Safe Preparation, Storage and Handling of Powdered Infant Formula

Powdered infant formulas are not sterile it is therefore essential that good hygiene practices are carried out when preparing and storing feeds.

Failure to follow 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, if you are not using sterile, disposable feeding equipment.

CLEANING AND STERILISING FEEDING EQUIPMENT

1. Wash hands thoroughly before cleaning and sterilising equipment.
2. Wash feeding and preparation equipment thoroughly in hot soapy water and rinse thoroughly.
3. Sterilise equipment following manufactures instruction on sterilising unit.
4. Wash hands thoroughly and clean the surfaces around the steriliser before removing equipment.
5. It is best to remove the bottles just before they are used.
6. 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 sterilised bottle and the inside and out side of the teat from being contaminated.

PREPARING FEEDS IN THE HOME.

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

1. Clean work surface thoroughly.
2. Wash hands with soap and water and then dry.
3. Boil fresh tap water in a kettle.
4. Important: Use water within 30 minutes of boiling.
5. Pour the amount of water required into the sterilised bottle.
6. Add the exact amount of formula as per instruction on the label and using the scoop provided by the manufacturer and leveling powder with the straight side of a knife.
7. Re-assemble the bottle following manufacture’s instructions.
8. Shake the bottle well to mix the contents.
9. Cool quickly to the feeding temperature by holding under cold running tap, or placing in a container of cold water.
10. Check temperature by shaking few drops onto the inside of your wrist, it should feel lukewarm not hot.
11. Discard any feed that has not been used in 2 hours
12. Prop feeding should never be used as this can be harmful to the baby.

PREPARING FEEDS FOR LATER USE

It is best to make up infant formulas fresh for each feed but there may be times when this is not practical and feeds need to be prepared in advance. For example, when taking the child to nursery, childminder or when leaving the house for a long time.

Ready to use liquid feeds are sterile and are the safest option. However they are more expensive.

PREPARING POWDERED FEEDS FOR LATER USE

It is the length of time for which the made up feed is stored that increases risk of bacterial growth. Reducing the storage time will therefore reduce the risk. So it is important feeds are made as close to the time you leave the house as possible.

The following steps outline the safest way to prepare and store feed for later use:

• Prepare the feeds in separate bottles, not in one large container( e.g. jug)
• Follow steps 1 to 6 above ‘preparing feeds in the home’.
• Store feeds in the fridge at below 5 degrees C. Prepared feeds are best stored at the back of the fridge and not in the door.
• The temperature of the fridge should be checked regularly using a fridge thermometer. A fridge that is opened frequently may need to be set at a lower temperature.
• The risk of infection is lower if the feed is stored for a short time. Feeds should never be stored for less than 24 hours.

TRANSPORTING FEEDS

Because of the potential for growth of harmful bacteria during transport, feeds should first be cooled in a fridge (below 5 degrees C) and then transported.

• Prepare feed(s) and place in the fridge as out lined in section preparing feeds for use later.
• Ensure feed has been in the fridge for at least 1 hour before transporting.
• Only remove feed from fridge immediately before transporting.
• Transport feed in a cool bag containing frozen ice brick.
• Feed transported in a cool bag must be used within 4 hours.
• Re-warm at the destination as in section ‘Re- Warming Stored Feeds’.
• Alternatively if you reach your destination within 4 hours, feeds transported in a cool bag can be placed in a fridge and kept for a maximum of 24 hours from the time of preparation- this is not ideal as the of illness increases the longer it is stored.

RE-WARMING STORED FEEDS

• Only remove stored feeds from the fridge just before it is needed.
• Re warm using a bottle warmer, or by placing in a container of warm water.
• Microwaves should never be used to re warm feeds. As hot spots can form in feeds which continue to warm and cause burns.
• Never leave feed warming for more than 15 minuets.
• Shake bottle to ensure the feed is heated evenly.
• Check the feeding temperature by shaking a few drops onto the inside of the wrist- it should be lukewarm not hot.

The above guidelines are based on the recommendation of the Food Standards Agency and the Department of Health 2007.

Weaning and Infant Nutrition

When to Start?

