Finding the right formula: Establishing the feasibility of doing science in the home to assess the safety of Powdered Infant Formula preparation

WHAT IS THE ISSUE?

Infant Formula is a substitute form of breastmilk fed to babies, which is used instead of mothers' breastfeeding when mums are unable, or do not want, to breastfeed. In the UK, services to support breastfeeding are inadequate, so the majority of babies are fed Infant Formula, with almost three-quarters receiving Infant Formula in their first six weeks.

In the early weeks of life, babies have an underdeveloped immune system and this means that they are very vulnerable to bacterial infections. For this reason, any Infant Formula they are fed must be made to be free from harmful bacteria (sterile). To create sterile milk from Powdered Infant Formula, it is essential to use water that has been boiled and cooled to 70 degrees centigrade.

The reason for this is that Powdered Infant Formula is not - and cannot be made to be - sterile during manufacturing. This means that by law it is allowed to contain small amounts of Salmonella and Cronobacter, bacteria which survive if the water used to prepare the formula is not hot enough. Over 3,000 babies end up in hospital in the UK each year because of these infections and another 10,000 are reviewed by a doctor in the community. Sadly, these infections can result in meningitis, sepsis and rarely even death.

We surveyed over 300 parents who use Powdered Infant Formula; one third of them reported lacking confidence in safely preparing Powdered Infant Formula, and one in 12 said that they do not always follow instructions; instead for example, boiling water, cooling it in the fridge and later making up Powdered Infant Formula with the cold water. This may be something that contributes to the bacterial infections associated with babies who are fed Powdered Infant Formula.

HOW CAN VOLUNTEER SCIENTISTS HELP UNDERSTAND THIS ISSUE?

"Finding the right formula" is a collaborative community science project developed between parents and researchers ("Participatory Action Research") to test the safety of Powdered Infant Formula prepared at home, by testing its temperature. These days, caregivers may use a variety of ways to heat up the water that they use to make Powdered Infant Formula, including instant hot water taps and machines designed specifically to prepare Powdered Infant Formula.

However, these machines are not recommended by the NHS because a small amount of research in laboratory conditions raised concerns about their safety, but this has not yet been tested when caregivers make formula at home.

200 participants will be given the opportunity to use a thermometer to test the temperature of a sample of the water they used to prepare Powdered Infant Formula at home, in the way that they usually do. They will record in an online research diary the temperature of the water, and information about how they prepared the formula. Anonymized data will be available to the online community, to gain a variety of perspectives about how caregivers make up Powdered Infant Formula.

Participants will be offered the chance to learn more about research and how they can contribute to it generally, to enable them to feel more confident to participate in research in the future. Small thank you payments will be provided to participants. WHAT WILL BE DONE WITH THE FINDINGS?

The academics running the study and the participants will work together to share the results with the public, health professionals and policymakers by creating video and written content. If the online community would like to grow the study, we will seek funding to repeat the project with a larger group of people.

As well as this, we will undertake an evaluation of how people have been able to engage with the research study (a "process evaluation"). This will allow us to learn about how food safety research can be conducted in the home by consumers, which may be valuable in other research studies, particularly where the temperature of a food is important to killing bacteria that can make us unwell.