Thursday, February 14, 2019

Sterilizing Bottles and Making Up Bottle-Feeds


Most mothers are aware of the importance of sterilizing feeding equipment, though few fully appreciate why it needs to be done. Once it is all explained, a mother will become much more confident about her ability to decide what needs sterilizing, how often, and when she can stop sterilizing altogether.

You need to sterilize because:
  • young babies are very susceptible to germs
  • milk is a perfect medium in which germs can multiply
  • sterilizing is the best way to ensure that germs are destroyed

Although mothers are told that they must sterilize all feeding equipment for a minimum of six months, it is, in fact, safe to use something that has not been sterilized providing you have washed it properly (see page 16). After all, a mother does not pop her breast into a sterilizer before it goes into her baby's mouth!

These are the basic principles of hygiene and sterilizing:

  • You should wash your hands before allowing your baby to suck on your finger but, having washed your hands once; you do not need to wash them again unless you do something that might contaminate them, such as a nappy change.
  • You do not need to be fanatical about washing every time you touch something, but you should wash your hands very carefully after handling raw meat, going to the loo, etc.
  • A dummy that falls out of your baby's mouth into his cot can be put straight back into his mouth, but if it falls onto a dirty street it should not be used again until it has been sterilized (or washed very thoroughly if you don't have a spare one to hand). Putting the dummy in your mouth and sucking on it does not make it germ-free and safe to go back in the baby's mouth.
  • You need to completely clean the baby bottle to avoid giving your baby a tummy upset because of the bacteria that may contain in the bottle. A minor tummy upset is unlikely to do much harm, but if there's a particularly nasty bug in the bottle, your baby could suffer severe gastroenteritis and might need to be admitted to hospital.
  • If you need a baby bottle in a rush (and don't have time to sterilize), it should be safe to wash the bottle thoroughly, fill it with milk and use it immediately. Any bacteria that might be left inside would not have a chance to multiply to a dangerous level in such a short time.

Washing before sterilizing

Sterilizing is not a substitute for washing, so everything must be cleaned thoroughly before you sterilize it. Bottles, teats, etc., should be rinsed in cold water immediately after use and then left soaking until all of them are ready to wash in one go - this makes cleaning quicker and easier.

  • A sink must be filled with hot soapy water and use a bottle brush to wash each bottle thoroughly, inside and out, making sure that you brush around the ridges of the bottle and its screw-top.
  • Teats can be cleaned by squirting a bit of neat washing-up liquid into them and then giving them a good squidge around (both inside and out) using your fingers. You can also use a small brush specially designed for washing teats.
  • Rinse with clean water and put all items straight into the sterilizer - you do not need to dry them first.
  • The bottle brush does not need to be sterilized but should be kept in a clean place, e.g., in a jam jar (which you should also wash regularly).

Everything you wash (but are not planning to sterilize) should be left to drip-dry on a clean rack or paper towel - or you can shake the water off and use it immediately. If you use a dirty drying-up cloth or put items to drain on a dirty work surface, you will directly contaminate them and make them unsafe to use.

Note: In the U.S., many mothers put all their baby-feeding equipment in the dishwasher and do not sterilize any of it. This is less safe to do here because dishwashers in the UK wash at a lower temperature than they do in the U.S.

Sterilizing methods

You can use an electric or microwave steam sterilizer, or sterilize in cold water using liquid or tablets following the manufacturer's instructions.

You can also sterilize items by boiling them in a saucepan. The bottles should be immersed in cold water (making sure there are no air bubbles left inside the bottles) and then boiled for at least 10 minutes. The teats can be added for the last three minutes but be aware that they will perish quickly if you boil them too often.

Note: Pouring boiling water over a teat, dummy, etc., does not sterilize it.

How long will equipment remain sterile?

Most manufacturers say that the contents need re-sterilizing every time you open the sterilizer to get something out. This is being overly cautious! If you wash your hands carefully before removing items from the sterilizer, everything left will remain safe to use for about 24 hours. But if your hands are dirty and you sneeze into the sterilizer before replacing the lid, you will need to wash and sterilize again! Bottles that are removed from the sterilizer and kept fully assembled with their lids on will remain sterile for about 24 hours, even when left at room temperature in the kitchen or out and about with you and the baby. These bottles can be left empty or filled with cooled boiled water, but if you put milk into them, they should be kept cool in the fridge.