For the first six months babies need only breast milk or formula milk. Solid food should be introduced at six months or on the advice of Health Visitor or Dietitian because this is when the need for more nutrition than milk alone can provide occurs. It is important to continue to give breast milk or formula to drink along side weaning.

Hints for successful weaning

The idea for weaning is to introduce the baby to a wide range of textures and tastes. Introducing a variety will help ensure the babies nutrition is balanced.

• Choose a time of day when baby and carer are relaxed.
• Go at the babies pace. The baby needs to learn how to move the food from the front of their mouth to the back and swallow it.
• Make sure every thing used for feeding the baby is really clean.
• Spoon out the amount of food the baby is to eat into a bowl and heat thoroughly. Always stir the contents of the bowl well and allow it to cool, test the temperature before offering to the baby. Always throw away any left over food never reheat.
• Always stay nearby when baby is feeding to make sure they do not choke.
• Do not rush or force feed a baby they usually know when they have had enough to eat. Babies learn to like foods by having different tastes the amount they eat are less important in the beginning.
• Babies are telling you they have had enough when they:-
  • turn their head away
  • keep their mouth shut
  • push the bowl or plate away
  • scream and shout
  • spit food out repeatedly
  • hold food in their mouth and refuse to swallow it.
• Use mashed up family food when ever possible but do not add salt or sugar to ingredients. NB stock cubes have a high salt content and so should be used rarely.

How to start

Most babies take time to learn how to take solid food. Remember it is often a messy business but it should be fun! It is a good idea to protect the floor, eg with news paper. Some babies may cry between mouthfuls, up until now food has come in a steady stream, now there are frustrating pauses.

Foods you might try first include mashed or pureed root vegetables like potato, carrot, parsnip. Mashed or pureed ripe fruit like pears, mango, and cooked apple. Mashed or pureed rice made with babies normal milk. Use mashed up family foods whenever possible. It is best to cook your own food for the baby. This way, you will know the ingredients and the baby will be getting used to family food. Don’t add salt or sugar to food for babies.

Once baby is used to the spoon give food first followed by milk. Gradually increase volume at the babies own pace.

You should attempt to clean any teeth after every meal.

Remember

Do’s

1. Do remember to wait for the baby to open his or her own mouth when food is offered.
2. Do let the baby touch the food on the dish or on the spoon.
3. Do allow baby to feed themselves, using their fingers or spoon as soon as they show an interest.
4. Do give the baby a range of foods and textures to taste.

Don’ts

1. Never add any foods (including rusks) to a bottle.
2. Don’t press food onto press the baby, if food does not seem to be wanted, wait and try again later.

More foods to try

As well as vegetables and fruit you can add other foods such as:

• Mashed-up meat, fish and chicken
• Mashed lentils, or split pulses.
• Full fat dairy products, such as yoghurt, fromage frais or custard.

Offer baby finger foods such as small pieces of fruit and vegetables and toast. Avoid sweet biscuits and rusks so that the baby does not get into the habit of expecting sweet snacks.

How Often

Move gradually from offering food once a day to two then three times a day. As the baby eats more solid food it will drink less milk. Once on three meals a day you should be aiming to offer the baby three servings of starch foods such as potatoes, sweet potato, butternut squash rice or bread, two servings of fruit and vegetables, one serving of meat, fish, eggs, tofu, or pulses during a twenty four hour period.

NB eggs must be well cooked with no runny yolks or egg white.

Cow’s milk can be used to add to breakfast cereals or in cooking from 6 months, but breast milk or formula must be given as a drink.

From about 9 Months

Baby needs to be offered three to four servings of starchy food, three to four to five servings of vegetables or fruit. Vitamin C helps with the absorption of iron so fruit and vegetables should be given with every meal. Two portions of meat, fish, eggs or pulses and 3 portions of dairy foods.

Offering fruit or vegetables is a better snack to offer than biscuits or crisps.

Babies and young children have small tummies and they need a lot of energy to grow so make sure they have full fat dairy products.

Vitamin D is naturally present in only a few foods such as fortified margarines, eggs and fatty fish. It is made naturally if the skin is exposed to gentle sun light. It is sensible to all babies’ vitamin drops from the age of one to five years.

