boiling water, cooling, then adding formula to cooled water. I'm guessing that wasn't the case for you, though?
katrina2017
New member
@chrissie0555 No, the issue is that powdered formula isn't sterile.
chrissie0555
New member
@katrina2017 Yes, I know.
@chrissie0555 That is the standard advice in the UK, and it's the advice from the WHO as well so arguably applicable worldwide.
Honestly to me it has always seemed like a sensible precaution, and even though German formula tubs don't say "must prep with water over 70C" I still followed that advice when we topped up my second. Although it's rare for formula to be contaminated, it does happen (see the US shortage last year) and preparing with hot water is just another safeguard against that eventuality. Particularly for younger or vulnerable babies, it was easy enough to do and it made me feel better.
However, I guess it's less practical in places where electric kettles are less common? Hadn't really thought about that angle.
ETA: I'm confused what your question is though - are you questioning the need to have water over 70C or are you interested in what the study says? Because the study takes the 70C messaging as the baseline and then is talking about how this advice is actually received.
In the UK, the advice is to boil 1 litre of water in a kettle - which takes longer and is a waste of energy compared with boiling the actual amount that you need for the feed, since we're also advised to make up feeds as needed rather than store for later. Then they say to leave it to cool for no longer than 30 minutes, but this is often shortened to or misinterpreted as leaving the water for exactly (or sometimes at least) 30 minutes. The problem is that even if you've boiled 1 litre (which my guess is that most people don't do) the study found that in many models of kettle, the water was already cooler than 70C at the 30 minute mark, so in practice most people are making up infant formula with water which is too cold to serve the purpose of using hot water in the first place, ie, to sterilise the powder.
It's my understanding that the "boil 1l and leave for 30 mins" advice is supposed to give you a standard temperature, which the study found is not the case, so perhaps they will change the advice to "freshly boiled" or something similar.
Certainly on UK parenting forums there are regular discussions about whether the point of boiling the water is to sterilise the water vs the powder, whether it's more important to make feeds up ASAP before feeding vs more important to use hot water, whether it's "leave for exactly 30 mins" vs "leave for up to 30 mins" - so people are in general confused by the official advice.
Lastly I believe this study looked definitively at the Tommee Tippee formula prep machine - on parenting forums for several years there has been a half/half method suggested which is: Make up some portion of the bottle with hot water, but all the powder (so it's over-concentrated), then top up with cool boiled water to make the bottle instantly the correct temperature and concentration. Tommee Tippee is a bottle manufacturer that made a machine which does this automatically. The NHS have been advising against them because they say it's not reliable what temperature the bottles are made at. I think this study showed that it's definitely lower than the recommended 70C.
Honestly to me it has always seemed like a sensible precaution, and even though German formula tubs don't say "must prep with water over 70C" I still followed that advice when we topped up my second. Although it's rare for formula to be contaminated, it does happen (see the US shortage last year) and preparing with hot water is just another safeguard against that eventuality. Particularly for younger or vulnerable babies, it was easy enough to do and it made me feel better.
However, I guess it's less practical in places where electric kettles are less common? Hadn't really thought about that angle.
ETA: I'm confused what your question is though - are you questioning the need to have water over 70C or are you interested in what the study says? Because the study takes the 70C messaging as the baseline and then is talking about how this advice is actually received.
In the UK, the advice is to boil 1 litre of water in a kettle - which takes longer and is a waste of energy compared with boiling the actual amount that you need for the feed, since we're also advised to make up feeds as needed rather than store for later. Then they say to leave it to cool for no longer than 30 minutes, but this is often shortened to or misinterpreted as leaving the water for exactly (or sometimes at least) 30 minutes. The problem is that even if you've boiled 1 litre (which my guess is that most people don't do) the study found that in many models of kettle, the water was already cooler than 70C at the 30 minute mark, so in practice most people are making up infant formula with water which is too cold to serve the purpose of using hot water in the first place, ie, to sterilise the powder.
It's my understanding that the "boil 1l and leave for 30 mins" advice is supposed to give you a standard temperature, which the study found is not the case, so perhaps they will change the advice to "freshly boiled" or something similar.
