FIRST STEPS NUTRITION TRUST

FIRST STEPS NUTRITION TRUST Safety advice fr infant milk preparatin: Vacuum flasks, cmbined frmula mixer and bttle insulatr and milk preparatin machines. March 2015 This statement ffers advice t prfessinals when asked abut making up pwdered milks n the mve, r using specialist equipment. 1. Vacuum Flasks The Department f Health recmmend that the safest way t make up feeds frm pwdered infant frmula (PIF) when away frm hme is t make the feed up freshly using a vacuum flask f biled water. The biling water shuld kill any bacteria present in the flask. The feed can then be made up in a sterilised feeding bttle using PIF pre-measured int a small, clean, dry cntainer and the crrect amunt f biled water frm the vacuum flask. The Department f Health state that vacuum flasks, if full and securely sealed, will keep the water temperature abve 70 fr several hurs. 1 We have tested several typical vaccum flasks, with tw vlumes f water, ver a perid f between 1-3 hurs, with the therms flasks warmed fr 1 minute with biling water befre use and stred at an ambient temperature f abut 19. We fund the fllwing average temperatures f water when the prcedures were cnducted three times, with each time test cmpleted n a freshly stred batch f biling water: Amunt f water in the bttle when biling water first added t flask after 30 minutes after 1 hur after 2 hurs after 3 hurs Full flask: (apprx. 17.5z) 92 90 90 86 76 10z 92 80 74 72 66 5z 92 72 70 64 58 The 10z flask f water was als tested at 2 hurs and 30 minutes and the temperature had drpped t an average 68. This suggests that a minimum f 10z f water shuld be carried in a flask, and that water shuld be used within 2 hurs. Smaller amunts f 5z will nly remain at the crrect temperature fr abut an hur. A full flask f water securely sealed as suggested by The Department f Health remains at >70 O fr abut 3 hurs. 1 http://www.nhs.uk/start4life/dcuments/pdfs/start4life_guide_t_bttle_feeding.pdf First Steps Nutritin Trust: February 2015. Page 1

2. mbined frmula mixer and bttle insulatr: Myyfeed The Myyfeed frmula mixer and bttle insulatr is currently the nly ne f its' kind available n the UK market, and retails at 24.99 (excluding the infant milk bttle). It is marketed as making the prcess f preparing a frmula feed mre cnvenient when utside the hme. The prduct cmbines a cntainer fr pre-measured amunts f PIF which sits inside a bttle insulatr abve the feeding bttle f warm water. Placing the PIF cntainer ver the neck f the bttle and clicking a buttn n the cntainer releases the PIF int the bttle, aviding any spillage f the pwder. The bttle must then be shaken t mix the PIF with the warm water. Prvided that the water has been previusly biled befre being measured int the bttle and placed in the insulatr, and the PIF is added when the water is nt belw 70º, the prduct allws frmula milk t be prepared accrding t current guidance (DH, 2012). The manufacturers' suggest that the insulatr will keep a 9 fluid unce bttle f water abve 70º fr up t tw hurs but d nt cautin against smaller amunts which may be cmmnly measured int the bttle fr a feed. There are ther factrs that will influence the rate at which the water cls including the temperature f the water when it was put in the bttle, the vlume f water and the ambient temperature and these factrs may reduce the windw f pprtunity in which the water may be safely used. We have taken the temperature f the water in the bttle using different amunts f water ver different lengths f time, using 9z f water suggested by the manufacturer and a smaller vlume that parents f yunger babies may measure int the bttle. We fllwed the prcedures used fr the vacuum flask wrk abve and had the fllwing average results: Amunt f water in the bttle when biling water added t bttle after 30 minutes after 1 hur after 2 hurs after 3 hurs 9z 92 74 70 66 60 5z 92 72 68 60 56 First Steps Nutritin Trust: February 2015. Page 2

We wuld cnclude that this system is less effective than carrying water in a therms flask, and the time saving f the autmatic mixing, cmpared t using a pre-measured vlume f pwder in a small cntainer seems minimal. If these flasks are used then a full bttle f biling water shuld be used, and then sme water discarded befre the pwder is added, and water shuld nt be held in the cntainer fr mre than 2 hurs. Larger vlumes than 9z are nt pssible in a bttle held in this flask. First Steps Nutritin Trust: February 2015. Page 3