Food Allergies

Babies are most likely to develop allergies if there is a family history of atopy, which means eczema, asthma, hay fever or food allergy. Introduce the common allergenic foods one at a time so that you can spot any reaction, do not introduce these to baby’s diet before 6 months.

Common Allergenic foods:

• Eggs
• Milk
• Wheat
• Peanuts
• Nuts
• Seeds
• Fish
• Shellfish

Nut Allergies

Serious nut allergy affects between 1 - 2 % of the population. In recent years, peanut allergy, although still rare, seems to be on the increase. It is not known why. The following may help to reduce risk of developing this life threatening allergy.

• Breast feeding mothers who are atopic or those for whom there is a family history allergy should avoid eating peanuts or peanut products while breastfeeding.
• Peanuts and food containing peanuts should not be given to babies from atopic or allergic families until they are at least 3 years old
• If there is no family history there is no need for children to avoid peanuts after weaning so long as they are ground down.

Foods to avoid

Salt

From 7 to 12 months babies should not have more salt than one gram of salt per day; both breast milk and formula milk contain salt. Do not add salt to foods for babies. When cooking family meals do not add salt so that baby can share family food. Avoid salty snacks e.g. crisps, or chips from fast food restaurants.

Sugar

Sugar can encourage a sweet tooth and lead to tooth decay when teeth first come through. Do not add sugar to food. Avoid introducing squash and sugary drinks. Remember that low calorie drinks are just as harmful to teeth. Water and milk are the best drinks to offer.

Honey

Don’t give honey until baby is over one year old. Very occasionally, it can contain a type of bacteria, which can produce toxins in the baby’s intestine and can cause a serious illness.

Remember that honey is sugar and can lead to tooth decay.

Nuts

Do not give whole nuts or whole peanuts to children under 5 years old in case of choking.

Low fat foods

Low fat foods, whether yoghurt, fromage frais, cheese or fat spreads are not suitable for babies or children under two. Fat is an important source of calories and some vitamins which they need.

Jar, Tinned and packet baby food

It can be useful to have a few jars, tins of baby food in the cupboard, but do not let them replace family foods. Remember to check food labels!

• Check the use by dates and best before dates.
• Check that the seals on cans and jars haven’t been broken.
• Choose sugar free foods and ones with out sugar and sweeteners.
• Always decant the amount of food the baby is to eat into a separate bowl and heat; the remainder of jar can then be stored in the fridge for no more than 24 hours.

Safety and Hygiene

• Always wash your hands well before preparing baby’s food.
• Check baby’s hands are clean before feeding.
• Keep surfaces clean and prevent pets from coming near food or surfaces where food is prepared
• Keep chopping boards thoroughly clean.
• Keep cooked and raw meats covered and away from each other and from other foods in the fridge.
• Thoroughly wash all bowls and spoons for feeding in hot soapy water.
• Don’t save and reuse food that your baby has half eaten.
• Cooked food should not be reheated more than once.
• Always check the temperature of food before giving it to baby it should be luke warm and never very cold or piping hot.
• Wash and peel fruit and vegetables, such as apples or carrots.
• Do not use raw or partially cooked eggs.

Freezing and reheating food

• Cool food as quickly as possible and freeze.
• Make sure food is fully thawed when defrosting, and before cooking.
• Reheat food so it is piping hot all the way through and cool to eating temperature.

Transporting food

Because of the potential for growth of harmful bacteria food should be placed in an air tight container, chilled in the fridge (below 5 degrees C) and then transported.

• Only remove from the fridge immediately before transporting.
• Transport food in a cool bag containing a frozen ice brick.
• Food transported in a cool bag must be used within 4 hours.
• If destination is reached within four hours then food can be put in fridge and can be kept for 24 hours.
• Reheat food so it is piping hot all the way through and cool to eating temperature.

Jar food is the safest food to transport as it is sterile until opened, it does not need to be chilled, (see section on jar foods) and can be served at room temperature. This may be important if baby is to be taken out and about as very few restaurants and cafes will heat baby food due to health and safety regulations.

This information was collated and compiled using information from NHS publications birth to five, weaning and information from the Department of Nutrition and Dietetics at the Royal Alexandra Hospital for Sick Children ,Brighton.