Be safe when preparing infant formula

Nov. 27, 2017 at 8:48 p.m.
Updated Nov. 28, 2017 at 1 a.m.

Kim Pagel

Kim Pagel   Contributed Photo for The Victoria Advocate

Kimberly Pagel

The World Health Organization, or WHO, recommends infants be exclusively breast-fed for the first six months of life; however, most infants in the United States rely on infant formula for some portion of their nutrition.

It is estimated 1 million infants in the United States are fed formula from birth, and this amount almost triples for infants who are 3 months old.

Infant formula comes in three common forms: powder, liquid concentrate and ready-to-feed.

Powder formula is the least expensive, must be mixed with water before feeding and is the most widely used variety.

In using powdered infant formula, it is very important to know it is not sterile. This means it may occasionally contain pathogens that can cause serious illnesses. Many studies were conducted by the Food and Drug Administration, and the two most commonly found bacteria in powdered infant formula were Cronobacter, formerly known as Enterobacter sakazakii, and salmonella.

Even though the FDA takes steps to ensure infant formulas are safe, the World Health Organization states it is not feasible to manufacture powdered infant formula in a sterile way using current processing technology.

Cronobacter is a germ that is found naturally in the environment and can survive in very dry conditions.

In addition to powdered infant formula, Cronobacter has been found in various dry foods, such as powdered milk, herbal teas and starches. Cronobacter infections are rare, but they can be deadly in newborns.

Cronobacter can cause diarrhea, problems in wounds and urinary tract infections. It can also cause severe blood infections or meningitis. Although all ages are susceptible to illness, infants who are under 3 months old, were born prematurely or have weakened immune systems are those at greatest risk.

The risk of infection increases when prepared feeds are handled or stored incorrectly as contamination can also occur once the container is opened.

Because of reported cases of infections and the potential for illnesses, in 2011 the CDC released safe infant formula preparation guidelines in alignment with the WHO guidelines. The first recommendation is to ensure all bottles and bottle parts are properly sterilized.

Next, ensure the water that will be mixed with the powdered formula is boiled. It is recommended to bring the water to a "bubbly boil" and keep it boiling for one full minute.

The WHO's safety precautions also indicated if using powdered infant formula, the amount of time after the water has finished boiling until you add the powdered formula is critical.

The Texas Health and Human Services department agreed with this and performed its own extensive testing.

The department's guidelines state you should pour the correct amount of boiled water into the sterilized bottle within 5 minutes after boiling and immediately add the correct amount of powdered formula to the water, then shake well to mix.

Adding the powdered infant formula to the very hot water can ensure you are adequately killing possible bacteria that may be present.

It is important to note the WHO/CDC safe formula preparation instructions differ from instructions you will find on powdered formula labels. At this time, formula manufacturers have no plans to change their labels to match the WHO guidelines.

In October 2016, the Texas Women, Infant, and Children Program, which is under the Texas Health and Human Services Department, implemented formula preparation guidelines that are consistent with WHO/CDC recommendations.

By doing this, the WIC Program educates participating mothers about these safer mixing practices in the hope of preventing possible illnesses.

It is also important to remember when mixing at such hot temperatures, steps must be taken to avoid scalding when feeding. Therefore, it is recommended to quickly cool hot formula by holding the bottle under cold running water or by placing it in a container of cold water.

To safeguard against possible infection of Cronobacter or salmonella, be sure to follow good hygiene, mix the formula with water hot enough to kill germs and safely store formula to prevent bacterial growth. These simple steps will help you safely prepare and feed infant formula to your baby.

For more information, please visit and

Kimberly Pagel, a registered and licensed dietician, is the WIC Program manager and registered dietitian at the Victoria County Public Health Department.



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