Selection, Preparation, and Storage of
Infant Formula
To assure that infant formula is safe for consumption, the infant formula must be properly selected, prepared, and stored and bottles must be properly sanitized.
Selecting Cans of Infant Formula
Encourage caregivers to take these steps when selecting and using cans of infant formula:
Infants 3 months of age and younger are more likely to contract illnesses from micro- organisms in bottles and nipples that are improperly cleaned, cleaned in contaminated water, or filled with contaminated water. Therefore, for infants less than 3 months old, glass or hard plastic bottles and bottle parts (nipples, caps, rings) should first be thoroughly cleaned using soap, hot water, and bottle and nipple brushes, and then either be sterilized in boiling water for 5 minutes, or washed in a properly functioning dishwasher machine. If disposable plastic bottle liners are used, the bags should be discarded after one use and the nipples, rings, and caps sterilized in boiling water or washed in a dishwasher until the infant is at least 3 months old. After 3 months, unless otherwise indicated by a health care provider, bottles should be thoroughly washed using soap and hot water and bottle and nipple brushes or cleaned in a dishwasher.
As a precaution, it is generally recommended to boil the water used for infant formula preparation during the first 3 months of life. Caregivers should consult their health care providers regarding whether the water used for preparing infant formula or for feeding should be boiled for the infant older than 3 months. If a caregiver is in doubt about the safety of the water supply or if there are reports in the community about the water supply being contaminated, he should find an alternate source of clean water and consult his health care provider as soon as possible.
Caregivers can boil water to make infant formula by bringing the water to a rolling boil, boiling it for 1–2 minutes, and then letting it cool.
The terminal sterilization of infant formula, which involves filling clean bottles with properly diluted infant formula first and then boiling all the formula-containing bottles in water, is not recommended because boiling destroys certain nutrients (e.g., folate and other water-soluble vitamins).
Preparing Infant Formula
Powdered infant formula is prepared by mixing one unpacked level scoop of dry powder to 2 ounces of sterile water. Concentrated infant formula is prepared by adding equal parts of water to concentrated liquid. Ready-to feed infant formula is ready for the infant to consume. These preparations will yield an infant formula that is approximately 20 calories per ounce.
General guidelines for infant formula preparation are provided; however, the caregiver should always follow the manufacturer’s instructions for preparation. Although infant formula cans include written instructions for preparation, caregivers may not be able to read or understand those instructions. If they are unable to read English but can read another language, printed instructions should be provided in their own language. Infant formula preparation instructions designed in picture format can be used for low-literacy or illiterate participants.
It is very important to prepare infant formula properly. Increasing the water-to-formula ratio is never recommended because it will yield a lowercalorie formula, which will not meet the infant’s calorie requirements. Decreasing the water-to formula ratio may be recommended for infants who are failing to thrive, but it should only be done when recommended by the infant’s health care provider. Infants consuming incorrectly reconstituted infant formula may develop serious health problems. Under-diluted infant formula (containing too little water) puts an excessive burden on an infant’s kidneys and digestive system and may lead to dehydration. This problem becomes worse if the infant has increased fluid needs due to fever or infection. Over-diluted infant formula (containing too much water) may contribute to growth problems, nutrient deficiencies, and water intoxication.
Store bottles of prepared infant formula in a properly functioning refrigerator until ready to use. Bacterial growth is reduced when infant formula is kept in a refrigerator at temperatures at 40 degrees Fahrenheit or below. (Use a special thermometer to test if the refrigerator is at the appropriate temperature.) Caregivers should always consult their health care provider and follow the manufacturer’s label instructions for infant formula storage procedures. In general, it is recommended that caregivers:
Traveling With Infant Formula
When traveling, caregivers can take along a can of powdered infant formula and separate water in clean bottles (or sterilized bottles for infants under 3 months old). Then, the infant formula can be mixed up to make single bottles when needed. Alternately, single servings of readyto-feed infant formula can be used. It is not recommended to travel with bottles of prepared infant formula held at room temperature.
Storing Infant Formula
Prepared infant formula is a highly perishable food that must be stored properly for safe consumption.
