Common q&a

Globally, there are many different recommendations for making up Infant Formula Milk (IFM).

Breastfeeding is the ideal but is not always possible so alternatives are required. Liquid IFM is completely sterile and is normally recommended for pre-term or otherwise immune-compromised babies. However, for most babies powdered IFM is suitable. Using a Formula Pro is one way of preparing IFM from powder. It does not heat water to 70⁰C but there are many who believe that not doing so is a better option – experts ranging from government bodies to manufacturers of probiotic milks (that cannot be heated beyond 40⁰C without reducing their nutritional value).

There is wide consensus that good hygiene should be maintained during the preparation of IFM and that it should either be consumed immediately after preparation or stored at less than 5⁰C. The UK is one of a few countries that only recommend using water at 70⁰C. Some countries e.g. Canada follow WHO advice and recommend using either water at 70C, or pre-boiled room temperature water (so long as the milk is consumed immediately). Other countries, for example USA and France have concluded that using water at 70C is not appropriate and this does not form part of their recommendations at all.

A study by Losio et al (1) puts into question the effectiveness of using water at 70⁰C to pasteurise the milk. Starting with water at 70⁰, they found rapid cooling may occur and such conditions were non lethal to pathogens. To achieve lethal conditions, 85⁰C water was required, but at these temperatures there was concern that proteins in the milk are denatured and their nutritional value reduced. Anses in France (French equivalent of Public Health England) considered the nutritional consequences of heat on formula milk (2). They concluded that the successive use of heat treatments should be minimised for IFM to maintain its nutritional integrity. Given that heat treatments are already used in the manufacture of milk powders to minimise microbial contamination, their recommendation was to use water at room temperature when making up IFM from powder - unfiltered water from the cold tap (Not from a mixer tap, or in buildings that may have lead pipework) or bottled water that meets quality criteria that ensure no risk to infants. If neither tap or bottled water were available, cooled, boiled water could be used.

Parents therefore have to decide which body of experts has the best advice for their baby. In the UK, many parents follow the NHS guidelines, but those that choose different advice should not be considered ‘wrong’ when the experts can’t agree.

Parents who choose to prepare milk at room temperature or just above accept that it can only be made up for immediate consumption; it cannot be stored, and the Formula Pro is one of their options for preparing it. To ensure the correct nutrition of the baby, IFM must be prepared accurately (correct ratio of powder and water). Robins and Meyers found the range of error of hand scooping can be as much as 25% (4). With a hungry baby, preparing the food quickly is important; the findings would indicate that this may be at the expense of accuracy. A Formula Pro will deliver the IFM both quickly and accurately when it is needed.

Good hygiene is essential in IFM preparation. With manual preparation, each bottle requires a hand to be inserted into the tin to scoop out the powder several times. Even with clean hands, this risks bacterial contamination of the tin and/or the introduction of moisture that can promote bacterial growth (the domestic kitchen is a well-documented location for acquiring food-borne disease - 3. Redmond and Griffith). Formula Pro is a practical, hygienic alternative. Components are regularly and easily cleaned. Milk powder is tipped into the clean, dry powder container avoiding human contact. Water is replaced daily and kept separate from the powder until the moment of milk preparation.

Being a parent involves making many choices that will affect the healthy development of a child. Which milk to use and how to prepare it is one of them.

If there are any concerns as to whether the Formula Pro is a suitable choice for a particular baby’s feeds a doctor or health visitor should be consulted.

1. https://journals.lww.com/jpgn/Fulltext/2018/10000/Preparation_of_Powdered_Infant_Formula__Could.25.aspx

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