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Inaccurate information on bottle milk labelling

Released on 04/03/2008

NCT calls for an end to inaccurate information on bottle milk preparation

The NCT is calling on formula milk manufacturers to update their information on formula milk preparation so it is clear, comprehensive and mirrors government guidelines. The leading parent information charity is concerned that current information is inaccurate and confusing. The NCT has also produced a new photo factsheet ‘Using infant formula: your questions answered’ to provide parents with correct information.

Advice provided on formula tins, on company websites and through company ‘Carelines’ on how to make up a bottle is often unclear and could lead to serious illness for the baby. The advice also contradicts guidance from the World Health Organization (WHO)¹ and the Food Standards Agency (FSA)².

Powdered formula milk is not sterile and can be contaminated with bacteria³, which could cause illness such as meningitis and septicaemia. Although illness is very rare, WHO and FSA advise making up only one bottle at a time using water at or above 70°C to kill the bacteria and minimise the risk.

In practical terms this means using the water within 30 minutes of boiling (after this time the temperature drops too low) and throwing away any unused milk.

These instructions from formula manufacturers are not in line with recommendations:

  • SMA Gold advises ‘allow to cool to hand hot (30-40 mins)’
  • Hipp First Infant Milk advises ‘boil and leave to stand until temperature reaches 50 - 60°C (30-40 minutes)
  • Cow & Gate website advises ‘leave kettle to cool’ and ‘you can put pre-boiled water into sterilised bottles and the water can then be stored, at room temperature, for up to 24 hours.’
  • Farley’s website advises ‘allow it to cool to hand hot (about 30-40 mins)’
  • Aptamil Careline advisor says: “Mothers can get out the number of bottles they will need for 24 hours, fill them with boiled water and keep them without refrigeration. They’ll remain sterile for 24 hours.”

In fact, formula made with water at 50°C ‘generally results in the greatest increase in risk’, according to WHO, unless it is consumed immediately, because it encourages the growth of bacteria rather than killing them.¹

The latest Infant Feeding survey shows those who use formula are not always clear on what to do and do not always make up the products using the safest method. Four in ten mothers (40%) who had made up powdered formula were not using water that had been left to cool for 30 minutes or less. And seven out of ten (69%) mothers were not following recommended practice of making up one feed at a time.

The new NCT factsheet sheet ‘Using infant formula: your questions answered’ includes a straightforward, step-by-step photo guide to making up a bottle of formula and explains what temperature the water needs to be to kill the bacteria and reduce the risk of contamination.

Belinda Phipps, Chief Executive, NCT, said; “We are very worried about the mixed messages and confusing advice given to parents and carers on how to make up a bottle. We want to see formula companies update the information on their products, websites and through Carelines so that it is clear and correct and reflects the FSA guidance.

"As the leading evidence-based parent information charity, the NCT has produced a factsheet to provide reliable and impartial information.

"Looking after a new baby can be stressful and parents who use formula need to feel secure in the knowledge they are using a technique that reduces the risks.”

The NCT factsheet also provides parents with information on the different types of formula and their contents. In addition, it looks at the effect on breastfeeding if mothers are mixing breast and bottle feeds and the best way to offer a bottle. The information provided in the factsheet is in accordance with the FSA, Department of Health and UNICEF.

For a free copy of the NCT’s factsheet ‘Using Infant Formula: your questions answered’, please call NCT Enquiries on 0870 4448707 or download from NCT website www.nct.org.uk/usinginfantformula

Parents who have questions or concerns can call the NCT’s Breastfeeding line on 0870 444 8708 or visit www.nct.org.uk. All breastfeeding counsellors are trained to support mothers in their feeding choices. Pads of fifty factsheets are also available for health care professionals to order.

Ends

For more information contact NCT Press Office on 020 8752 2404 or email press@nct.org.uk

References

  1. WHO Guidelines for the safe preparation, storage and handling of powdered infant formula 2006. www.who.int/foodsafety/publications/micro/pif2007/en
  2. Food Standards Agency, Guidance on preparing infant formula. www.food.gov.uk/news/newsarchive/2005/nov
  3. Enterobacter sakazakii and salmonella are the organisms of concern.
  4. Bolling K, Grant C, Hamlyn B, Thornton A. Infant Feeding Survey 2005. The Information Centre 2007.

The Food Standards Agency (FSA) guidance for parents states that ‘Infant formula powder is not sterile; the risks associated with using powdered infant formula milk are reduced if:

  • feeds are made up using boiled water that is greater than 70°C; in practice, this means using water that has been left to cool for no more than half an hour
  • feeds are made up fresh each time; and any left over milk is thrown away.’

