In a Baby-Friendly Facility:
1. There cannot be formula of any type: True or False
2. All patients, regardless of feeding choice, should be taught safe preparation and storage of artificial infant milk (AIM): True or False
3. Policies should address only breastfeeding: True or False
If you answered false for each of these questions, you are correct. Formula or AIM has a place and time for proper use. And in a facility that is on a pathway to Baby-Friendly designation, mothers who make an informed choice not to breastfeed, need respect for their decision and one-to-one instruction on the proper preparation and storage of AIM. As well, their education should include feeding based on infant cues of hunger and satiety.
As you know, powdered infant formula is not a sterile product, and has been found to contain Clostridia botulinum, Enterobacter sakazakii now called Cronobacter sakazakii, and Salmonella enterica. Preterm infants are at risk in the development of bacteremia past the age one month and term infants are at risk for meningitis at less than one month of age, caused by C. sakazakii. Some cases have resulted in death. The risk of infant infection with Salmonella enterica is 8 times higher than that of the adult population. Clostridia spores of 12 different varieties were isolated in a 2009 study by Barash, Hsia, and Arnon. Although no neurotoxigneic clostridia were found in this small study, the authors state, "The isolation of C. sporogenes and potentially pathogenic clostridia from U.S.-manufactured PIF (powdered infant formula) suggests that neurotoxigenic clostridial spores have the potential to be present in these products."
The World Health Organization has a teaching tool at this link: http://www.who.int/foodsafety/publications/micro/PIF_Care_en.pdf and other sources have shorter versions, all in multiple languages for the safe preparation and storage of powdered infant formula. http://www.foodsafetynews.com/2016/04/125714/#.WI5NOfkrKUk http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm285401.htm. In the U.S., the Federal Women's Infant's and Children's (WIC) Program has new criteria and handouts on safe preparation of powdered infant formula.
Barash, J. R., Hsia, J. K., & Arnon, S. S. (2009). Presence of soil-dwelling clostridia in commercial powdered infant formulas. The Journal of Pediatrics, www.jpeds.com. doi: 10.1016/j.jpeds.2009.09.072
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Last Updated: September 2018