ARTIFICIAL INFANT FOODS: Avoiding infection caused by bacteria in baby milk
What’s the risk?
Babies are born with immature immune systems and rapidly developing organs. They do not have the same capacity as adults to fight off bacterial infection.
Breast milk provides your baby with both active and passive immunity to protect against infection. Artificial feeding does not provide these protective antibodies and anti-infective agents.
Bacteria and pathogens live all around us, and they love to breed in warm milk. Unfortunately, powdered artificial infant milks and formulas are not sterile products: they can contain trace amounts of bacteria and these will multiply rapidly once water is added to make up the milk for the baby´s feed.
Many bacteria are harmless, but some – such as Salmonella and Enterobacter species – can cause serious illnesses, including meningitis, enteritis, septicaemia and even death. This risk is greatest in areas with hot climates without refrigeration or adequate fuel to prepare products safely.
How can I reduce my baby’s risk of exposure to bacterial infection?
You can work to minimize your baby’s risk of exposure to harmful bacteria by using World Health Organization Guidelines on the safe preparation, storage and handling of powdered infant formula: http://www.who.int/foodsafety/publications/micro/pif2007/en/ . These Guidelines state: "Powdered infant formula has been associated with illness and death in infants due to infections with Enterobacter sakazakii. During production, powdered milks can become contaminated with harmful bacteria, such as Enterobacter sakazakii and Salmonella. This is because, using current manufacturing technology, it is not feasible to produce sterile powdered formulas."
The WHO recommendations are summarized here:
Latest news on bacterial contamination
What you must I do? |
Why? |
Clean and sterilize all feeding equipment before using it |
Cleaning and sterilizing kills harmful bacteria on equipment that may grow in the feed once it is prepared. |
Use water that is no cooler than 70°C to prepare feeds from powdered infant formula. |
This temperature will kill harmful bacteria that may be present in powdered formula. |
Cool quickly and feed immediately |
The longer a feed is kept after it is prepared, the greater the chance that harmful bacteria will grow in it. |
Refrigerate feeds that you want to use later: if you need to store feeds for use later – put them in the refrigerator (at 5°C or less) |
Low temperatures (5°C or less) will slow down or stop the growth of harmful bacteria. |
Throw out leftovers: throw out feed that has not been consumed within two hours. Throw out refrigerated feed that has not been used within 24 hours. |
The longer a feed is kept after it is prepared, the greater the chance that harmful bacteria will grow in it. |
- Traces of Enterobacter sakazaki, a variety of colon bacteria that can cause meningitis or enteritis, have been discovered in unopened containers of powdered baby milks in most industrialized countries where testing methods are sophisticated.
- In Indonesia, 74 packages of powdered follow-on formula from five different manufacturers were analyzed.
A total of 35 samples, or 47% tested positive for Members of the Enterobacter family, and ten samples or 13.5% for Enterobacter sakazakii. "Improper preparation and conservation of these products could result in a health risk for infants in Indonesia". [See pdf file]
- A study in Brazilian hospitals showed formula was often left for up to four hours at room temperature, allowing Enterobacter sakazaki and Enterobacteriaceae to grow. (Journal of Food Protection: January 2009)
- In Italy, a 2008 study concluded: "Safety guidelines would not be needed at all if all infants were breastfed as recommended by the World Health Organization. Paediatricians and other health professionals should be made
aware of the potential risks of powdered infant formula in order to give correct advice to parents". [See pdf file]
- In the USA, a 2008 study showed that "Many mothers do not follow safe practices when preparing infant formula. Additional research is needed to understand why more mothers do not follow safe formula-handling recommendations". [See pdf file]
- The global prevalence of Enterobacter sakazakii infection from artificial baby formulas, especially in countries with large impoverished populations, is largely unknown and may be considerable.