3. Frmula Preparatin Machines Frmula preparatin machines are relatively new t the UK market and are marketed as being a sterile and cnvenient methd f preparing frmula feeds at the crrect temperature fr cnsumptin, within minutes. In the UK, the nly frmula preparatin machine currently available at high street retailers is the Tmmee Tippee Perfect Prep TM Machine. This machine claims t "prepare a fresh bttle at just the right serving temperature within 2 minutes". The machine uses a tw-step prcess t prepare the feed. In the first step the machine dispenses a "ht sht" f water directly int the bttle. The user then has tw minutes t add the PIF, place the hlding cap n the bttle, shake t mix and return the bttle t the machine. In step 2, cld water is added by the machine t make up the selected feed vlume t a cmfrtable temperature t feed immediately. Whilst research int the safety and efficacy f the Perfect Prep TM Machine has been carried ut by the manufacturer, this is nt currently in the public dmain and the manufacturer has declined t release it fr business cmpetitin reasns. Maybrn Grup Ltd. wh prduce Tmmy Tippee brand prducts have said: Our Perfect Prep prduct has been tested by an independent labratry that validated that the ht sht f water addressed the (E.Sakazakii) species f cncern. The labratry used was Intertek Testing Services (UK) Limited. The filter we use is nt a standard water filter, such as the nes yu might find in a Britta system it s an antibacterial filter. We have independently validated the remval f bacteria that may be present in water, and we have dne this test in extreme circumstances, dsing the water with significantly higher levels f bacteria than typically fund in water supplies, s we can be truly cnfident f the filter efficiency. Validatin was carried ut by Intertek Testing Services (UK) Limited. Unpublished university based research which investigated the efficacy and temperature prfile f the Tmmee Tippee Perfect Prep TM Machine using PIF inculated with knwn amunts f rnbacter sakazakii has suggested that whilst the machine ht sht f water nt a small vlume f pwder was able t eradicate mre than 95% f the bacteria, it failed t reduce their numbers t an undetectable level. Whilst the machine prduced water fr the "ht sht" at a temperature higher than the 70º stipulated in current guidelines, the temperature fell t arund 60º after 2 minutes. Furthermre, when PIF was added at 30, 60 and 90 secnds after the "ht sht" - the temperatures in the bttle were nly maintained fr arund five secnds befre they fell again t between 52.5 and 55.5º. This research shwed that dependent n when the PIF is added, the water temperature may be t lw t effectively eradicate all bacteria present. The vlume f the initial ht sht f water used fr a fur unce feed is abut ne fluid unce, and it is questinable as t whether this small vlume f water can adequately make cntact at the right temperature with the amunt f PIF added. The research suggests that this vlume f water is insufficient t maintain a temperature f greater than 70º fr the duratin f the tw minute windw First Steps Nutritin Trust: February 2015. Page 4

recmmended fr the additin f PIF. This data has nt been published in a peer-reviewed jurnal and therefre can nly be cnsidered as cntributry evidence at the present time 2. The Fd Standards agency made the fllwing statement when asked abut the safety f these frmula machines in 2014: The issues we have with it are, althugh it states it dispenses a ht sht at 70 t kill bacteria that ptentially culd be in the pwder, the reality (if yu watch the TT advert) is that this amunt f ht water used is very small, and nce this is dispensed int a cld bttle/cld pwder the heat will be quickly lst (mre s than when preparing a full bttle with cled, biled water t >70), s we wuld be interested t see whether TT have dne any validatin t see what temperatures the ht sht/pwder cmb actually reaches (and whether this is enugh t destry any bacteria).the ther issue, is that the rest f the bttle is then tpped up with cld water, which TT state is filtered t remve impurities. Again we wuld be interested t knw whether it has been validated that the TT filter remves ptential bacteria in the tap water (as this wn t previusly have been biled). At present the Fd Standards Agency wuld still advcate the use f ur Best Practice Guidance, t use cled, biled water at >70 t make up infant frmula. (Email cmmunicatin between Francesca Entwhistle (UNIEF) and Lrna Rwswell at FSA. February 2014) Department f Health guidance n frmula feeding des nt cver the use f frmula making machines, hwever in sme areas, fr example ambridgeshire mmunity NHS Trust and Lanarkshire NHS staff have been advised that these machines shuld nt be recmmended r prmted by staff since there is insufficient data available abut their safety. ambridgeshire mmunity NHS Trust state that: "Due t the inability t have cnfidence in all f these machines t crrectly prepare a bttle safely, staff must nt recmmend these and discuss with parents their danger."(ambridge mmunity Services NHS Trust, 2014) The cnvenience f this type f frmula preparatin machine is questinable as users are still required t sterilise all feeding equipment and wash surfaces and hands befre preparatin and accurately measure and add the PIF t the feeds. There are als maintenance issues t address such as changing filters and running de-scaling cycles - which cst bth time and mney. The nly benefit t parents appears t be the time saving assciated with nt having t wait fr water biled in a kettle t cl befre the milk pwder can be added. First Steps Nutritin Trust therefre believes that there remains insufficient evidence that these machines are safe in the preparatin f pwdered infant frmula, and recmmend that families and carers use cled, biled water at >70 t make up pwdered infant frmula as currently recmmended by the Department f Health. 2 Persnal cmmunicatin with First Steps Nutritin Trust First Steps Nutritin Trust: February 2015. Page 5