Preparing and handling powdered infant formula

Young children, especially infants, are vulnerable to foodborne illness. Babies can have difficulties fighting off infections because their immune systems are not yet fully developed. Infants who are at a higher risk of developing an infection include babies who are premature, have a low birth weight, or weakened immune systems.

Health Canada recommends breastfeeding your baby. Breast milk is the best source of nutrients for your baby and can help boost the baby's immune system. When a baby is not breastfed, liquid infant formula and powdered infant formula are acceptable alternatives. Infant formulas available in Canada undergo a strict pre-market review process, which includes the assessment of data to show that the formula supports the normal growth and development of infants.

Liquid Infant Formula

Health Canada recommends that infants who are premature, have a low-birth weight, or weakened immune systems, drink sterile liquid infant formula if they're not being breastfed.

There are two types of liquid infant formula: ready-to-feed and liquid concentrates. Ready-to-feed liquid infant formula is heat treated by the manufacturer to produce a formula that is sterile. This type of infant formula is safe for high risk infants to consume. The second type of liquid infant formula is concentrated and requires water in order to dilute it. While the concentrated formula is sterile, you should use boiled water, which is cooled to between room and body temperature, to dilute the concentrated formula before feeding high-risk infants.

For caregivers and parents that may not have access to liquid infant formula, or when a suitable liquid infant formula is not available, powdered infant formula can be used if it's prepared properly.

Powdered Infant Formula

Powdered infant formula can be used for infants who are healthy and full term and also for high-risk infants in situations where sterile liquid infant formula is not available. Unlike liquid infant formula, which is heat treated to sterilize the product, powdered infant formula isn't manufactured to be sterile.

Scientific information shows that E. Sakazakii can be present in powdered infant formula. While there are no recent cases of illness due to Enterobacter sakazakii in Canada, there have been approximately 120 recorded worldwide. As a result, if it's not prepared properly, powdered infant formula could expose a child to potentially harmful bacteria such as Enterobacter sakazakii (Cronobacter spp.). Caregivers need to make sure that powdered infant formula is prepared properly to reduce the risks of foodborne illness.

Tips for Preparing and Handling Powdered Infant Formula

You can reduce the risk of foodborne illness for your infant by following these steps at home:

Clean your counters and utensils:

  • Wash your hands using soap and hot water, and clean and disinfect utensils, digital food thermometers and counters before preparing infant formula.
  • Make sure that all bottles, spoons, nipples, lids and other equipment are sterilized by placing the items into a pot of water and bringing it to a rolling boil for 2 minutes. If these items aren't used immediately, you can cover and store them in a clean place.

For premature and low birth weight infants under two months of age or immunocompromised infants:

Always follow recommendations from your doctor or your health care professional. If you don't or can't breastfeed your child, it's safer to use a sterile liquid infant formula.  However, if you are using powdered infant formula, you should follow these steps:

  • Bring the water you're using for preparing the powdered infant formula to a rolling boil for 2 minutes. After cooling the water to 70°C (this takes about 30 minutes), pour the required amount of water into a sterilized bottle and add the formula powder according to the instructions on the label. You should make sure that the temperature of the water does not go below 70°C during the mixing period. You can use a clean, digital food thermometer to make sure.
  • The powdered infant formula should be used immediately after preparation after having been cooled to the right temperature. Cool the bottle to between room and body temperature by quickly placing the bottle under cold running water or into a container of cold or ice water. Check feeding temperature by shaking a few drops of the formula onto the inside of your wrist.
  • In some cases, powdered infant formula cannot be prepared with boiled water cooled to 70°C because of potentially heat-sensitive ingredients, such as human milk fortifiers or formulas for special medical purposes. You should consult and follow the advice from your doctor or health professional before using these formulas.
  • Prepared formula can be kept in the refrigerator for 24 hours. You should follow the instructions for preparing formula for later use below.
  • Once you have started feeding your child, the bottle should be used within 2 hours. All leftovers should be thrown out.

Alternatives for healthy, full term infants:

  • For healthy, full-term infants, you can use previously boiled water that has been cooled to room temperature to prepare powdered infant formula. It's best to feed your child immediately. However, the prepared formula can be kept in the refrigerator for 24 hours. If you choose to refrigerate the formula, you should follow the instructions for preparing formula for later use below.
  • Remember, once you've started feeding your child, the bottle should be used within 2 hours.

Preparing formula for later use:

  • Follow the instructions above for preparing powdered infant formula for high risk infants. The formula should be placed in individual sterilized bottles and quickly cooled under cold, running water and kept refrigerated at a temperature of 4°C or below until you're ready to use it. Use any prepared formula within 24 hours.
  • When you're ready to use the prepared formula, re-heat it by placing the bottle in a bottle warmer or hot water for no more than 15 minutes until it's between room and body temperature. Don't use a microwave because it doesn't heat the formula thoroughly and can create hotspots that can scald your baby's mouth.
  • Once you've re-heated the prepared infant formula, feed your child immediately. The bottle should be used within 2 hours. All leftovers should be thrown out. Don't refrigerate and reuse re-heated formula.

What the Government of Canada does to keep our food supply safe

The Government of Canada is committed to food safety.

Health Canada establishes regulations and standards relating to the safety and nutritional quality of foods sold in Canada. Through inspection and enforcement activities, the Canadian Food Inspection Agency verifies that food sold in Canada meets Health Canada's requirements.

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