All content of this blog is my own opinion only. It does not represent the views of any organisation or association I may work for, or be associated with. Nothing within this blog should be considered as medical advice and you should always consult your Doctor.

Something To Consider When Buying an Electric Breast Pump

I've had a few requests to make yesterday's Facebook Status into a blog post so it has a static location, here it is :)

Medela Swing
Ameda Purely Yours
Did you know that for over £25 less than the non code compliant Medela swing pump (priced at £99.99), an open system which isn't recommended for sharing or reselling - you can get a code compliant Ameda Purely Yours, closed system single electric pump? (priced at £72.24 )
As you can also see on that page, click double and for £7 more than the single Medela swing, you can get the Ameda double Lactaline pump (£107.24)
Ameda Purely Yours
Lactline Double
Ameda is a brand many Baby Friendly hospitals use due to code compliance issues, including my local hospital 9 yrs ago when I had my preemie.

What is the code?

If you're not familiar with the importance of the code, it's explained by Best for Babes Foundation here.
Kellymom gives a good run-down of companies to avoid/choose here.

What is a closed v open pump?

Dispelling Breastfeeding Myths highlights perfectly why you should never buy second hand, or resell an open system like the swing here - as it's not sealed milk can enter the internal mechanism, and many are not aware they need to take the whole pump body apart to clean and sterilise in there.

Closed systems like the Ameda, have a proven airlock protection system, which prevent the air from the breast pump from coming in contact with milk. A new user can then simply replace the collection kits/choose a different size if needed and away you go:

Is the Perfect Prep Formula Machine Really Perfect? & Cheaper Cheat Alternative...

It sounds like a dream for formula feeders everywhere; previously torn between risking making bottles in advance or trying to prep them as per the guidelines at 2am - now the perfect prep machine promises to help.

At first glance it looks like the baby equivalent of a Tassimo.

I get the appeal.

Making up formula properly (as any honest mum will tell you) is a complete pain in the arse.  It's not easy or convenient to wash, sterilise and prepare each and every bottle to a 14 step plan; particularly when you consider newborns can feed 12 times per day if fed responsively/on demand.

The perfect prep promises to deliver a ready made bottle in under 2 minutes, at just the touch of a button.

Too good to be true?

If you're expecting something like a coffee machine, whereby you press a button and get a ready to go bottle of formula, you're probably going to be quite disappointed.

You still have to measure and add the powder, add to the machine which first adds a "hot shot" to kill any bacteria in the powder.  You then shake the bottle before cold water is dispensed, resulting (when all works well) in a body temperature bottle.

You also can't make up bottles any smaller than 4 ounces, which is a vast amount for a newborn or young baby and may result in lots of waste or encouraging overfeeding.  This is in my opinion a big downside to the product, as surely it's mums of newborns who wake and feed lots who would potentially benefit most from such a gadget?

So how hot is the hot shot?

Establishing this isn't as easy as you might think, a Google threw up different results and so two mums with perfect prep machines kindly dispensed a shot and measured the temperature.

One reported a reading of 99 degrees and the other 92.  Of course this doesn't mean much as it's hardly controlled, one might have a less accurate thermometer or suchlike - but suffice to say these two are well above the recommended 70 degrees.

Does this matter?

As many will know there has been changes in formula preparation guidelines over the past 10 years or so. We've gone from people using any temperature cooled boiled water, storing bottles for long periods etc to quite a strict protocol.

This has come about not because the UK Government wants to make life difficult for formula users, but because the more we have learnt about the bacteria linked with conditions like gastroenteritis and what their main vessels of transfer are, we can make things safer.  For example we now know 50 degrees is a lovely temperature for bacteria to breed, whereas 70 kills things like E-Coli.

Initially the formula companies were (in my opinion and for quite obvious reasons) quite resistant to these changes. Making the product more difficult and time consuming to prepare is not a manufacturers dream. Even now tins say things like "3 Level scoops; Cooled, freshly boiled water", with no measure of an appropriate temperature (taken from SMA first milk for sale @ Ocado).

The infant nutrition council (the association for the infant formula industry in Australia and New Zealand) quite quickly expressed concerns about people using water too hot stating:
"Nutrients most destructible by heat are the vitamins; thiamin, folate,pantothenic acid and vitamin C. For example, thiamin is destroyed at 100°C."
I had the link for this saved, but interestingly whilst other references to it remain online, I can't locate it any more anywhere on the internet:

Their general guidance as to safe preparation of formula has also been removed.

