What type of water is recommended for preparing infant formula?

Water Recommendations for Infant Formula Preparation

For preparing infant formula, use safe drinking water that is either bottled, previously boiled and cooled, or filtered municipal water. In the event of a "boil-water" advisory, water should be boiled and then cooled before using it to prepare infant formula 1.

Types of Water Recommended for Formula Preparation

Safe Water Sources

• Municipal tap water: Generally safe if from a regulated public water system
• Bottled water: Commercial bottled water is an acceptable alternative
• Previously boiled water: Boil water for 1 minute and allow to cool before mixing with formula
• Filtered water: Using appropriate filtration systems that remove contaminants

Special Considerations

Fluoride Content

• Infants consuming formula prepared with fluoridated water may receive higher fluoride intake than breastfed infants 1
• Since 1979, U.S. manufacturers have voluntarily lowered the fluoride concentration in infant formula products to <0.3 ppm 1
• In areas with optimally fluoridated water (0.7-1.2 ppm), infants may consume between 0.21-0.54 mg fluoride per day 1

Microbial Safety

• Powdered infant formula is not sterile and may contain pathogenic bacteria such as Cronobacter spp. (formerly Enterobacter sakazakii) 2, 3
• Proper water temperature and handling are critical to reduce infection risk
• There are differing recommendations regarding water temperature:
  • WHO recommends using water at least 70°C (158°F) to inactivate potential pathogens 2, 3
  • ESPGHAN (European Society for Pediatric Gastroenterology, Hepatology and Nutrition) has concerns about this high temperature affecting nutrients and posing burn risks 2

Water Preparation Guidelines

Standard Preparation

1. Wash hands thoroughly before preparing formula
2. Use clean utensils and containers
3. Use safe drinking water at appropriate temperature
4. Follow manufacturer's instructions for powder-to-water ratio
5. Prepare fresh formula for each feeding when possible

During Boil-Water Advisories

• Similar precautions should be taken for infant formula as for drinking water for adults 1
• Boil water for at least 1 minute (longer at higher elevations)
• Allow water to cool before mixing with formula powder
• Prepare only enough formula for immediate consumption

Potential Risks to Consider

Chemical Contaminants

• Infant formula can contain chemical contaminants from water sources or manufacturing processes 4
• These may include heavy metals, pesticides, and packaging materials
• Using appropriate water sources helps minimize these risks

Bacterial Contamination

• Recent research indicates that even the recommended 70°C water temperature may not completely eliminate pathogens like Salmonella and Cronobacter 5
• Formula should be prepared fresh for each feeding when possible 6
• Any leftover formula should be discarded rather than saved for the next feeding 6

Best Practices for Formula Preparation

• In home settings, prepare formula fresh for each feeding 2, 6
• Do not keep prepared formula warm in bottle warmers or thermoses 6
• If formula must be prepared in advance, store at 4°C (39°F) or below 6
• In hospital settings, use sterile liquid formula for newborns when available 2
• Follow written guidelines for formula preparation in institutional settings 2, 6

By following these recommendations, caregivers can minimize the risk of contamination and ensure the safest possible nutrition for infants who are formula-fed.