Powdered Infant Formula: When and How to Use It Safely

Powdered infant formula is a convenient, cost-effective way to nourish a formula-fed baby. However, unlike commercially produced liquid formula, it cannot be sterilized. This puts children under one year of age at risk for contracting a rare severe infection with a germ called Cronobacter sakazakii. According to the World Health Organization the groups of infants at greatest risk are babies less than 2 months old, pre-term infants, low-birth-weight (<2.5 kg/5 lb 8 oz) infants or immunocompromised infants. However, infants who are compromised for any other reason may also be at greater risk of this infection.

From the Centers for Disease Control and Prevention*

Getting sick with Cronobacter does not happen often, but infections in young infants can be deadly. Learn here what steps you can take to protect your baby from getting sick.

Cronobacter, formerly known as Enterobacter sakazakii, is a group of germs that can be found naturally in the environment. The germs
can also live in dry foods, such as powdered infant formula, powdered milk, herbal teas, and starches. Health officials have also found Cronobacter germs in other places like sewer water. Anybody can get sick from Cronobacter, but the infection occurs most often
in infants.

Rare, but Serious Illness in Infants

Cronobacter infections are rare, but they can be deadly in newborns. Infections in infants usually occur in the first days or weeks of life. CDC is usually informed of about 4-6 cases a year, however state health departments are not required to report Crononbacter infections to CDC.

Cronobacter germs can cause dangerous blood infections (sepsis) or infections of the linings surrounding the brain and spine (meningitis). Infants two months of age and younger are most likely to develop meningitis if they get sick with Cronobacter. Infants born prematurely and infants with a lower ability to fight germs and sickness due to illness (such as HIV) or medical treatment (such as chemotherapy for cancer) are also more likely to get sick.

The first symptom of Cronobacter infection in infants is usually a fever, coupled with poor feeding, crying, or very low energy. Parents or caregivers should take an infant with these symptoms to see a doctor.

Follow these 5 guidelines to protect your baby from Cronobacter:

  1. Breastfeed. Breastfeeding is one of the best things you can do for your baby’s health, and benefits include preventing many kinds of infections. CDC reported very few cases of Cronobacter infections among infants who were fed only breast milk and no formula or other foods.
  2. Clean, sanitize, and store feeding items and breast pump parts safely. You can help prevent contamination with germs and keep the milk you feed your baby safe by carefully cleaning, sanitizing, and safely storing
    • baby bottles,
    • other feeding items,
    • breast pump parts (if you are pumping milk).

            For detailed information visit How to Clean, Sanitize, and Store Infant Feeding Items and How to Keep Your              Breast Pump Clean: The Essentials.

        3. Use liquid formula [concentrate or ready-to-feed], when possible. If your baby gets formula, choose infant                  formula sold in liquid form over powdered, especially when your baby is a newborn or very young. Liquid                          formula is made to be germ-free and should not contain Cronobacter germs.

  1. Prepare powdered infant formula safely. Keep powdered formula lids and scoops clean and close containers of infant formula or bottled water as soon as possible. The best way to prepare formula is to follow the steps below:
  • Warm water to at least 158 °F /70 °C and pour it into the bottle.
  • Add formula, and carefully shake, rather than stir the bottle.
  • Cool the formula to ensure it is not too hot before feeding your baby by running the prepared, capped bottle under cool water or placing it into an ice bath, taking care to keep the cooling water from getting into the bottle or on the nipple.
  • Before feeding the baby, test the temperature by shaking a few drops on your wrist.
  • Use formula within 2 hours of preparation. If your baby does not finish the entire bottle of formula, throw away         the unused formula. If you do not plan to use the prepared formula right away, refrigerate it immediately and         use it within 24 hours. Refrigeration slows the growth of germs and increase safety. Remember, when in doubt,     throw it out.
  1. Practice proper hygiene! Always wash your hands carefully with soap and water during key times.
    • Before preparing and feeding bottles or foods to your baby.
    • Before touching your baby’s mouth.
    • Before touching pacifiers or other things that go into your baby’s mouth.
    • After using the toilet or changing diapers.

            If soap and water are not available, use an alcohol-based hand sanitizer with at least 60% alcohol (check the                    product label to be sure). Hand sanitizer with at least 60% alcohol is effective in killing Cronobacter germs. But                  use soap and water as soon as possible afterward because hand sanitizer does not kill all types of germs and                  may not work as well if hands are visibly greasy or dirty. It is also important to keep all objects that enter a                          baby’s mouth (such as pacifiers and teethers) clean.