How to Safely Feed Formula in Wake of the Recent Scare


It's a sad, sad day when any of us here at The Stir have to write about a baby's death. Ten-day-old Avery Cornett of Missouri died from a rare bacterial contamination in his itty bitty gut, and the fear that it came from the formula he was fed is like a knife in the gut -- not only for moms using that formula, or any formula, but for anyone. He's actually the second baby to die from the same bacteria in Missouri this month.

While Enfamil/Mead Johnson didn't issue a recall, Wal-Mart pulled the specific batch from shelves while they investigate it; however, I think this really points to a much larger problem: Are moms being taught all they need to be taught about how to properly prepare the formula they feed their kids?

The problem is that formula cans, pediatricians, and most books don't teach us moms how to safely formula-feed babies -- nor do they adequately warn you about the things that can happen if you don't.

I promise -- no "my boobs never get recalled here" from me, and I'd appreciate it if none of that comes through in the comments either. It's not about breastfeeding versus formula feeding. Even the most staunch breastfeeding advocate knows that sometimes formula just has to happen. Not to mention, it's thoughtless and plain ugly. I used formula when my first kiddo was a newborn. Pallets of ready-to-feed tiny bottles and one can of powder that we'd gotten from hospitals for free, and one can we purchased ourselves. Knowing what I do now, I'm pretty grateful for the instant-feed bottles, because that step alone could have helped little Avery from getting ill.

You see, powdered infant formula is not sterile. Period. Has never been, cannot be by the process of production. It's just impossible. Enterobacter sakazakii (cronobacter ... what infected the baby's gut) has been noted as present in powdered infant formula just by its intrinsic nature. In the United States of America, an incidence rate of 1 per 100,000 infants for E. sakazakii infection has been reported. Even though it's estimated that that's very under-reported, that number is small, so please don't worry too much ... however, it's important to note that there are very, very specific ways to make formula that protect your baby not only from this bacteria, but from other potential problems as well.

1. Use liquid "Ready to Feed" or concentrate in the early days.
The World Health Organization states that babies under 12 months old are at biggest risk. The especially sensitive groups are the neonates (babies younger than 28 days) and those who are preterm/premature, low birth weight, immuno-compromised, or otherwise ill or "delicate." Still, any baby is at risk. So, think about using the more expensive kind, if only just for the first month.

2. Keep your water hot.
One tiny, simple, but time-consuming step could make a huge difference: use water hotter than 158 degrees Fahrenheit (70 Celsius). Which I know is way too hot for baby to drink, but if you mix the formula with this super hot water, it can kill the bacteria that may or may not be there. Then cool it for serving. See next step ...

3. Don't let formula sit out.
Once you've used hot water to make it, pop it in the fridge quickly to cool it to baby's safe temperature. Seems weird, I know, but this is the suggestion to avoid the temperature range in which the bacteria grows the most. So, make it hot and cool it FAST. Also, don't let bottles sit out and feed from them later. You can always make more. I know you don't want to waste good formula but then only heat up what you think you need ... and dispose of the rest. It's okay to make it right, pop it in the fridge, and then heat it back up later to just the right temp for baby.

4. Use safe water if you can't use hot.
If you're going to be out and about and absolutely can't use boiling water or liquid formula, try to bring your own water and use at room temperature, then use immediately once you mix. This won't kill bacteria that may be in the formula, but can help prevent its growth.

It is important to note that there has been no difference found between any brands of powder formula in the levels of contamination, which, again, are very low. This is not something to panic over ... you just have to be smart about your preparation and, if nothing else, try to do a little extra work when they are under 28 days old.

Because this stuff is complicated, I can't get to all of it, but you can read it for yourself. Print out this "safe preparation, storage and handling of powdered infant formula guidelines" pamphlet, and follow it. Encourage your pediatrician to give these out too, and share with moms you know who use formula, even your babysitter. It could save one tiny little life.


Image via thesoftlanding/Flickr

baby health, formula, natural parenting, newborns


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nonmember avatar Ashley

...or use distilled water. The health department hasn't determined the cause of infection yet as far as I know and said the water could be the source of the issue.

Stacey. Stacey.


shami... shamillionaire

I'm wondering if this baby is a he or she? This story is the only one listing Avery as a she? All other news sources say Avery is a he... ????? May "he" RIP...

RanaA... RanaAurora

That's a good question, Stacy. This bacteria has never been found in breastmilk, so this is a formula issue that is well-known but thankfully, rare, especially with proper precautions.

mrssu... mrssundin

If breastmilk has it too then any baby can get it. All babies are at risk. You can use sterile water so you don't have to boil it.

nonmember avatar TJ

Another important thing is to make sure that your hands are as clean as possible when scooping the formula out of the can. Also, instead of using the scoop, which we tend to put back, figure out how much of the formula you would need to take out with a clean stainless steel spoon.

Randi02 Randi02

Breast milk does not contain enterobacter sakazakii. Breast milk can be left out for several hours after being pumped, and it may actually have LESS bacteria than when first pumped, due to the antibodies.

Contamination from these pathogens is an issue with powdered formulas. Also, beetles and larva, glass and plastic particles and other nasty things.

Shado... ShadowLark

EXCELLENT post!  @ Stacey - way to be defensive.  THIS SPECIES OF BACTERIA IS A KNOWN CONTAMINANT OF POWDERED FORMULA!  HOW hard is it to acknowledge that tiny babies need special care?  You have to act as though EVERY bottle of POWDERED formula you make is potentially contaminated.  So you take some extra steps to keep your baby safe.  If you can't/won't take those steps, BUY THE CONCENTRATE!  Concentrate and RTF formula IS sterile!  So buy that stuff until baby is a month old.  Really?  Is that SO hard?

And don't tell me that you can't afford it.  Exchange some of those millions of outfits that no baby ever manages to wear and buy the SAFE formula.  Or buy used nursery bedding and a used stroller.  WIC gives you the concentrate, at least in Ohio.  So even if you can't afford ANY formula (and can't nurse) YOU CAN GET THE CONCENTRATE FROM WIC!

And just ftr - NO.  There has NEVER been a case of a baby dying from bacterial contamination of breast milk straight from the tap.  That CANNOT be said for formula fresh from the can.  TAKE PRECAUTIONS!

nonmember avatar Beverly

There is always an out for formula. Donor milk/milk sharing or milk banks. At least untill the baby is 6 months or so and can handle things a little better.

Shado... ShadowLark

@ Mrssundin - you can't kill the bacteria that are in the formula with sterile water.  If boiling is too much work, get the concentrate.  THAT is sterile, then you use your sterile water and you're golden.

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