Babies, Bottles, & Boiled Water
“When can I stop boiling water for powdered infant formula?”
If you’ve had this question, googled it or asked someone, and got a dozen different answers, you aren’t alone.
A small baby being fed with a bottle of infant formula
The Canadian guidelines have shifted slightly over the past few years, which when combined with individual recommendations and personalized advice, leads to a ton of confusion.
Something to keep in mind is that ultimately, we are trying to reduce risk of foodborne illness. Babies do not have a fully developed immune system at this age and can be more susceptible to infections, including from bacteria found in water or powdered infant formula.
Previously, it was commonly recommended NOT to provide powdered infant formula to ANY infants until they were 2-4 months old. However, there are situations where parents/guardians may have only had access to powdered formula or even been advised to specifically use it for their child, leading to guilt, shame and confusion, particularly on social media.
We also want to be careful of “survivor bias”, the comments like, “well I did that when you were small and YOU were fine!”. We may not have had the information or tools to have made different decisions in the past and feel we need to justify them compared to present-day information.
However, research and guidelines often come around because of the ones who had negative outcomes of an action. Nutrition research is a long-game; it often takes decades to see the results of a choice mixed with genetics & other variables. Therefore, recommendations try to mitigate risk as well as provide the best possible outcomes for the widest group of people.
As we go through, please keep in mind that your health care team is evaluating your specific child & circumstances, so your experience may differ from others and the advice may not apply to those who seem to be in similar situations. It is also okay to ask for second opinions from health-care providers, or for an explanation of why they came to a particular conclusion, to help you understand the reasoning of the advice and how to best implement it.
Let’s briefly look at the general guidelines (pulled from a Alberta Health Services document updated January 2024 and the 2022 Health Canada Formula Preparation Guidelines):
Sanitize all equipment used during formula preparation & feeding until baby is 4 months old. This is recommended to be done each time you prepare a bottle, by boiling in an open pan of water for 2 minutes.
Clean the space where you’ll prepare the formula, and wash your hands with soap and water.
Boil water for 2 minutes; cool to room or body temperature before using to prepare infant formula (concentrate or powdered).
Infants who are premature, have a low birth weight, or a weakened immune system should be fed sterile liquid infant formula to reduce risk of foodborne illness or contamination during preparation.
This may be in the form of ready-to-feed formula or liquid concentrate, prepared with water boiled as described above.
A new key point has been added where, if liquid is not an option for these babies, then powdered infant formula may be used if care is taken to prepare it properly.
To prepare properly, boil water for 2 minutes. Allow it to cool to 70C (not lower, this will take up to 30 minutes) and then use it to prepare your desired amount of formula. The water at this heat will kill any harmful bacteria.
Ensure it is not too hot; no warmer than body temperature as babies are at higher risk of burns at lower temperatures than adults.
Some formulas or fortifiers cannot be prepared at 70C; ensure you check the package & products you’re using, and speak to your health care team if you need additional directions or guidance.
For healthy, full-term infants:
Boil your water for 2 minutes. You may add to formula at 70C or allow to cool to room temperature.
A selection of appropriate food thermometers. Do not use plastic body temperature versions.
For all babies, once a bottle has started to be consumed, it must be used within 2 hours or discarded. You can find more instructions for preparing ahead of time here.
As a note, bottled water is not sterile and is recommended to also be boiled. If you’re on well water, it’s recommended to test at least once a year, or after weather events that disturb the groundwater, in addition to boiling.
*When it comes to using automated machines for preparing powdered infant formula, it is important to consider some key points:
Ability to view, clean and sanitize nooks & crannies.
Is the water heated to boiling, hot enough to mix & replaced often?
Water that does not get hot enough will not kill off bacteria in the water OR in the formula.
You likely will need to boil the water prior to adding to the machine, even if it recommends using bottled or distilled water.
Is it adding the proper amount of formula?
Is it mixing properly or does it need some additional shaking/stirring?
Do you have specific mixing instructions from your healthcare team, are adding fortifiers, etc?
These are questions that may make formula preparation easier for you, or add to your physical or mental workload. Each machine is different and may have pros and cons to it. Overall, they are generally not supported by evidence to be safer or more accurate than preparing formula manually. However again, it’s a personal choice; as long as the formula is prepared & served safely, you can make the decision that works for your family.
So to summarize, it’s not always the most simple of situations & can be a very emotional, derisive topic!
Boil your water for 2 minutes;
Sterilize your bottles, clean the preparation area, wash your hands;
Determine whether your child is at higher risk for foodborne illness; or alternatively, if you prefer to add the water while it’s hot to err on the side of caution;
Prepare your formula;
Ensure it’s a safe temp to serve; serve it immediately or refrigerate and use within 24 hours.
Dispose of bottles that have have been drank from and not finished within 2 hours; or prepared bottles that were refrigerated longer than 24 hours.
The general consensus is that you can stop boiling water & sterilizing at 6 months for otherwise healthy infants.
Home dishwashers do not get hot enough in most situations. Look for NSF/ANSI 184 approved somewhere on your machine. If using a commercial home sterilizer, follow the instructions and inspect it regularly to ensure it’s working properly.
So, the initial question we set out to answer was: When do we stop boiling water?
The consensus is generally around 6 months for the majority of infants who are not immunocompromised.
For further reading on the evidence of these recommendations, visit the links in the blog post & the citations within, as well as this WHO booklet and this Alberta Health Services professional practice paper.
Have questions? Please don’t hesitate to reach out! We’ll update this post with any frequently asked questions.
Information in this post is up-to-date as of February 10th, 2025.
Yours,
Ann Marion & Danielle