Food Safety: Baby bottles

It's common in my practice to have this conversation at least 2-3x a day. What's unfortunate is that pediatricians, hospital staff, and other professionals that deal with babies do not always cover this or check for understanding. 

Proper handling and cleaning of baby bottles, whether filled breastmilk or formula, is crucial when dealing with a baby, as foreign bacteria can easily grow and multiply, reeking havoc in the young one once ingested. 

The risks

A recent study, conducted right here in Knoxville, showed that more than half of the population studied using infant formula was not only missing crucial steps in formula prep, but had cultures of dangerous bacteria growing in the formula, the water used, and the mixed batches. This included "nursery water", a common product perceived to be able to use "as is", without the need to have to boil prior to mixing. The scary part is that the bacteria found predominately in powdered formula "came alive", if you will, upon the addition of water, multiplying rapidly by the second. 

Other risks include new products, such as the "formula Keurig" Baby Brezza, being used to prepare infant formula,

 

as they do not heat up to sterilizing temperatures and do not use up the older formula being mixed in prior to newer powder added in, allowing risk of expired formula being used. Proper cleaning after use of this machine was not displayed, either, by the subjects.

Safe handling of formula (from ready-to-feed to concentrate)

• Wash hands

•All utensils used, including bottles and nipples, should be hand washed followed by boiling or sterilizing in a dishwasher.

 

For mixing powdered and concentrated formula:

• All water used to mix with the formula, including bottled, city, well and nursery* water, should be boiled 2 to 3 minutes.

*Nursery water is merely bottled water, and is not sterile. In fact, in small print it still reminds the consumer to follow proper mixing instructions, including boiling. 

• While the water is still hot, but not boiling, formula should be added to the water, then stirred/mixed.

• It is important to add water first when measuring, as formula displaces water once added. Be sure to follow close measurement instructions so as not to concentrate or dilute the formula too much.

• Formula that has not been used yet can be kept in the refrigerator up to 48 hours. If a bottle has already been drunk out of, and is placed back in the refrigerator, discard after 24 hours.

• Both opened ready-to-feed formula and mixed formula should not be kept out at room temperature longer than one hour.

• Formula should not be microwaved to reheat, rather put in a warm bowl of water or run under a hot tap. Always remember to check before feeding baby. Microwaving can cause "hotspots", so testing may not show how hot the middle of the formula bottle could be, risking burning the infant.

Safe handling of breastmilk 

Handwashing to never be underestimated! Bottles, nipples, and pump parts that come in contact with milk should be scrubbed by hand then boiled or sanitized in dishwasher before and after use. Handling pumped and expressed breastmilk tends to be safer and easier, as bacterial growth is prolonged and limited due to the healthy flora and "bad bacteria"-fighting enzymes present in the human milk. However, following the rule of "5" is strictly advised:

• 5 hours or less at room temp 

• 5 days in kept in the refrigerator (not the door) 

• 5 months in freezer (not the door)

- or 12 months in deep freezer

Breast milk should not be microwaved to reheat, rather thawing frozen milk in cool/warm bowl of water or run refrigerated milk under a warm tap for a few seconds. Always remember to check before feeding baby. Microwaving can cause "hotspots", so testing may not show how hot the middle of the bottle could be, risking burning the infant.

For more information, feel free to send your questions to me and check out the following links:

http://pediatrics.aappublications.org/content/pediatrics/130/5/e1076.full.pdf

http://www.fda.gov/Food/ResourcesForYou/HealthEducators/ucm089629.htm

http://www.foodsafety.gov/keep/types/babyfood/

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

http://www.foodauthority.nsw.gov.au/consumers/life-events-and-food/infants#.Vke5JF88KnM