One of the most enjoyable moments while caring for infants is holding and cuddling them during bottle feeding. For the infant, that bottle represents love, warmth, a full tummy, and afterwards, a satisfied burp! As a caregiver in the childcare setting, it is important to keep bottled breast milk and infant formula safe. A few simple policies and procedures can assure that the bottle provides infants with nourishment, and not harmful bacteria or other hazards.
First, the childcare provider must decide if parents are to provide bottles from home "ready to feed," commercially prepared (canned) formula is brought and empty bottles provided, or if caregivers are to prepare bottles using dry formula. The childcare program policy should be clearly stated and provided to each parent in writing. Most parents provide bottles each day "ready to feed." However, for infants taking formula, it could be beneficial to have unopened commercially prepared containers of each child's formula on hand in case a parent forgets the bottles, a bottle spills, or the parent is later than usual and the child needs an additional bottle.
Whether bottles are brought from home or are prepared on site, each bottle should be labeled with the infant's full name and that day's date. Then, only use bottles labeled for that date. Unlabeled bottles should not be accepted or used. This assures that the correct child receives the bottle intended for them. It also is helpful when the label indicates whether the bottle contains infant formula (F) or breast milk (B). The color, consistency, and odor of breast milk vary depending upon the mother's diet, whereas formula should appear and smell the same each day. A change in appearance or odor of the formula could indicate the presence of bacteria or other contaminants.
The bottles should be immediately stored in a refrigerator by the caregiver. Use caution to keep the bottles away from potentially hazardous foods such as thawing meats. A thermometer should be easily visible at all times in that refrigerator to be sure the temperature is 39 degrees F. or below.
At the end of each work day the refrigerator should be checked and unused bottles sent home with the parent. Some parents prefer that after the child is fed, the bottle with any remaining milk be placed in the diaper bag so that they can see how much the infant consumed during that particular feeding. Other parents request that caregiver empty and rinse the bottle and place the empty bottle in the diaper bag.
Another recommendation is that the same bottle should not be used for two feedings; bottles should be prepared with just enough milk for a single feeding. The reason is that the infant's mouth has come in contact with the milk. The normal microorganisms found in the infant's mouth then mix with the breast milk or formula, which provides a place where these microorganisms can grow to potentially harmful levels. Neither refrigeration nor reheating will prevent this growth. Another recommendation is that the baby's feeding be completed in an hour to ensure the formula will still be safe.
It also is important to follow proper and safe warming techniques:
- Thaw bottles of frozen formula or expressed breast milk in the refrigerator or under cold water. Thawing bottles at room temperature can allow unsafe levels of bacteria to develop.
- It is not safe to warm bottles in a microwave. Serious burns may occur because of "hot spots" in the bottle. Also, using a microwave oven to warm breast milk can change the milk's composition.
- To safely warm refrigerated bottles, take bottles to an area away from children, loosen the cap of the bottle, and heat it in a pan of hot (not boiling) water for five minutes. The immunological components of breast milk can be destroyed if the water in the pan is too hot.
- Always shake the bottle after heating to prevent "hot spots," then check the temperature by shaking a few drops out onto the back of your hand. It should feel cool or slightly warm. Remember, a baby's mouth and skin are very sensitive. Milk that feels warm to you will probably be too hot for the infant.
Following safe handling procedures for bottled breast milk and infant formula is essential to the safe feeding of young children.
What if a child is given the wrong bottle?
With proper labeling and storage, there should be little room for errors. However, it is possible for a child to receive the wrong bottle, especially if two infants have the same initials or name. If a child mistakenly receives the wrong bottle, immediately check the contents to determine if the bottle contained breast milk or formula.
If the bottle contained formula, immediately contact the parents to be sure the child is not allergic or sensitive to the milk or formula given.
If a bottle of breast milk is mistakenly given to the wrong child, the parents should be immediately informed that their child was given another child's bottle of expressed milk.
Ask the mother when the breast milk was expressed and asked how it was handled before being brought into the childcare setting. Provide this information along with (or in addition to) details on how the bottle was handled in the childcare setting to the child's parents.
Although the risk of contamination is very small, it should be treated as a possible HIV exposure. Recommended procedures for a possible HIV exposure from breast milk are as follows:
The parents should notify the child's physician of the situation. The physician may recommend a baseline test for HIV.
The mother of the child who supplied the expressed breast milk may be asked if she has ever had an HIV test. If she has not, or does not know if she has had a test, ask if she would be willing to have one and share the results.
Childcare providers have very little risk of being exposed to HIV through breast milk. Skin and mucous membrane exposure to HIV is very low; therefore, staff does not need to wear gloves when feeding children bottles of expressed milk. If breast milk is spilled on the skin, the area should be washed with soap and water.
Pamela David, RD
Nutrition Consultants, Inc.
Baby Fit, babyfit.com/articles.asp?id=429
Baby Bottle Safety, www.babybottle.org
National Network for Child Care, www.nncc.org/Health/cc23_babyfood.safe.html
North Carolina Dept. Health & Human Services, www.nutritionnc.com/snp/00-01.htm