Industry concerned about WHO recommendation to prepare infant formula with hot water(>70 degrees C)

Formula Manufacturers have raised concerns over the WHO's recent guideline that recommends that the powdered formula be added to boiled water cooled to no less than 70°C.

The  Australian Infant Feeding Guidelines for Health Workers recommend the addition of powdered infant formula to cooled ('lukewarm') boiled water. The basis of WHO's recommendation is that powdered infant formula is not sterile and has been linked to death/ illness in susceptible infants due to bacterial contamination by Enterobacter sakazaki and Salmonella enterica.

The concerns raised by IFMAA and NZIFMA in their position statement are:- 1. E.sakazakii infection is rare and results mainly from incorrect storage of prepared infant formula rather than formula preparation itself. 2. The risk of scalding the infant is high if formula is prepared with water at 70 degrees C, rather than at  lukewarm or body timperature of 37 degrees C. The formula will need to sit for about 30 mins to reach a suitable temperature for feeding, allowing bacteria to grow. 3. Nutrients in the infant formula are at risk of being destroyed 4. May encourage parents to make formula bottles ahead of time rather than just before feeding, increasing the risk of bacterial growth through incorrect storage. 5. May cause undue parental stress  as sterile thermometres will be required to measure water temperature; increased waiting time for cooling formula before being fed; danger of scalds from steam and the possiblity of the bottle top 'exploding' when the sealed bottle with prepared formula is shaken.

References. 1. WHO. Guidelines for the safe preparation, storage and handling of powdered infant formula, 2007  www.who.int/foodsafety/publications/micro/pif2007/en/print.html

2. IFMAA & NZIFMAA. Positon on the safe preparation and handling of powdered infant formula - concerns about WHO recommendation to prepare at 70 degrees C. February 2008 www.ifmaa.org/hotwater.pdf