Formula feed preparation: helping reduce the risks; a systematic review

Abstract

Aims:To assess what is known about the risks associated with errors in reconstituting the present generation of infant formula feeds, and to examine which methods are likely to be safest. Methods: Systematic review, and examination of the range of infant formula products currently on sale in the UK. Studies from developed countries conducted after 1977 were included. All studies investigating the reconstitution of formula feeds for full term, healthy babies were eligible. Parameters studied were: measures of accuracy of feed reconstitution including fat, protein, total solids, energy content, and osmolality of feed; weight of powder in scoop; and reported method of preparing feed and measuring powder. Formula products were collected from one large UK supermarket in 2002. Number of different types of infant formula preparations available for sale were determined, together with scoop sizes for powdered preparations. Results: Only five studies were identified, none of adequate quality or size. All found errors in reconstitution, with a tendency to over-concentrate feeds; under-concentration also occurred. Thirty one different formula preparations were available for sale in one UK supermarket, with a range of scoop sizes. Some preparations had never been tested. Conclusions: There is a paucity of evidence available to inform the proper use of breast milk substitutes, and a large array of different preparations for sale. Given the impact incorrect reconstitution of formula feeds can have on the health of large numbers of babies, there is an important and urgent need to examine ways of minimising the risks of feed preparation. B reast feeding is the safest way to feed babies. For the majority of babies in all countries it is a perfect source of nutrition 1 and is available, ready-to-feed, via a clean delivery system. Breast feeding protects against infection, [2][3][4] and has benefits for health in childhood and beyond. [5][6][7] National and international agencies recognise the superiority of breast feeding and support it unequivocally.1 8 However, many babies in many countries are not breast fed.In the UK, in spite of initiatives to encourage more women to breast feed their babies, and to do so for longer, 9-11 over the past 20 years there has been no real change in the proportion of babies who are breast fed at birth. 12 In 2000, by 4-10 weeks of age (the first stage of the most recent national survey), 75% of babies were either exclusively fed on formula milks, or were receiving a combination of breast and formula feeds.12 These figures, which reflect infant feeding patterns in many westernised populations, highlight the fact that most babies in the UK are fed, wholly or in part, on breast milk substitutes. It is, therefore, important that while attempting to increase the prevalence and duration of breast feeding, 9 13-15 attempts should also be made to minimise the risks associated with artificial feeding.The most common breast milk substitutes are formula feeds manufactured as dried powders, reconstituted by ad...

Evidence of Oxidative Stress in Relation to Feeding Type During Early Life in Premature Infants

“…We have found that human milk with HMF allows bacterial growth within 1 h (unpublished). There is a paucity of information on the proper reconstitution and use of human breast milk substitutes (37). Typical errors include over-and under concentration, but there are persistent clinical questions as to the need for sterility, the safety and means of storage, and liquid versus powder formulations.…”

Mothers who Formula Feed: Their Practices, Support Needs and Factors Influencing their Infant Feeding Decision

“…Despite the recognised health (Kramer and Kakuma, 2002;Harder et al, 2005;Quigley et al, 2007) and safety (Renfrew et al, 2003;WHO, 2003) benefits of breastfeeding, many babies worldwide are not breastfed (Organisation for Economic Cooperation and Development, 2009). National and regional data report that 55% (National Perinatal Statistics, 2009) and 66% (Tarrant et al, 2010a) …”

Nain, Mam and Me: Historical artefacts as prompts for reminiscence, reflection and conversation about feeding babies. A qualitative development study

“…Survey research indicates that while most mothers tend to understand the new guidelines, this knowledge has not always translated into compliance (Moore et al, 2014). A systematic review published in 2003 found that mothers commonly make errors in reconstitution of formula milks, with a tendency to over-concentrate feeds, and highlighted potential for confusion stemming from the wide range of different formula preparations that were available for sale in the UK supermarket, with a range of scoop sizes (Renfrew et al, 2003). The onus on mothers to make 'critical choices' about feeding has an impact on consumer decisions about which formula milks, baby foods and feeding-related items to use (Afflerback et al, 2013).…”