Notes to Editors

1. Examples of different information from formula companies include:

a) Cow & Gate website advises ‘leave kettle to cool’ and ‘you can put pre-boiled water into sterilised bottles and the water can then be stored, at room temperature, for up to 24 hours.’ http://www.cowandgate.co.uk/en/article.asp?chco_id=58679&chli_id=&from=latest

b) Farley’s website advises ‘allow it to cool to hand hot (about 30-40 mins)’ http://www.farleyscloserbynature.co.uk/content/newborn/feeding_your_baby/bottle_feeding/making_up_bottles.aspx

c) Aptamil Careline advisor says; “Mothers can get out the number of bottles they will need for 24 hours, fill them with boiled water and keep them without refrigeration. They’ll remain sterile for 24 hours.” Reference Baby Feeding Law Group, Mystery Shopping Exercise, 13 September 2007.

2. Questions and answers:

  • Why has the NCT produced this factsheet?
    The NCT is concerned by the inaccurate and confusing information provided to parents on formula milk preparation by formula manufacturers. Information provided on formula tins, on company websites and through company ‘Carelines’ on how to make up a bottle is unclear and could lead to contamination and possibly serious illness for the baby. The advice also contradicts guidance from the World Health Organization (WHO) and the Food Standards Agency (FSA).

    Research has also shown that those who use formula are not always clear what to do and therefore do not always make up the products using the safest method. (Renfrew MJ, Ansell P, Mcleod KL (2003) Formula milk preparation: helping to reduce the risks: a systematic review. Arch Dis Child. 88(10) 855-8. Boiling K, Grant, C, Hamlyn B, Thornton A. Infant Feeding Survey 2005. The Information Centre 2007)
  • What are the dangers?
    Powdered formula milk may be contaminated by bacteria (mainly Enterobacter sakazakii and Salmonella) during the manufacturing process and from the environment.

    Although the chances of a baby becoming infected are very low, the consequences can be serious and lead to life-threatening illnesses such as meningitis and septicaemia. Premature and young babies and babies with weak immunity are at greatest risk.

    One large US study estimated the rate of E. sakazakii infection as 1 per 100 000 babies, and it is approximately 9 per 100 000 low birth weight babies, but this will vary according to how the babies are fed and carers’ hygiene practices. (Food Safety Authority of Ireland. Guidance Note No. 22 Information Relevant to the Development of Guidance Material for the Safe Feeding of Reconstituted Powdered Infant Formula (2007) Dublin.)
  • What is the Department of Health and Food Standards Agency advice?
    More than two years ago updated advice was issued by the Department of Health (DH) and the Food Standards Agency (FSA) which recommended new safety measures when powdered formula is mixed with water for feeding bottles.

    The advice states that people making up formula milk should use fresh tap water (not bottled or artificially softened water), and that feeds should be made up with water that is 70oC or more, since at this temperature it only takes four seconds for pathogenic bacteria to be killed.

    In practical terms, if a full kettle is boiled to make up a feed it shouldn’t be left for more than half an hour or the water will be too cool.     The advice also recommends that parents make up each feed as it is needed, since warm milk has been shown to be a breeding ground for bacteria.

    Once parents have made up the feed, they should cool it to the right temperature for their baby, by running the cold tap and holding the bottle under it, remembering to ensure that the cap is covering the teat. To check it is at the right temperature, a parent or carer should test it carefully on the inside of their wrist before giving it to the baby – it should feel neither warm nor cold on the skin.

    Milk made from powder should never be reheated nor left over milk re-used - instead, it should be thrown away.
  • How many mothers are not following the correct advice?
    According to the latest Infant Feeding Survey, four in ten mothers (40%) who had made up powdered formula in the last seven days were not using water that had been left to cool for 30 minutes or less. And seven out of ten (69%) mothers were not following recommended practice of making up one feed at a time.

    In fact, only 13 per cent of all mothers making up formula milk followed all three recommendations of only making up one feed at a time, using water within 30 minutes of it boiling and adding the water to the bottle before the powder.     (Bolling K, Grant C, Hamlyn B, Thornton A. Infant Feeding Survey 2005. The Information Centre 2007.)
  • What is formula milk?
    Formula is usually based on cows’ milk. There are two main types of protein in all milk: casein proteins which separate out when milk curdles in the stomach and whey proteins which stay in the liquid.     ‘First stage’ formula milks are mainly whey-based. Milks sold for older or ‘hungrier’ babies are mainly casein-based. These do not contain more energy, but tend to be more difficult to digest.

Further information