The issue of how to prepare the bottle is one of the most worrying, because most parents prepare them in a way that is not the most recommended, and not only because the milk bottles are poorly explained (then the parents do not seem to follow the instructions either), but also because most professionals do not correctly explain how a bottle is prepared.
The water to prepare the bottle has been boiled throughout life to remove impurities. One filled a saucepan with tap water and boiled it for a few minutes. Then he removed it from the heat, threw it in the bottle, mixed with the powder of the formula and cooled the bottle externally to give it to the baby.
Now most fathers and mothers use bottled water, which gives us all more security, and this makes parents and professionals believe that the water does not have to be boiled, and yet it is not so. Why it is advisable to boil the water for the bottle even if it is bottled.
Artificial milk powder is not sterile
When we boiled the water we got two things, that the water was valid for the baby and that all possible bacteria and microorganisms disappeared from the dust. But people thought I was only doing the first.
When changing the tap water for the bottle, and stop heating it, the powder is no longer heat treated and many babies may be at risk of catching mild, but sometimes serious diseases.
This happens because artificial milk powder is not sterile. Current industrial methods are not able to offer it to the consumer in this way, so it is the parents who have to perform the appropriate "maneuvers" so that the milk that the baby finally receives is not dangerous.
Cronobacter and Salmonella
Although there are many microorganisms that we can find in the artificial milk powder, the ones that attract the most attention, the ones that are most scary, are the Chronobacter (previously called Enterobacter sakazakii) and the Salmonella.
Of the two, it is the Chronobacter that can cause more problems, because may cause meningitis, bacteraemias and necrotizing enterocolitis (as you can see in this study), especially in premature and low birth weight babies; diseases that have a mortality of between 40 and 80%.
According to the US Centers for Disease Control (CDC), it is unlikely that a baby will get Cronobacter, but when mortality occurs it is high:
It usually occurs in the first days or weeks of life. The CDC is informed of about 4-6 cases of Cronobacter disease in newborns each year, although the declaration of the disease is not mandatory.
That is, it seems to happen a few times, but we do not have a clear figure either because doctors are not required to declare the disease to the CDC.
When the presence of Cronobacter in baby formulas has been studied, it has been found that contamination could occur in the same factory, although it could also happen at home, once the canister is opened or during the preparation of a bottle.
In the case of industries, a 2010 study analyzed 5 artificial milk factories to see how far Cronobacter could be found in them. Of the 298 environmental samples (not of milk, of the environment) that they took in them, 32% contained the pathogen, and that counting that the hygiene in these factories is beyond doubt: the Cronobacter is able to survive in extremely dry conditions. A few days ago a study was published in which they analyzed milk samples in China. Of 1032 samples collected between 2011 and 2013, 42 samples were contaminated with Cronobacter.
Liquid baby formulas are sterile
Given this situation the recommendation is that, whenever possible, and especially if you have a premature baby, or underweight who is not breastfed, receive liquid artificial milk; The one that is already prepared. This milk is sterile and cannot contain Cronobacter, Salmonella or any other pathogen.
And how is the bottle prepared with powdered milk?
The instructions that come in cans of powdered milk are not always adequate. Yes there are some brands that say that the water should reach 100 ° C and prepare a few minutes later, but they are the least. The majority speaks of 40 ° C, and at this temperature the Chronobacter, if there is any in the powder, is not eliminated.
But most parents don't even heat the water until they reach 40 degrees, so just they are not doing anything with powdered milk. If it comes without pathogens, the baby will receive a safe milk. If it comes with a pathogen, then the baby will receive it directly, simply mixed with water to swallow the milk.
WHO has been explaining for years that bottles should be prepared with water at 70 ° C, also the CDC, and in the United Kingdom it is rare for parents to explain that the water should not be boiled first, because from their health system (the NHS) the recommendation is exactly the same (in fact, they do not even recommend the use of bottled water in case you had too much sodium).
