More Bugs in Formula Stress Importance of Bottle Preparation

Thirty-one-year-old Scottish mom Jenny Vardy opened her can of Aptamil formula and saw black spots. Then she saw the black spots moving. She ripped open the second can she had bought online at the same time, and the same thing -- there were live bugs in her 3-month-old's formula.

Disturbingly, Aptamil was under fire a mere few months ago for having beetles and live SPIDERS in the formula. Supposedly eggs got inside, were exposed to air when the seal was broken, then hatched. Ugh, I'm twitching just writing that.

Sadly, we know this isn't a foreign problem, since we had (thankfully) dead beetles in Similac powder not that long ago. Companies always stress that powdered formula can't be sterile, and the process of making a bottle and killing things often falls on you, the parent.

But how many moms really know all the details and procedures to safely make a bottle?


The World Health Organzation has put out a easy-to-use guide to help people understand the process necessary to help eliminate potentially deadly bacteria such as Enterobacter sakazakii and Salmonella enterica, but would also kill (but not remove) things like live bug eggs. Ugh.

First, it's important to understand that there are three different types of formula:

  1. Ready-to-feed, single-serve, and multiple serving bottles. These ARE sterile and do NOT contain microorganisms and bacteria. They're also the most expensive, often prohibitively so. If you have a preemie or immune-compromised baby and neither breast milk nor safe donor milk is an option, this is your best choice, the safest choice.
  2. Liquid concentrate. These are also initially sterile, and cheaper than ready-to-feed, though still expensive. Your concern when making these is generally your water, and just making sure you store it properly.
  3. Powdered infant formula (which I'm going to call "PIF") is the only one that can't be sterile, but the most commonly used. It's also frequently contaminated with lots of things, though very rarely are any of them harmful, even if beetles are really, really disgusting. 

Enterobacter sakazakii (e. sakazakii) is one probably the biggest concerns out of all contaminants, and is specifically the bacteria that many of the sterilization procedures are designed to kill off. What makes it so scary is that it can cause meningitis (inflammation of the brain and spinal cord), sepsis, and necrotizing enterocolitis. In the U.S., an incidence rate of 1 per 100,000 infants for e. sakazakii infection has been reported. This incidence rate increases to 9.4 per 100,000 in infants of very low birth weight. It's estimated that it is present in a whopping 14 percent of PIF ... and when you consider how many cans you go through with a formula-fed baby, that means your baby WILL be exposed, period. While it's the biggest threat to preemies and immune-compromised babies, it's still a major threat to babies under one in general. Yikes.

So, while just dumping some powder in a bottle with tap water seems simple, you've got some really good reasons to take the extra steps.

  • Sterilize equipment before first use. Fill a large pot with water, enough to completely submerge everything, put all pieces in, and remove all air bubbles. Boil, making sure the pan doesn't run dry, then remove with something clean to another totally clean place for drying. Your counter near your sink is not a good place.
  • Clean bottles by hand. Soap residue from dishwashers can make babies sick, and doesn't always get all the crevices, and can cause scratches that can harbor bacteria on their own, especially in plastic bottles. Hand-wash in hot, soapy water (no bleach or chemicals necessary), and let completely dry.
  • Use water that is at least 158°F (70°C). That's not boiling, but boil water and let it sit for a minute. It's about the temperature of your latte when it's fresh. You can buy a cheap thermometer to gauge temperature. This step ALONE is responsible for a dramatic decrease in bacterial infections, though doesn't kill all microorganisms or bacteria. A whistling teapot could come in handy here, as you can't get distracted and forget, and it's easy to use.
  • Serve prepared PIF immediately. If you make a bottle and then end up not using it, it needs to go in the fridge right away.
  • Cool quickly to safe temperature by running under cold water, sticking in ice, or popping it in the freezer for a couple of minutes.
  • Store any pre-made formula in less than 40°F (5°C) immediately. Your fridge should be less than 40 but more than 32, obviously. Get a cheap thermometer for the fridge to check if you're not sure, and put bottles towards the back where it's colder, not in the door. PIF that hasn't been used can be stored under these conditions for 24 hours.

Day cares often make bottles that sit out before use, or they make batches to be used throughout the day. Make sure they're following these guidelines as day cares and hospitals are the places where these bacteria occur most often from these types of bad habits.

Remember too, bottled water isn't sterile. It still needs to be boiled and can contain the exact same contaminants as your tap. I know formula's a pain in the butt to prepare and these steps can make it worse, but it's your baby's health and potentially life on the line. The steps are necessary.

Do you follow these steps when preparing your baby's formula?

Image via nerissa's ring/Flickr

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