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Safe Infant Formula Preparation and Handling

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.




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.




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.



References

https://www.who.int/foodsafety/publications/micro/pif_guidelines.pdf

who.int/foodsafety/publications/micro/PIF_Bottle_en.pdf

https://www.cdc.gov/cronobacter/infection-and-infants.html

https://www.cdc.gov/nutrition/InfantandToddlerNutrition/formula-feeding/index.html

https://www.cdc.gov/nutrition/downloads/prepare-store-powered-infant-formula-508.pdf

https://www.who.int/foodsafety/publications/micro/PIF_Care_en.pdf

https://www.fda.gov/consumers/infant-formula-recall-what-know

https://www.cdc.gov/cronobacter/outbreaks/infant-formula.html

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