The following guidelines are recommended to prevent spoilage of infant formula:
Warming Infant Formula
The following guidelines are recommended to warm refrigerated infant formula:
Guidelines for Using Infant Formula When There Is Limited Access to Common Kitchen Appliances
The following guidelines regarding use of standard milk- and soy-based infant formulas are recommended for caregivers with limited access to a refrigerator or stove (or when their own appliances are not functioning properly; e.g., a caregiver’s refrigerator is not working and not keeping foods at or below 40 degrees Fahrenheit).
If there is no access to a refrigerator:
If there is no access to a stove or dishwasher:
Guidelines for Using Infant Formula After a Natural Disaster or Power Outage
The Centers for Disease Control and Prevention (CDC) recommends the following after a natural disaster or power outage:
Selecting Cans of Infant Formula
Encourage caregivers to take these steps when selecting and using cans of infant formula:
- Check the infant formula’s expiration date on the label, lid, or bottom of the can. If the expiration date has passed, then the infant formula has expired and should not be used.
- Do not select cans of infant formula that have dents, leaks, bulges, puffed ends, pinched tops or bottoms, or rust spots. These characteristics indicate that the product quality may be diminished and the product is unsafe.
- Store cans of infant formula in a cool, indoor place – not in vehicles, garages, or outdoors.
Infants 3 months of age and younger are more likely to contract illnesses from micro- organisms in bottles and nipples that are improperly cleaned, cleaned in contaminated water, or filled with contaminated water. Therefore, for infants less than 3 months old, glass or hard plastic bottles and bottle parts (nipples, caps, rings) should first be thoroughly cleaned using soap, hot water, and bottle and nipple brushes, and then either be sterilized in boiling water for 5 minutes, or washed in a properly functioning dishwasher machine. If disposable plastic bottle liners are used, the bags should be discarded after one use and the nipples, rings, and caps sterilized in boiling water or washed in a dishwasher until the infant is at least 3 months old. After 3 months, unless otherwise indicated by a health care provider, bottles should be thoroughly washed using soap and hot water and bottle and nipple brushes or cleaned in a dishwasher.
As a precaution, it is generally recommended to boil the water used for infant formula preparation during the first 3 months of life. Caregivers should consult their health care providers regarding whether the water used for preparing infant formula or for feeding should be boiled for the infant older than 3 months. If a caregiver is in doubt about the safety of the water supply or if there are reports in the community about the water supply being contaminated, he should find an alternate source of clean water and consult his health care provider as soon as possible.
Caregivers can boil water to make infant formula by bringing the water to a rolling boil, boiling it for 1–2 minutes, and then letting it cool.
The terminal sterilization of infant formula, which involves filling clean bottles with properly diluted infant formula first and then boiling all the formula-containing bottles in water, is not recommended because boiling destroys certain nutrients (e.g., folate and other water-soluble vitamins).
Preparing Infant Formula
Powdered infant formula is prepared by mixing one unpacked level scoop of dry powder to 2 ounces of sterile water. Concentrated infant formula is prepared by adding equal parts of water to concentrated liquid. Ready-to feed infant formula is ready for the infant to consume. These preparations will yield an infant formula that is approximately 20 calories per ounce.
General guidelines for infant formula preparation are provided; however, the caregiver should always follow the manufacturer’s instructions for preparation. Although infant formula cans include written instructions for preparation, caregivers may not be able to read or understand those instructions. If they are unable to read English but can read another language, printed instructions should be provided in their own language. Infant formula preparation instructions designed in picture format can be used for low-literacy or illiterate participants.
It is very important to prepare infant formula properly. Increasing the water-to-formula ratio is never recommended because it will yield a lowercalorie formula, which will not meet the infant’s calorie requirements. Decreasing the water-to formula ratio may be recommended for infants who are failing to thrive, but it should only be done when recommended by the infant’s health care provider. Infants consuming incorrectly reconstituted infant formula may develop serious health problems. Under-diluted infant formula (containing too little water) puts an excessive burden on an infant’s kidneys and digestive system and may lead to dehydration. This problem becomes worse if the infant has increased fluid needs due to fever or infection. Over-diluted infant formula (containing too much water) may contribute to growth problems, nutrient deficiencies, and water intoxication.
