This is a strange post, is it not? My children are 8 and 6 years old and it has been quite some time since I made up bottles.
There was a discussion on Mumnset recently about making up baby formula safely. We had discussed the fact that many parents were still making up the formula to outdated instructions and putting their babies at risk from Salmonella poisoning.
I am particularly interested in this topic as my son had Salmonella poisoning when he was just 5 months old, which was particularly unpleasant for him. We were lucky. I always err on the side of caution with any kind of tummy bug - and this one was extreme, I could see that - so we hotfooted it down to the doctor. We were in Scotland and the time, visiting my parents, and our family doctor thought it was likely an infection but sent a stool sample off to make sure it was nothing nastier.
It was indeed nasty. Salmonella infection. How did that happen? He was bottle-fed, not weaned yet and did not eat anything else. We racked our brains to think what could have happened since none of the rest of the family were ill. A woman from Environmental Health came out to the house and asked us some questions to see if we could pinpoint the cause, but it remained a mystery. Our son was put on antibiotics and made a full recovery.
We were indeed lucky, as Salmonella can be extremely nasty when young children catch it.
In 2004, the year our son was born, the Food and Agricultural Organisation of the UN and the World Health Organisation met in Geneva to convene a meeting on the risks of food poisoning from infant milk formula. They found that two things could dramatically decrease the risk of food poisoning:
- boiling the water, then cooling to no less that 70°C before mixing with the formula
- a decrease in holding times and feeding times, ie. using up the milk later, particularly reheating the milk.
The WHO in it's resolution WHA 58.32 requested that the WHO develop guidelines on the safe preparation and storage of infant milk formula to reduce the risk of food poisoning. The group met again in 2006 to address further issues.
A lot of people do not know that infant formula is not sterile. The FAO/WHO group found that the biggest danger is from the pathogens Enterobacter sakazakii and Enterobacter Enterica. (Salmonella). Severe illness and sometimes death can be caused by an infection by these pathogens. Those at most risk are young babies, particularly premature babies, and any children with compromised immune systems.
The manufacture of sterile infant formula is currently not possible so the only way of preventing these illnesses is the safe preparation of infant milk.
The report of the FAO/WHO group included the recommendation that water for preparation of infant formula be boiled then let to cool to no less that 70° and that bottles should not be kept for a later feed. Each feed should be made up individually.
So far, so good. These recommendations, while coming too late to have saved my son from a nasty infection would prevent other children suffering the same or worse.
Only if the parents and carers preparing the bottles know about it. There are still very many parents who do not know this, or who have been falsely informed by their midwives, health visitors or who have asked friends and relatives.
Ok, so if a parent is unsure then he or she can look up the internet or check the back of the packet. This is where the shocking bit comes. When I checked the internet pages of several German formula manufacturers to see what the current recommendation is, I found this:
Nestle (click on Zubereitung) Benötigte Wassermenge abkochen, auf etwa 40°C abkühlen und ca. die Hälfte in die Flasche geben.
Kochen Sie frisches Leitungswasser ab (benötigte Menge entnehmen Sie der Dosierungstabelle auf der jeweiligen Milupa Milumil Packung) und lassen Sie es auf 40° abkühlen.
So both of the leading manufacturers of infant formula are still recommending a temperature of 40°C, which will not kill off the bacteria responsible for Salmonella poisoning and other nasty infections.
Hipp and Humana have both changed their preparation instructions to reflect the FAO/WHO recommendations.
Nestle's UK website carries no advice on how long to cool the water before using.
This is a disgrace. It has been 5 years since the FAO/WHO recommendations were published. Why has Nestle not followed their advice and changed the preparation instructions? Why does Nestle think that it is just fine to leave things as they are and put small babies at risk?
Further to this, why are is there no recommendation on any of the German websites that I looked at (with the exception of Humana and Hipp) about the safe preparation of baby formula. Even baby fora such as this one have it wrong. Almost all of the websites that I looked at had the wrong information, even a website from the Thüringer Midwives Association.
Despite several searches, I could not find any official (ie. from the Bundesministerium für Ernährung, Landwirtschaft und Verbraucherschutz, or any other German Government agency) advice on how to prepare baby formula, such as the this website from the UK Department of Health.
What can be done? I will be writing to Nestle and to the German Minister, Frau Aigle, to askifor an explanation. I will also be contacting WHO and the Midwives Associations of Germany. I hope that others will join me in protesting.
Sichere Lebensmittel
ReplyDeleteVorbereitung von Baby Nahrung - aber sicher.
Sehr geehrte Bundesministerin Aigner,
ich möchte Sie bitten, meinen Blog anzusehen und die dazu aufkommended Fragen antworten.
Ist es Ihnen bewusst, das der FAO/WHO in 2006 eine Empfehlung herausgebracht hatte zu der sichere Zubereitung von Babynahrung?
Warum empfehlen die führende Anbieter in Deutschland die Vorbereitung von Babynahrung konträr zu diese Empfehlung?
Warum ist es so schwer in Internet eine Website zu finden, die dieser Information ordentlich und klar and die Eltern von Säuglinge in Deutschland?
Ich möchte gerne andere Babies und Ihre Eltern das ersparen was uns passiert ist.
Vielen Dank für Ihre Aufmerksamkeit,
The advice on how to make up bottles of formula changed a lot between having our two children. They are 5 years apart (2001 & 2006). We were also surprised when staying in Belgium that they advised to use bottled water, not boiled & cooled down.
ReplyDeleteIt can be quite confusing what nurses, doctors and midwives tell you because they have different opinions and in hospital they can reheat readymade milk more often because they use it up more quickly than at home with just one child.
ReplyDeleteWhat we´ve done: a thermobottle with boiling water, a bottle of Volvic and we just mixed the water to a drinkable temperature, added the powder and the milk was ready. If it was too much boiling water I just put the bottle under the cold tap and rinsed the outside to that the milk cooled down a bit more.
I had an early birth and really had to look that he is not getting any salmonella or similar, otherwise we could have had many problems.
In the beginning when he didnßt drink all the milk I put the bottle aside and only used it if he came during the next hour. Otherwise I prepared a new bottle.
Utili
ReplyDeleteSo there was no consensus in opinion from the medical staff?
Presumably you were then mixing water that was under 70°C with the powder, so it was just luck that your child did not get ill.
This worries me. That you were not given the advice that the WHO has been recommending since 2006.
Well... explained the wrong way around. I personally put the bouiling water in the bottle, added the powder and then put cold water into it. I did that because the powder resolved better in the hot water.
ReplyDeleteI got loads of advices really. Hospital doesn´t really say anything because the milk they give is "ready". They get the Aptamil as a liquid milk which normal people can´t buy anywhere. Therefore they naturally only heat up the milk and then it´s drinkable.
The APtamil package says the same: boil, let cool down, add powder. But I never did that.
I never really heard of any recommendations from the WHO of how to prepare a bottle. And I agree, it is NOT good that most mothers are kept in the dark!
You have a very good blog that the main thing a lot of interesting and useful!
ReplyDelete
ReplyDeleteI’m sending it to a few friends ans also sharing in delicious. And certainly, thanks for your effort!