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how long do you boil water for 1. infant formula use 2. sterilisation of bottles

This question was posted the Infant and young child feeding interventions forum area and has 9 replies.

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Mija

Normal user

27 Jul 2022, 14:36

Hi all, I am looking for your specific recommendations on duration of boiling water in the contexts you work. 

1. What is your recommendation on the duration of boiling water to make water safe for use with powdered BMS.                                                                                      

2. How long do you recommend to boil bottles/teats in water to 'sterilise' it?      

I read and hear various durations: 1, 3, 5 and 10 min but like your opinion/source.

Let me know your recoomendations for which contexts/country and your source (if you have one).

Thanks so much, Mija
 

Jay Berkley

Professor of Parediatric Infectious Diseases

Frequent user

28 Jul 2022, 09:46

CDC recommend one minute: https://www.cdc.gov/healthywater/pdf/drinking/Backcountry_Water_Treatment-508.pdf

However, this is  conservative as enteric bacteria and viruses would not survive even a few seconds at the boiling point of water.

Jay Berkley

Professor of Parediatric Infectious Diseases

Frequent user

28 Jul 2022, 09:50

Just to add for bottles and teats, these items need to come up to the boiling temperature of water, to be sure this happens, a longer period id recommended, e.g. 10 minutes:

https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/sterilising-baby-bottles/

Anonymous 31975

Normal user

28 Jul 2022, 10:40

For anyone not aware of the inherent risk in powdered formula, boiling water is required too because of things like chronobacter and e-coli.

https://www.cdc.gov/cronobacter/pdf/Cronobacter-prevention-infographic-html.pdf

This is how it's taught in the NHS UK: https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/making-up-baby-formula/ 

Hope that's useful

Mija

Normal user

28 Jul 2022, 16:03

Thanks Jay and Anonymous. Some additonal queries.

Concerning point  1.The NHS site states 'boil the water' (for preparation of infant formula), but does not state for how long. Meaning bring water to boil and then slowly let it cool. 

CDC states 1 min.

Concerning point 2. For the sterilisation of equipment NHS states 10 min boiling. 

However, both recommend for domestic audiences (UK, USA) where tap water is generally clear and safe to consume. What about tap water in contexts in low or middle income countries (LMIC) in a disaster setting? In case bottled water is not available for formula preparation, would the 1 minute recommendation be sufficient for tap water - point 1?

Is 10 min always sufficient even in some (disaster) contexts in LMIC for point 2, sterilisation of equipment?

Anonymous 31975

Normal user

28 Jul 2022, 16:21

Whilst these guides are for emergencies, the same principles apply. Diluted bleach can eradicate the need for heating water if an issue. Or sodium hypochloride.See guides for details.

1. https://www.cdc.gov/nutrition/emergencies-infant-feeding/cleaning-feeding-items.html

2. https://www.cdc.gov/healthywater/emergency/making-water-safe.html

3. https://www.cdc.gov/nutrition/emergencies-infant-feeding/downloads/pages/Clean-Infant-Feeding-ItemsIYCF-E-H.pdf

Cups can be simpler and safer than bottles and teats in low resource settings, and require less complex cleaning regimens.

4. https://www.cdc.gov/nutrition/emergencies-infant-feeding/cup-feeding.html

Hope that's helpful.

A. Mackenzie, IBCLC (I need to change my handle lol)

Vicky Sibson

First Steps Nutrition Trust

Normal user

28 Jul 2022, 22:52

Hi Mija

on the NHS recommendation to used boiled water for make up PIF, I've never stopped to think about it but I think there is no time on the recommendation for boiling because the context is to use a kettle, and as most people in the U.K. would use an electric kettle this comes to the boil and then goes off. Does that make sense? Ie the recommendation implies boil the water for ??30seconds. Nb also relevant context is that the water being boiled is meant to be tap water.

Best wishes 

Vicky 

Jay Berkley

Professor of Parediatric Infectious Diseases

Frequent user

29 Jul 2022, 13:12

Hi Mija

The CDC guideline I gave was not for tap water but 'backcountry water' - 1 minute boiling water is more than adequate to kill all viruses and bacteria.

For equipment, provided it is not at very high altitiude (lower boiling temperature) 10 minute is more than enough to bring the equipment up to 100 degrees C. It does not depend on the type or quantity of bacteria.

Jay

Jodine Chase - SafelyFed

Co-Lead, SafelyFed Canada

Normal user

29 Jul 2022, 13:36

Such an interesting question, Mija. I notice the CDC IYCF-E guidance provided by Annabelle above says boil for five minutes for sterilizing (which the CDC says should be fine for infants under the age of 2 months or if infants are sick.) 

(I also notice they don't specific the bleach concentration in their guidance for cold sterilization, which I believe is a problem since bleach concentration varies wildly with products, (in my experience it can range from 2-8 per cent in North America and at least some brands synonymous  with bleach have no bleach at all.) Recently bleach manufacturers started taking concentration off labels so you have to visit a website to confirm.)

In Canada our guidance was reiterated earlier this year. https://www.canada.ca/en/health-canada/services/milk-infant-formula/preparing-handling-powdered-infant-formula.html

We also say 2 minutes for boiling both for sterilizing equipment and for prep for powdered formula. We also revised our guidance on the latter some years ago to recommend water boiled for 2 min and then cooled to 70C to only infants under 2 mo of age or immune compromised. 

-- Jodine Chase

Maryse Arendt

Lactation consultants Luxemburg BLL - IBFAN

Normal user

29 Jul 2022, 14:17

hello

This is what WHO is saying in their guidelines. I have identified information on page 12, 16 and 17 https://www.who.int/publications/i/item/9789241595414

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