More information on bacterial contamination of powdered infant formula
- Enterobacter sakazakii in follow-up formula (Food and Agriculture Organization of the United Nations, 2008) http://www.fao.org/ag/agn/jemra/enterobacter_en.stm
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NABA requests Food Safety authorities to protect babies’ health (National Alliance for Breastfeeding Advocacy, 2007) |
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Powdered Infant Formula-How Safe is it? (The India Journal of Community Medicine, Jan 2007) |
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How safe are infant formulas? (Journal of Neonatology, March 2006) |
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Stop press: Official action on Enterobacter sakazakii January 2005 (IBFAN, 2005)(word document) |
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Ten reasons for informative labelling of powdered infant formulas (IBFAN, 2005)(word document) |
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Enterobacter sakazakii in follow-up formula (Food and Agriculture Organization of the United Nations, 2008) |
Formula Milks: Contamination, Toxicity and Physiological Imbalances (Indian Pediatrics, 2002)http://www.indianpediatrics.net/aug2002/aug-795-797.htm
In 2003, the Risk Profile on Enterobacter sakazakii, was prepared at the request ofthe Codex Committee on Food Hygiene by USA and Canada. This Risk Profile identified the presence of heat-resistant pathogens such
as Enterobacter sakazakii in powdered infant formula as a "known public health risk". The Risk Profile noted that: "E. sakazakii is known to be present in a proportion of powdered infant formula, such formula has been epidemiologically linked with illness in neonates, and such illness may be life threatening. That alone is enough to seriously consider appropriate strategies to reduce this documented risk". Codex defines such a known public health risk as having “high impact in terms of severity for a wide range of consumers and for specific sensitive populations"[1].
At the 36th session of the Codex Committee on Food Hygiene in 2004, the Proposed draft principles and guidelines for the conduct of Microbiological Risk Assessment (MRA) refer to the Codex General Principles:
"Principle 3: Industry has the responsibility for producing and marketing safe products"[2].
See also past press releases and articles on contaminants and infant feeding available on the Baby Milk Action website http://www.babymilkaction.org/resources/contaminants.html
What is IBFAN doing to help?
- IBFAN participates in the standard setting processes for infant and follow-on milk formulas at the Codex Alimentarius Commission, a body created in 1963 by FAO and WHO to develop food standards and guidelines. We’re working to protect breastfeeding and infant and young child health through the application of the International Code of Marketing and Breastmilk Substitutes, as well as demanding full and informative
labelling on baby milk products.
- IBFAN also works with the Codex Committee on Food Hygiene (CCFH) and on the CCFH Working Group which proposed the Code of Hygienic Practice for Powdered Formulae for Infants and Young Children. This new
Codex Code was adopted in July 2008. The previous code dates back to 1979, the year before Enterobacter sakazakii was even identified as a separate species.
IBFAN success story
In 2005, IBFAN successfully advocated for a strong World Health Assembly resolution to urge governments to take national measures to inform product users of risks. Resolution WHA 58.32 urges governments to: "ensure that clinicians and other health-care personnel, community health workers and families, parents and other care-givers, particularly of infants at high risk, are provided with enough information and training that powdered infant formula may contain pathogenic microorganisms and must be prepared and used appropriately; and .. that this information is conveyed through an explicit warning on packaging".
In 2008, IBFAN was successful in advocating for a follow-up resolution WHA 61.20 (see pdf file for commentary) to urge governments "to implement the WHO Guidelines on safe preparation, storage and handling of powdered infant formula,… and to take action through food safety measures, including appropriate regulatory measures, to reduce the risk of intrinsic contamination of powdered infant formula by Enterobacter sakazakii and other pathogenic micro-organisms during the manufacturing process as well as the risk of contamination during storage, preparation and handling, and monitor the effectiveness of these measures".
IBFAN action
The World Health Organization has issued an important notice with new safety advice:
Powdered infant formula is not sterile. It may contain bacteria that can cause serious illness for infants. By preparing and storing powdered infant formula correctly, you can reduce the risk of illness. |
It is the responsibility of governments and industry to inform and warn mothers and families.
Parents and care-givers cannot take the correct steps to reduce risk to babies unless they receive the necessary information. The IBFAN network works globally to maintain pressure on governments to implement the World Health Assembly resolutions and on manufacturers to provide clear warnings on all product labels:
Powdered infant formula is not a sterile product and may be contaminated with pathogens that can cause serious illness. Correct preparation and handling reduces the risk of illness. |
[1] Development of process, procedures and criteria to establish priorities for the work of the Codex
Committee on Food Hygiene (CX/FH 04/5-Add.2, December 2003)
[2] Principles for Risk Analysis for Application in the Framework of the Codex Alimentarius, Adopted at 26th session of the CAC (ALINORM 03/41)
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