Why sterilise?

Because milk is such a good environment for the growth of bacteria, infant feeding equipment that has not been properly cleaned can be a source of infection1.

The thorough cleaning and sterilising of equipment used for feeding young babies is critical in avoiding infection2,3. This is the conclusion of a report by the European Food Safety Authority (EFSA) that recommends the use of both chemical and heating methods for sterilising.

The World Health Organisation (WHO) guidelines of 20074 are also consistent with these recommendations.

For the first few months of life and until they develop resistance, babies are very vulnerable to infections – of particular concern, those caused by bacteria like Salmonella2 and Cronobacter sakazakii2,5. In order to reduce the chance of infection it is recommended that infant formula feeds are made with boiled water that is at least 70°C and that formula should be made up fresh for each feed6. Some authorities now express the view that ‘Any woman who wishes to feed her baby formula milk should be taught how to make feeds’.

How long?

Parents should be advised to sterilize all equipment before it is used. This needs to be done before each use and for at least the first 6 months.

Equipment?

Depending on the chosen technique (see Which sterilizer?) parents will need a large pan with lid (not used for cooking), a steam sterilizer or a cold water sterilizer with fluid or tablets. They will also need bottles and teats, teat brush and teat tongs. All feeding equipment should be without cracks, scratches or damage as these can hide germs.

Preparation?

Before sterilising feeding equipment parents should follow the procedure below.

1. Wash hands and work surface thoroughly

2. Wash equipment thoroughly in hot soapy water. Use a bottle brush to clean inside and outside of bottles. Use a teat brush to remove all traces of milk from teats, then squirt water through them to remove any residue.

3. Thoroughly rinse all equipment in running water

When sterilising is complete

Before removing equipment, hands and surfaces should both be washed. Equipment should be removed just before using but if not being used immediately should be fully assembled in order to minimize possible contamination.

References.

1. Thompson J (2002) Benefits of breastfeeding and current controversies: part two. Community Pract 75, 106-107.

2. European Food Safety Authority (2004) Opinion of the Scientific Panel on Biological Hazards on a request from the Commission related to the microbiological risks in infant formulae and follow on formulae. EFSA Journal 113,1-35.

3. Rowan N & Anderson J (1998) Effectiveness of cleaning and disinfection procedures on the removal of enterotoxigenic Bacillus cereus from infant feeding bottles. J Food Prot 61, 196-200.

4. World Health Organisation/Food and Agriculture Organisation of the United Nations (2007) Safe preparation, storage and handling of powdered infant formula: Guidelines. http://www.who.int/foodsafety/publications/micro/pif_guidelinespdf

5. Forsythe SJ (2005) Enterobacter sakazakii and other bacteria in powdered infant milk formula. Matern Child Nutr 1, 44-55.

6. Food Standards Agency (2006) Guidance on preparing infant formula February 2006. http://www.food.gov.uk/news/newsarchive/2007/jul/nonsterile