Store bottles of prepared infant formula in a properly functioning refrigerator until ready to use. Bacterial growth is reduced when infant formula is kept in a refrigerator at temperatures at 40 degrees Fahrenheit or below. (Use a special thermometer to test if the refrigerator is at the appropriate temperature.) Caregivers should always consult their health care provider and follow the manufacturer’s label instructions for infant formula storage procedures. In general, it is recommended that caregivers:
- Use refrigerated bottles of concentrated or ready-to-feed infant formula within 48 hours of preparation or
- Use refrigerated bottles of powdered infant formula within 24 hours of preparation.
- Opened cans of concentrated or ready-to-feed infant formula should be covered, refrigerated, and used within 48 hours. Freezing infant formula is not recommended.
- Powdered infant formula should be tightly covered and stored in a cool, dry place and used within a month after opening.
- Discard any infant formula remaining after a feeding. The mixture of infant formula with saliva provides an ideal breeding ground for disease-causing micro-organisms.
- Infant formula that is removed from refrigeration should be used within 1 hour or discarded.
- Before reusing any bottles or their parts, they should be cleaned and sanitized
Traveling With Infant Formula
When traveling, caregivers can take along a can of powdered infant formula and separate water in clean bottles (or sterilized bottles for infants under 3 months old). Then, the infant formula can be mixed up to make single bottles when needed. Alternately, single servings of readyto-feed infant formula can be used. It is not recommended to travel with bottles of prepared infant formula held at room temperature.
Storing Infant Formula
Prepared infant formula is a highly perishable food that must be stored properly for safe consumption.
The following guidelines are recommended to prevent spoilage of infant formula:
Warming Infant Formula
The following guidelines are recommended to warm refrigerated infant formula:
- For infants who prefer a warmed bottle, warm the bottle immediately before serving.
- A safe method of warming a bottle is to hold it under running warm tap water. Shake he bottle before testing the temperature. Always test the temperature before feeding to make sure that it is not too hot or cold (test by squirting a couple of drops onto the back ofyour hand).
- Warm only as much infant formula as you think will be needed for a feeding.
- Never use a microwave oven to warm infant formula because this practice is dangerous. Liquid in a bottle may become very hot when heated in a microwave oven and remain hot afterwards even though the bottle feels cool. Infants have been seriously burned while being fed liquids warmed in microwave ovens. Covered bottles, especially vacuum-sealed and metal-capped bottles of ready-to-feed infant formula, can explode when heated in a microwave oven
Guidelines for Using Infant Formula When There Is Limited Access to Common Kitchen Appliances
The following guidelines regarding use of standard milk- and soy-based infant formulas are recommended for caregivers with limited access to a refrigerator or stove (or when their own appliances are not functioning properly; e.g., a caregiver’s refrigerator is not working and not keeping foods at or below 40 degrees Fahrenheit).
If there is no access to a refrigerator:
- Use powdered infant formula instead of 32 ounce ready-to-feed cans or 13 ounceconcentrated cans. The latter two are designed for the preparation of multiple bottles ofinfant formula at one time and require use of a refrigerator for storage. Alternately, readyto- feed infant formula in 8 ounce servings can be used.
- Follow instructions for properly sanitizing bottles and water
- Prepare one bottle at a time, if powdered infant formula is used; fill it with the approximate amount of infant formula that the infant can consume at one feeding. Make sure to scoop the powder out of the can using a clean, dry scoop when preparing infant formula. Make sure no liquid enters the can because it will facilitate the growth of bacteria and spoilage of the infant formula.
- Use infant formula immediately after it is prepared or after a ready-to-feed can or nursette is opened.
- Discard any infant formula left over after a feeding or infant formula that has been sitting at room temperature for more than 1 hour.
If there is no access to a stove or dishwasher:
- Nursette bottles are the ideal packaging of infant formula to use for infants less than 3 months old when a stove or a dishwasher (for sterilizing bottles and their parts and boiling the water) is not available.
Guidelines for Using Infant Formula After a Natural Disaster or Power Outage
The Centers for Disease Control and Prevention (CDC) recommends the following after a natural disaster or power outage:
- Use ready-to-feed infant formula if possible.
- Use bottled water to prepare powdered or liquid concentrated infant formula.
- If bottled water is not available, use boiled water. Use treated water (treated with chlorine or iodine to disinfect it per manufacturers directions) to prepare infant formula only if bottled or boiled water is not available.