There was no reference for this statement at the time and nobody seems very sure whether it's actually true.
Several members of a parenting forum therefore contacted formula companies directly to ask.  These posts still currently stand including comments like:
"Originally Posted by mamas_melon I actually emailed sma about this and this is what they said:
Thank you for your enquiry.
We would expect boiling water to adversely affect the nutritional value of Vitamin C, followed by Vitamin B1 and B6. We would not expect any of the other nutrients to be adversely affected, but we don't have any data to support this position."
Others have been told it's because of the probiotics or to avoid scalding the powder.

I found this "Letter to the Editor" in the Journal of Pediatric Gastroenterology & Nutrition 2010
"On the other hand, the use of hot water implies acceptance of some untoward consequences, such as the formation of curds and the loss of some nutrients, mainly vitamins" (14) 
In conclusion, before definitive changes in the recommendations on home handling of powdered milk are made, additional studies may be needed to clarify the cost/benefit ratio of the 2 possible options: water heated to 50°C or to ≥70°C. 
According to the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition, water heated to ≥70°C is not required and may be potentially harmful to the nutritional quality of formulas.
Unfortunately I was also unable to track down the paper for reference 14: "Buchanan R. 2003. Resistance-Thermal and Other. Presentation to the US FDA Advisory Committee, 18–19 March 2003."

A midwife I asked said some parents she has worked with, have commented some breastmilk substitutes become really lumpy if the water is too hot.  A quick scan through Amazon reviews suggests others have had experienced similar:
"Great invention but the bottles end up too full of air and lumpy."
Other reviewers suggest people check the temperature as they felt the resulting formula was much too cold.

Overall the good reviews do outweigh the bad - a lot of the negative reviews are about reliability and technical problems experienced with the machine, rather than dissatisfaction when it was working well.

So I wondered: is there a cheaper alternative to faster, safer formula?

If you want instant boiling/near boiling water instead of waiting for a kettle?  I can't see any reason you couldn't use something like the Breville hot cup currently selling for £25 if you can wait for it to return to stock (you will see under other sellers on the right there is Amazon at the cheaper rate).

There's your instant "hot shot" - simply top up with cooled boiled water as per the amounts listed on the tin, and tada - fast formula. 

I decided to try a quick experiment for those who want to make up milk with 70 degree water - using either a kettle or an instant hot water machine:

I boiled my kettle and discovered it clicks off at 82 degrees (checked by two thermometers). 

I poured 60ml into an empty bottle and added 10 mls of cooled boiled water.  This (when checked) created water of 72 degrees.

Add this to the infant powder, shake and if making a 4oz bottle (which for the brand I looked at calls for a total of 120ml) adding a further 50ml of the cooled boiled water resulted in a bottle at a suitable for drinking.

You would need a cheap thermometer to test yourself at home what ratios worked for you (because everyone's kettle will be slightly different, as will fridge temp of the cooled boiled water) - then all one needs is to keep cooled boiled water in the fridge, and you can make a bottle quickly in the time it takes to boil the kettle.

Another option to a flask is a water container - you could add the cooled boiled water to something this so it's even quicker when needed, and can still be used long after the days of making formula are gone.

If you wanted a really rapid 2am setup with 70 degree water - you could even pour the initial small amount needed with the hot shot into sterilised, sealed bottles in the fridge all ready to go.  When needed just add the hot shot, powder and top up cold water..  

If you really wanted you could even get the "top up water" amounts ready in advance too - so you grab one bottle with the small amount, add a "hot shot" or water from kettle and then top up with the second bottle of water.

Out & About?
OK so neither the perfect prep or a hot water dispenser can go in your pocket, so I get asked a lot about safe formula preparation outside the home.

Something like this fold up liquid thermometer can be really handy to test liquids on the go, and can also be used to check the milk is cool enough to drink.

If you want a product that can serve more than one purpose, and doesn't need wiping/washing like something that touches milk would, we have this one below.

It has one mode to take the temperature of people or animals, and a second for liquids or other objects.  I've compared this with a mercury thermometer and was surprised at how accurate it was.  It comes in a drawstring bag for travel too.

Have you got a perfect prep?  Has it revolutionised formula making for you?  Let me know in the comments below :)