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Why are formula preparation instructions different in the UK and Africa?

This question was posted the Infant and young child feeding interventions forum area and has 4 replies. You can also reply via email – be sure to leave the subject unchanged.

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Leigh Elston

Normal user

28 Mar 2017, 10:15

The WHO recommends that the water for preparing baby formula should be at least 70C.

Brands such as Nestle and Similac do not follow these guidelines for the preparation of formula for their products sold in South Africa and Mozambique (and potentially elsewhere in Africa, but I haven't checked). On the tins of formula sold here it says water should be cooled to body temperature.

However, Similar does follow WHO guidelines on their tins of formula sold in the UK.

Do you know why there is this discrepancy?

I have contacted Nestle and they wouldn't answer my question. They said water should be body temperature to preserve the activities of probiotics.

But why isn't this the case for formula prepared in the UK?

Do you know if there is a difference between the ingredients of formula used in the UK and Africa? And what these are?

Many thanks in advance for your help on this.

Anonymous 2680

Normal user

28 Mar 2017, 12:11

Water for preparing artificial baby milk should reach a heat of 70°C (https://www.cdc.gov/features/cronobacter/) when added to the powder. This gives the best kill ratio for possible bacteria in the formula (such as enterobacter sakazakii). It may indeed inactivate some vitamins the probiotics too. But to acknowledge that would remove one of the hottest new selling points for artificial baby milk.

Here a a couple of readily accessible articles on the topic:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2717663/
https://ijponline.biomedcentral.com/articles/10.1186/s13052-016-0228-9

Dr Helen Crawley

First Steps Nutrition Trust

Normal user

28 Mar 2017, 13:57

Hi

In the UK we have managed to protect Infant formula making up guidelines to the WHO recommendations of >70C, and when a company tried to bring in a formula with probiotics as an infant formula, this was not allowed. However, if an infant milk is categorised as a 'food for special medical purposes' (even if this is not necessarily sold or used under medical supervision) then the Government does not insist that formula instructions say to use water >70C, so for formula with added carbohydrate ('stay-down' or anti-reflux formula) or those with probiotics for example then manufacturers are allowed to suggest lower temperatures and we cannot persuade the health departments to challenge this. Other EU countries do not have the same restrictions for temperature of water when making up infant formula with probiotics. In our report on specialised formula in the UK (all those that come under FSMP legislation) we highlight all those where the temperature recommendations are lower than WHO guidance, and have asked the companies why - you can find this on pages 34-36. http://www.firststepsnutrition.org/pdfs/Specialised_infant_milks_March2017.pdf

bw
Helen

Leigh Elston

Normal user

28 Mar 2017, 15:45

Thank you both for your replies to this

Mike Brady

Campaigns Coordinator/Baby Milk Action

Normal user

28 Mar 2017, 18:17

This requirement in the UK came about due to the work of Baby Milk Action and the Baby Feeding Law Group (BFLG), a coalition of UK health worker and mother support groups.

The issue of powdered formula not being sterile was one of the issues we said should be addressed when our Infant Formula and Follow-on Formula Regulations were updated in 2007. The requirement did not make it into the law, but was included in Guidance Notes on how to interpret the regulations produced by the Food Standards Agency. These have come under the Department of Health since 2010 when there was a change in government.

The labels in the UK give instructions to use boiled water that has not cooled for more than 30 minutes (which the Food Standards Agency found was more readily understandable than saying above 70 deg.C).

Much that is included in the Guidance Notes is ignored by the companies and not enforced, but the instructions have been changed. We have campaigned on this over the years, highlighting labels that had not changed, for example.

The Guidance Notes can be found here:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/204314/Infant_formula_guidance_2013_-_final_6_March.pdf

The specific section is this:

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Labelling relating to the preparation, storage and disposal of infant formula and follow-on formula

24. Regulation 17 (1)(d) and 18(1)(d) require that instructions are provided for appropriate preparation, storage and disposal of the product. The Department recommends that these instructions should include information noting that:

Powdered infant formulae and follow-on formulae are not sterile, and as such can contain harmful bacteria. It is therefore important to be very careful when preparing formula to reduce the risks. Boiled tap water (not bottled water) cooled for no more than 30 minutes should be used to prepare infant feeds.

All equipment used for feeding and preparing feed must be thoroughly cleaned and sterilised before use, and bottles should be made up fresh for each feed, as storing made- up formula milk may increase the chance of a baby becoming ill.

In our submission during the consultation, we highlighted that labels and information from companies were undermining the public health advice on reconstituting formula from WHO and the Food Standards Agency. You can find the full submission here (search the document for “sterile” for this specific information):
http://archive.babymilkaction.org/pdfs/bflgweb1007.pdf

There are other countries that have also taken action to implement the requirement. The Philippines is an example and we campaigned with IBFAN partners in the Philippines to stop Nestlé overturning the regulations. There is an image of the Philippines label on the campaign page here. The label warns “There is a likelihood that pathogenic microorganisms will be in this product if it is prepared and used inappropriately”:
http://www.babymilkaction.org/philippines2013

We have a sheet of Nestlé labels from around the world that does not look at the instructions, but the health claims used. This may be useful as it shows how Nestlé gets away with as much as it can where regulations are not implemented or enforced. See:
http://archive.babymilkaction.org/pdfs/nestlelabels13.pdf

Nestlé’s claims to the public regarding labelling are analysed in this response from the company:
http://www.babymilkaction.org/nestle-response-2014

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