So, I leave below the instructions for preparing a bottle in the best possible way:
Proper hygiene
The first thing to keep in mind is that hygiene when preparing the bottle should be adequate. Wash our hands and prepare the bottle on a clean surface. The Babby bottle no need to be sterilized, but previously it must have been washed properly and left to dry without touching rags or anything like that (putting the cloth to dry the bottle is not recommended).
Boil water
The reason for boiling the water is to bring it to 100 ° C to calculate the time needed thereafter. At this temperature we cannot dust because it would agglutinate and harden, and also bacterial spores would be activated, so you have to wait for the water to be between 90ºC and 70ºC.
Wait 5 to 30 minutes
It is considered that 30 minutes is the maximum time that can be expected to prepare a bottle, because after that time the water will be below 70 ° C. Before 5 minutes it will be too hot, so the window of time to mix the dust with the water is between 5 and 30 minutes.
According to studies, Cronobacter disappears from the powder in about 6 minutes at 90 ° C, and Salmonella takes about the same; at 80 ° C the Cronobacter takes between 7 and 13 minutes, and the Salmonella between 10 and 12; at 75 ° C, Cronobacter takes between 23 and 24 minutes to disappear, which is the same as Salmonella. But it is only an orientation to explain that it is better to do it after 5 minutes and that, although we have 30 minutes of margin, it is better not to wait long.
Dust in the right proportion
Once at least those 5 minutes have passed, we put the powder in the right proportion: a small bowl for every 30 ml of water, and stir the mixture.
Give it to the baby or refrigerate it
If the child is going to be given immediately, the bottle must be cooled (obviously). For this we can put it in contact with very cold water, even ice water, and be sure before offering it that it does not burn.
Since it is prepared there are two hours of margin for the child to take it... after two hours you have to throw it away, because the proliferation of bacteria makes it an unsafe milk for the baby.
Therefore, in case it is not going to be given in that period of time, the bottle should be refrigerated as soon as possible. It is then recommended to prepare the bottle, cool it a little after preparing it and put it in the fridge, where you can stay up to 24 hours.
Remove the bottles from the fridge
When we need it, just take it out of the fridge and heat it to the water bath, in contact with hot water or with a bottle warmer until it is at a comfortable temperature to consume it. From that moment we have two hours to finish it. After that time, two hours, you have to throw what about.
And all this must be done at night?
Not necessarily. As I explained a couple of years ago, bottles can be prepared at night and left in the fridge (as I just explained now). Thus, it is enough to take them out as the child asks ... in a moment we have them warm and we can give them to them.
This measure can also be done during the day, if we have a baby of those who have little wait (if he is not warning, but starts crying as if he had not eaten in 7 years). We can prepare the bottle when the previous one is finished, for example, cool it and leave it in the fridge. It is actually better when it is prepared and given to the baby at the moment, but between boiling, waiting 5 minutes and cooling, you can spend 15 minutes quietly with the broken baby.
What if we continue to make bottles without heating the water?
Given that most parents do not do what I just said and that most babies are fine, the risk does not seem to be very high (Although, and this is my theory and perhaps it is nonsense, I don't know if those non-eliminated microorganisms could be the cause of so many colic and intestinal discomfort in many babies who take a bottle). However, the recommendation is what I comment, the best way to prepare them is with hot water between 70 and 90ºC.
In case of not having it, WHO says the following:
- The safest way to prepare a shot is to use water that has been boiled and cooled to no less than 70 ° C.
- If you cannot have boiling water, you may want to use sterile liquid infant preparations.
- You can also prepare the shots using clean drinking water at room temperature and administer the food immediately.
- Sockets prepared with water below 70 ° C should be consumed immediately; They should not be stored for later use (no fridge).
- Discard all the remains of shots after two hours.
Photos | iStock
In Babies and more | The water to prepare the bottle must be boiled yes or yes, Artificial milk is not sterile, Why BabyNes is not recommended for babies, How to clean the bottle?