Certainly on UK parenting forums there are regular discussions about whether the point of boiling the water is to sterilise the water vs the powder, whether it's more important to make feeds up ASAP before feeding vs more important to use hot water, whether it's "leave for exactly 30 mins" vs "leave for up to 30 mins" - so people are in general confused by the official advice.
Lastly I believe this study looked definitively at the Tommee Tippee formula prep machine - on parenting forums for several years there has been a half/half method suggested which is: Make up some portion of the bottle with hot water, but all the powder (so it's over-concentrated), then top up with cool boiled water to make the bottle instantly the correct temperature and concentration. Tommee Tippee is a bottle manufacturer that made a machine which does this automatically. The NHS have been advising against them because they say it's not reliable what temperature the bottles are made at. I think this study showed that it's definitely lower than the recommended 70C.
chrissie0555
New member
@cutin I just found both studies interesting. There was no question other than asking for opinions/thoughts.
I've heard of many people, especially on reddit, boasting of being able to give their kids room temp/cold formula, and I'm now wondering if they only used pre-made/pre-boiled formula or what. I know some specifically stated making bottles on the go was easy as pie when it doesn't have to be heated so just not taking the precaution or what?
In the US, other than specifically on the container, I've not heard of boiling formula first except for those premie or immunocompromised. Maybe I just wasn't informed? I also never had premie/immunocompromised infants, so I wasn't specifically told to do this by my ped with any of my 3.
I use the Baby Brezza with my twins and I don't know if internally it boils and cools, probably not, but it definitely doesn't go to 70C when it comes out. And honestly, with my twins, I could never wait 30 mins with how unpredictable their feedings were in the beginning. They were not consistent with when they decided 2 hours was ENTIRELY TOO LONG lol and flipped their shit.
Also, using boiling water + plastic makes me nervous. Is that why people are so into glass, because they're boiling it and I just hadn't thought of that until now? I dunno. I would be very nervous about using plastic if I was boiling it 5 times a day or whatever. I guess you could boil bulk and then heat it up again in a safe manner? Unsure, never done it.
I've heard of many people, especially on reddit, boasting of being able to give their kids room temp/cold formula, and I'm now wondering if they only used pre-made/pre-boiled formula or what. I know some specifically stated making bottles on the go was easy as pie when it doesn't have to be heated so just not taking the precaution or what?
In the US, other than specifically on the container, I've not heard of boiling formula first except for those premie or immunocompromised. Maybe I just wasn't informed? I also never had premie/immunocompromised infants, so I wasn't specifically told to do this by my ped with any of my 3.
I use the Baby Brezza with my twins and I don't know if internally it boils and cools, probably not, but it definitely doesn't go to 70C when it comes out. And honestly, with my twins, I could never wait 30 mins with how unpredictable their feedings were in the beginning. They were not consistent with when they decided 2 hours was ENTIRELY TOO LONG lol and flipped their shit.
Also, using boiling water + plastic makes me nervous. Is that why people are so into glass, because they're boiling it and I just hadn't thought of that until now? I dunno. I would be very nervous about using plastic if I was boiling it 5 times a day or whatever. I guess you could boil bulk and then heat it up again in a safe manner? Unsure, never done it.
@chrissie0555 Well there was a big thing a few years ago about BPA in baby bottles, and yes, some people switched to using glass. You can also buy stainless steel here if you don't want the breakable issue with glass. But then BPA was banned, and bottles/plastic in general started to come with a thermometer symbol and max temp warning (I think for baby bottles it's 110c) so most people kind of forgot about it/assumed that it's all fine now. Steam sterilisation is pretty common as well (am I right in thinking US doesn't have guidelines to sterilise baby feeding equipment?) so most people do heat bottles up multiple times a day.
