WHO Preparation Guide
WORLD HEALTH ORGANIZATION FORMULA PREPARATION GUIDELINES
Preparing a feed using powdered infant formula (PIF)
It is best to make PIF fresh for each feed and to consume immediately, as reconstituted PIF provides ideal conditions for the growth of harmful bacteria. The steps below outline the safest way to prepare individual feeds of PIF in bottles or in feeding cups for immediate consumption.
1. Clean and disinfect a surface on which to prepare the feed.
2. Wash hands with soap and water, and dry using a clean cloth or a single-use napkin.
3. Boil a sufficient volume of safe water. If using an automatic kettle, wait until the kettle switches off; otherwise make sure that the water comes to a rolling boil. Note: bottled water is not sterile and must be boiled before use. Microwaves should never be used in the preparation of PIF as uneven heating may result in 'hot spots' that can scald the infant's mouth.
4. Taking care to avoid scalds, pour the appropriate amount of boiled water that has been allowed to cool to no less than 70 °C, into a cleaned and sterilized feeding cup or bottle. To achieve this temperature, the water should be left for no more than 30 minutes after boiling.
5. To the water, add the exact amount of formula as instructed on the label. Adding more or less powder than instructed could make infants ill. a. If using bottles: assemble the cleaned and sterilized parts of the bottle according to the manufacturer's instructions. Shake or swirl gently until the contents are mixed thoroughly, taking care to avoid scalds. b. If using feeding cups: mix thoroughly by stirring with a cleaned and sterilized spoon, taking care to avoid scalds.
6. Immediately after preparation, quickly cool feeds to feeding temperature by holding the bottle or feeding cup under running tap water, or by placing in a container of cold or iced water. Ensure that the level of the cooling water is below the top of the feeding cup or the lid of the bottle.
7. Dry the outside of the feeding cup or bottle with a clean or disposable cloth.
8. Because very hot water has been used to prepare the feed, it is essential that the feeding temperature is checked before feeding in order to avoid scalding the infant's mouth. If necessary, continue cooling as outlined in step 6.
9. Discard any feed that has not been consumed within two hours.
Preparing feeds in advance for later use
It is best to make PIF fresh for each feed and to consume immediately, as reconstituted PIF provides ideal conditions for the growth of harmful bacteria. For practical reasons, however, feeds may need to be prepared in advance. The steps below outline the safest way to prepare and store feeds for later use. If refrigeration is not available, feeds should be prepared fresh and consumed immediately rather than prepared in advance for later use.
1. Follow steps 1 to 7 of the preparation powdered infant formula guidelines
If using feeding cups, a batch of formula should be prepared in a clean, sterile jar that is no larger than 1 litre, with a lid. The prepared PIF can be refrigerated and dispensed into cups as needed.
2. Place cooled feeds in a refrigerator. The temperature of the refrigerator should be no higher than 5 °C.
3. Feeds can be stored in the refrigerator for up to 24 hours.