Breastmilk is the only source of nutrition which is required until six months of age. These recommendations are for parents/guardians who have decided not to (or cannot) exclusively breastfeed.
How to prepare a feed using powdered infant formula?
- Clean and disinfect a surface on which to prepare the feed.
- Wash hands with soap and water, and dry using a clean cloth or a single-use napkin.
- Boil a sufficient volume of safe water. If using an automatic kettle, wait until the kettle switches off; otherwise make sure that the water comes to a rolling boil.
Note: bottled water is not sterile and must be boiled before use. Microwave ovens should never be used in the preparation of powdered infant formula as uneven heating may result in 'hot spots' that can scald the infant's mouth.
- Taking care to avoid scalds, pour the appropriate amount of boiled water, which has been allowed to cool slightly, but not below 70 °C, into a cleaned and sterilized feeding cup or bottle. The temperature of the water should be checked using a sterile thermometer.
- To the water, add the exact amount of formula as instructed on the label. Adding more or less powder than instructed could make infants ill.
- Cool feeds quickly to feeding temperature by holding under a running tap, or placing in a container of cold water or iced water. Ensure that the level of the cooling water is below the top of the feeding cup or the lid of the bottle.
- Because very hot water has been used to prepare the feed, it is essential that the feeding temperature is checked before feeding in order to avoid scalding the infant's mouth. If necessary, continue cooling as outlined in step 6 above.
- Discard any feed that has not been consumed within two hours.
Are there risks with infants consuming under or over concentrated formula?
When preparing powdered infant formula, it is important to follow the instructions for proper amounts of water to add. Always use the proper amount of formula and water recommended on the formula can unless otherwise prescribed by a pediatrician. Adding more water than recommended reduces the caloric value of the formula, which can cause protein energy malnutrition.
In addition to inadequate calorie consumption, consuming an abundant amount of overly dilute formula can lead to water intoxication.
What is the hygienic practice before preparing the feed?
The person preparing the feed should clean and disinfect the preparation surface and wash hands with soap and water before preparing a feed. This is because harmful bacteria can be carried on hands and can also be present on surfaces. Washing hands and cleaning and disinfecting surfaces reduces the risk of feeds becoming contaminated during preparation.
Hands must also be washed after using the toilet and after diaper changing because harmful bacteria, have been found in the urine and stools of infants. These bacteria can easily be carried on the hands and contaminate feed during its preparation.
Until what age does water need to be sterilized for healthy term infants?
Water used in infant feeding should be sterilized for infants less than four months of age.
Can bottled water be used to prepare infant formula?
Commercially bottled water (excluding carbonated and mineral water) can be used to prepare infant formula. However, bottled water is not sterile and therefore must be boiled (to sterilize) until an infant is four months of age.
Can you sterilize water by boiling in an electric kettle?
Water can be sterilized in an electric kettle without an automatic shut-off. Kettles with an automatic shut-off should not be used as they turn off once the water comes to a boil and will not allow water to be at a rolling boil for two minutes.
Are antibacterial soaps or special cleaning products needed to wash feeding equipment?
No, feeding equipment can be washed with regular dish soap and hot water to remove residue. For infants less than four months of age, equipment should be sterilized in a pot with boiling water for two minutes.
How should cans of powdered infant formula be stored?
Powdered infant formula should be stored in a cool, dry place (not in the refrigerator) with the lid tightly closed. The scoop should be dry before placing back in the can. The date that powdered infant formula is opened should be recorded on the lid. Powdered infant formula should be used within one month of opening. Powdered infant formula which has passed the expiry date should not be used.
What is the recommended way to store prepared infant formula?
It is preferred to prepare formula for immediate use, however, if formula needs to be prepared ahead, an option for preparation for later use is provided. Feeds should be stored in a refrigerator immediately after preparation. Refrigerators should remain at ≤4 °C to prevent or slow down growth of harmful bacteria.
Infant formula should not be held in the refrigerator door as this section has been found to have higher temperatures than shelves in a refrigerator.
What are the warming and holding time recommendations for infant formula?
Infant formula should be prepared for immediate use. If it is not possible to prepare for immediate use, infant formula prepared earlier and stored in the refrigerator should be removed from the refrigerator just prior to feeding to decrease the risk of bacteria growth. Warming formula can be done with a bottle warmer or by placing the bottle in a container of warm water. Formula should be warmed for no more than 15 minutes as many bacteria can grow rapidly in warm temperatures (6 to 47 °C). Caregivers should swirl the formula in the bottle and check the temperature on the inside of their wrist to prevent hotspots and to ensure that the formula is not too hot for the infant. Once warmed, the formula should be fed immediately. Any infant formula that is not consumed within two hours should be discarded. Leftovers should never be reheated, refrigerated or saved for next feed.
Reference: Safe preparation, storage and handling of powdered infant formula; World Health Organization; Year 2007