Guidance on safe preparation, storage and handling of powdered infant formula

Powdered infant formula is not a sterile product and may be contaminated with pathogens that can cause serious illness. Correct preparation and handling reduces the risk of illness.

The Department of Health and the Food Standards Agency have issued revised guidance on the preparation and storage of powdered infant formula milk. This guidance covers the home and other care settings, including nurseries and child minders. The guidance for home settings is included on the site, below.

According to recent studies, key recommendations for preparing and storing infant formula
issued by UK Health Departments and the Food Standards Agency (FSA) are commonly not adhered to. Only 13% of the parents and carers looking after a sample of UK infants followed all three recommendations of making one feed at a time, making feeds within 30 minutes of the water boiling, and pouring the required amount of water into the bottle before adding the powder.

We are told that a formula fed baby has five times the risk of being admitted to hospital with gastroenteritus - perhaps the statistic above describing how few babies are given formula which has been prepared according to the guidelines, goes some way to explaining that.

The risks

The European Food Safety Authority’s Scientific Panel on Biological Hazards has issued an opinion in relation to the microbiological risks in powdered infant and follow-on formulae. The panel concluded that Enterobacter sakazakii and Salmonella are the micro-organisms of greatest concern.

Although infections with these micro-organisms from formula milk are rare, the risks can be reduced by following the guidelines below. Younger infants are more susceptible to these organisms than older infants.

For high risk infants (pre-term, low birth weight and immunocompromised) using ready to feed liquid formula, which is sterile, in place of making up powdered formula is considered the safest option.

The Department of Health and the Food Standards Agency advise all health professionals, particularly nurses, midwives and health visitors, to change/revise/ update their advice to parents and carers on the preparation and storage of infant formula milk in the home and in other care settings.

Health professionals should re-emphasise to parents and carers:
• that powdered infant formula is not sterile and good hygiene practices are essential in preparing and storing feeds made from powdered formula
• failure to follow the manufacturer’s guidelines may increase the chances of a
baby becoming ill

In order to reduce the risk of infection it is recommended that the following steps are
taken:

• Cleaning and sterilising feeding equipment: It is very important that all equipment used for feeding and preparing feeds has been thoroughly cleaned and sterilised before use.
• Wash hands thoroughly before cleaning and sterilising feeding equipment
• Wash feeding and preparation equipment thoroughly in hot soapy water
• Bottle and teat brushes should be used to scrub inside and outside of bottles and teats to ensure that all remaining feed is removed
• After washing feeding equipment rinse it thoroughly under the tap
• If using a commercial steriliser, follow manufacturer’s instructions
• If your bottles are suitable for sterilising by boiling: fill a large pan with water and completely submerge all feeding equipment, ensuring there are no air bubbles trapped; cover the pan and boil for at least 10 minutes, making sure the pan does not boil dry. Keep the pan covered until equipment is needed.
• Wash hands thoroughly and clean the surface around the steriliser before removing equipment.
• It is best to remove the bottles just before they are used.
• If the bottles are not being used immediately, they should be fully assembled with the teat and lid in place to prevent the inside of the sterilised bottle and the inside and outside of the teat from being contaminated.

Guidance for Preparing Feeds in the Home

Preparing a feed using powdered infant formula

Important

Normally each bottle should be made up fresh for each feed. Storing made-up formula milk may increase the chance of a baby becoming ill and should be avoided.

1. Clean the surface thoroughly on which to prepare the feed
2. Wash hands with soap and water and then dry.
3. Boil fresh tap water in a kettle. Alternatively bottled water that is suitable for infants can be used for making up feeds and should be boiled in the same way as tap water.
4. Important: Allow the boiled water to cool to no less than 70º C. This means in practice using water that has been left, covered, for less than 30 minutes after boiling.
5. Pour the amount of boiled water required into the sterilised bottle.
6. Add the exact amount of formula as instructed on the label. Adding more or less powder than instructed could make the baby ill.
7. Re-assemble the bottle following manufacturer’s instructions.
8. Shake the bottle well to mix the contents.
9. Cool quickly to feeding temperature by holding under a running tap, or placing in a container of cold water.
10. Check the temperature by shaking a few drops onto the inside of your wrist – it should feel lukewarm, not hot.
11. Discard any feed that has not been used within two hours

Further Information
Further information on the Safety Guidelines issued by the European Food Safety Authority’s (EFSA) Scientific Panel on Biological Hazards can be found HERE