Making up bottle-feeds

Current advice is that bottles should be made up immediately before a feed, rather than being prepared in advance and kept stored in the fridge. This is another example of manufacturers being overly cautious! Mothers are advised to make up one feed at a time to make allowances for those who fail to sterilize and store the feeds correctly - the milk does not start deteriorating once the powder is added.

You can, therefore, decide which suits you the best; preparing 24 hours' worth of feeds in advance or waiting until your baby is hungry before mixing the milk.

These are the pros and cons:

Method one: preparing in advance

  • I think it is quicker and more efficient to get into the habit of preparing all the bottle feeds at the same time each day rather than doing each bottle as and when you need it.
  • Your crying, hungry baby doesn't have to wait while you prepare his bottle.
  • Bottles of milk must be kept cool, which means taking a cool bag when you are out for the day, traveling etc.
  • The milk has to be warmed before you give it - easy and quick if you microwave it, but slower if you don't.

Method two: making individual bottles

  • Can be stressful if your baby is screaming for his feed. Anyone can get a bottle out of the fridge for you, but not everyone (e.g., a visiting friend) will know how to find and add the powder in a hurry.
  • When out and about, you have to take bottles and powder with you in separate containers.
  • You can keep the bottle filled with water at room temperature -no need for cool bags and possibly no need to heat the bottle either. (See page 24, "Warming the milk.")
  • Safer if you are not meticulous with hygiene and sterilizing.
  • No chance of your baby being given old milk that has been left at the back of the fridge for a week (or longer).

When making up the feeds, you should:

  • Rinse out the kettle, fill it with water (taken from the cold water tap) and bring it to the boil.
  • Allow the water to cool for about 10 minutes (so that the water is still hot, but not boiling).
  • Wash your hands, take the bottles out of the sterilizer and stand them on a clean work surface.
  • Baby bottler must be filled with the exact amount of water, i.e., 180 ml (6 oz) of water if you want to make up 180 ml (6 oz) of milk.
  • Add the milk powder to the water, first checking the tin for instructions as to how much powder to add. It is usually one level scoop of powder per 30 ml (1 oz) of water.
  • Dissolve the powder by putting the tops back on the bottles and giving them a really good shake.
  • Put bottles straight into the fridge, even though they will be quite hot. (The sooner you cool the milk down, the sooner you will stop germs multiplying if you have failed to sterilize the bottles correctly.)
  • You can leave the bottles out of the fridge if you are not adding a powder to the water.

Do not:

  • Use mineral water, as this is designed for adults, not babies (unless the label explicitly states that it is suitable for babies).
  • Use water that has been softened (i.e., water softener in your home).
  • Boil the water more than once as this concentrates the chemicals in the water.
  • Add more than what is the prescribed amount of milk powder.
  • Use milk that is more than 24 hours old - all old milk must be thrown away.
  • Put a half-finished bottle of milk in the fridge to be used again later in the day. (This is unhygienic and can allow harmful bacteria to multiply.)

Note: It is only necessary to use bottled (rather than tap) water in countries where there is no safe water to drink. In this case, you should always boil the water, regardless of whether you are using tap or bottled water.

How much milk to offer

As a rough guide, most babies under the age of four months will need approximately 150 ml (5o z) of milk per kg of body weight (or 2%2-3 oz per lb) every 24 hours. To work out how much your baby will need at each feed, you divide the total amount of milk he needs by the number of feeds he is having.

Metric

For a 3 kg baby on six feeds a day, you would multiply 3 kg by 150 ml = 450 ml. Divided by six feeds = 75 ml per feed.

Imperial

For a 7 lb baby on seven feeds a day, you should multiply 7 lb by 3 oz = 21 oz. Divided by seven feeds = 3 oz per feed.

As this is only a rough guide (because I have multiplied by 3 oz, rather than by 2% oz), you should not worry if your baby takes slightly more or less than this.
  • Always make up a bit more than you think your baby needs so that if he is particularly hungry at one feed, he can have more.
  • A small amount of milk should always be left in the bottle at the end of each feed, so you can be fairly sure that the baby has finished bottle-feeding because he has had enough milk, rather than because there was no more milk available to him.
  • A bottle-fed baby tends to take pretty much the same amount of milk at each feed, but his appetite will vary a little. Don't force him to drink more when he has had enough, as this is likely to make him gain too much weight.


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