The fact that most people don't have a kettle on hand at all times (though you can bring hot water in a thermos type flask) and the UK guidance also suggests feeding on demand and making the feeds up right before feeding is what leads to all the confusion on UK parenting forums. Because yes, at first glance you'd think it's impossible to follow all the instructions (hot water, wait 30 mins, make immediately, feed on demand, don't keep made up bottles, don't use cold water) - if you look at the official guidelines, there is a sort of hierarchy where they say instantly made up is best, next best is made up with hot water then kept chilled up to 24 hours, if you take it out of the fridge then you can keep it in a cool pack up to 4/6 hours (I think it used to be 6, but it seems to say 4 on the NHS website now). The feeding on demand recommendation comes from a totally different part of guidance, which is probably why they come across as conflicting at first reading.
In reality, most people make up at least a little in advance because like you said, a hungry baby isn't going to wait 30 minutes let alone the time for the bottle to cool down. However, a lot of people do feed on a schedule, which means that you can make the bottles in time for them to be ready.
A lot of people either misunderstand the guidance, assuming that the boiling is to sterilise the water, and that the making up immediately is the important part, or say that it's unrealistic, and bring a formula portion tub plus bottles of cool boiled water and just make it up with that cold/room temp water. This sparks huge arguments on parenting forums - in reality, it's probably not that high of a risk if you're feeding immediately. The real risk is when you have made up bottles, sitting in the danger zone for hours before being consumed. And even that was standard advice 20 years ago - 2001 apparently was the start of the guidance about making bottles up fresh and refrigerating them if you can't make up fresh. Previously to this, standard practice was to make the day's bottles up and leave them standing on the kitchen counter (!) which sounds crazy to me today.
ETA: I've also never seen anyone in the UK make up formula in bulk in those jugs like you can buy in the US. I have only ever known people make formula up directly in the bottle. They might make several bottles up at once and chill them, but I haven't seen the jug method.
The fact that most people don't have a kettle on hand at all times (though you can bring hot water in a thermos type flask) and the UK guidance also suggests feeding on demand and making the feeds up right before feeding is what leads to all the confusion on UK parenting forums. Because yes, at first glance you'd think it's impossible to follow all the instructions (hot water, wait 30 mins, make immediately, feed on demand, don't keep made up bottles, don't use cold water) - if you look at the official guidelines, there is a sort of hierarchy where they say instantly made up is best, next best is made up with hot water then kept chilled up to 24 hours, if you take it out of the fridge then you can keep it in a cool pack up to 4/6 hours (I think it used to be 6, but it seems to say 4 on the NHS website now). The feeding on demand recommendation comes from a totally different part of guidance, which is probably why they come across as conflicting at first reading.
In reality, most people make up at least a little in advance because like you said, a hungry baby isn't going to wait 30 minutes let alone the time for the bottle to cool down. However, a lot of people do feed on a schedule, which means that you can make the bottles in time for them to be ready.
A lot of people either misunderstand the guidance, assuming that the boiling is to sterilise the water, and that the making up immediately is the important part, or say that it's unrealistic, and bring a formula portion tub plus bottles of cool boiled water and just make it up with that cold/room temp water. This sparks huge arguments on parenting forums - in reality, it's probably not that high of a risk if you're feeding immediately. The real risk is when you have made up bottles, sitting in the danger zone for hours before being consumed. And even that was standard advice 20 years ago - 2001 apparently was the start of the guidance about making bottles up fresh and refrigerating them if you can't make up fresh. Previously to this, standard practice was to make the day's bottles up and leave them standing on the kitchen counter (!) which sounds crazy to me today.
ETA: I've also never seen anyone in the UK make up formula in bulk in those jugs like you can buy in the US. I have only ever known people make formula up directly in the bottle. They might make several bottles up at once and chill them, but I haven't seen the jug method.
kennethe62
New member
@kennethe62 Nah we definitely have formula mixing pitchers. They’re handy once your baby is predictable enough to have a set amount of formula in a day. You can then dose it into bottles to pack it for daycare or as needed throughout the day and keep it in the fridge.
https://www.target.com/p/munchkin-smart-blend-formula-mixing-pitcher-clear/-/A-51443497
https://www.target.com/p/munchkin-smart-blend-formula-mixing-pitcher-clear/-/A-51443497
kennethe62
New member
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