What Are the Potential Problems with Baby Bottles?

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Patient Presentation
A 4-day-old male came to clinic with his parents. He was a first-born term male without prenatal or natal complications who had been discharged at 2 days of life. He was breast feeding.

The pertinent physical exam showed a healthy male with mild facial jaundice. His weight was down 5.6% from birthweight and only down 1.9% since discharge. His length and head circumference were 25%. Transcutaneous bilirubin was 8.4 mg/dL.
His examination was otherwise normal.

The diagnosis of of a healthy male was made. The parents had many questions regarding infant feeding and were committed to continued breastfeeding. They were particularly concerned about the risk of plastic and chemical contamination of infant baby bottles. The pediatrician encouraged the continued breastfeeding and talked about potential choices for types of baby bottles. He noted that the chemical BPA had been outlawed in the US for several years. He also noted that as the mother would be going back to work they also would need to consider how they were going to store expressed breastmilk as many storage containers were plastic disposable liners but that other materials were available. “As you said, right now you have a bottle that you are okay with so let’s continue to work on the breastfeeding and we can continue the conversation when you return next week. In the meantime, I’m more concerned about you resting and taking care of yourselves than you doing a lot of research, but will also give you some online resources if you want to explore them,” he offered.

Discussion
The basic rules for preparing formula and using baby bottles and cups are the same for any food preparation and presentation.

  • Wash hands with clean water.
  • Wash with hot soapy water, rinse and dry all bottles, cups, nipples, rings or other equipment (including breast pumping equipment). Some people recommend boiling these utensils for 5 minutes as well. For glass bottles, a dishwasher with heated water and hot drying cycle can be used. Remember to include any measuring cups, measuring spoons, can opener, etc. which can also touch the formula.
  • Wash, rinse and dry the top of the formula (or other food) container.
  • Add the proper amount of clean, safe water to the baby bottle or cup. Room temperature tap water from a clean water source is fine to use. If unsure about water safety, use bottled water or bring cold water to a boil for 1 minute and allow to cool for at least 30 minutes before using. Always test the temperature of the water used (couple of drops on your wrist) to make sure it isn’t too hot for the infant. Room temperature tap water from a clean water source is fine to use. Bottles do not need to be warmed but some infants seem to prefer that. If bottles are warmed then they can be warmed through warm-to-hot tap water, on the stove (water filled to the same height as the milk) and just warmed through, or a bottle warmer. Remember to thoroughly mix the milk (to make sure there aren’t hot spots) and test the temperature before feeding it to the infant.
  • Prepared formula storage. Any food served to the infant should be discarded after 1 hour. Formula not served can be stored for 24 hours in a refrigerator. Opened containers of ready-to-feed or concentrated formula should be covered and can be refrigerated for up to 48 hours.

Learning Point
Since the beginning of time, humans have fed their infants in many ways including direct breastfeeding or providing breast milk or other milk by a variety of containers. Container designs vary but usually there is a cup-like reservoir for adding and containing the milk along with a small spout for the infant to drink from. Containers were made from many materials especially clay and glass. Even animal horns were used. Later malleable materials were sometimes added as a nipple for the spout. A variety of different types can be found here. Today, containers are usually plastic or glass and usually have some type of nipple, spout, and/or straw.

Many people are concerned about the use of plastics and especially nano- and microplastics and other chemicals used in the manufacturing process. It is a complex problem. There are many advantages of plastics yet there are potentially many negatives including potential changes in the gut microbiome, endocrine disruption, and epigenetic changes. These nano and microplastics potentially can enter the human body and not be eliminated. Entrance for young children can occur through the mother when in-utero or through breastfeeding, or through the environment including dermal, inhalation and ingestis to be inadequate studies of these potential contaminants in the pediatric age group.

Bisphenol A (BPA) was used for many years as a plastic hardener and anti-bacterial chemical in food containers including those designed for infants and children. BPA is also used to protect the container integrity. In 2012, the use of BPAs was stopped in infant food containers, and in 2014 was stopped as a coating for infant formula containers.

Practically in the US, there are a few choices for infant feeding materials:

  • Plastic containers which are the most readily available but do contain plastic and chemical elements. They don’t break and can be recycled. Disposable bottles are made of plastic.
  • Glass containers which risk breakage or chipping of the glass making it a hazard. They can be recycled.
  • Silicone containers which are food grade are much more common these days. They can be a little more expensive. They still are a manufactured chemical product and can be recycled.
  • Stainless steel containers are more expensive and less available generally.

Some aspects of food containers are regulated in the US but may not be in other countries. All container types could also have surface contamination from the environment including the water supply and/or the home, daycare or other settings. Glass and stainless steel containers may contain plastic or silicone in other parts of the bottle such as the ring or nipple.

Remember that infants and mothers may also be exposed to plastics and chemical elements if they are expressing breastmilk, as the breast pump equipment and/or the storage containers could have these materials. There are small storage breastmilk storage jars made of silicone.

Questions for Further Discussion
1. What are your recommendations for bottles types for infants?
2. What are methods for encouraging breastfeeding of infants?
3. What are the advantages of breastfeeding?

Related Cases

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for these topics: Infant and Newborn Nutrition, Food Safety and Foodborne Illness.

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Baby Bottles and Bisphenol A (BPA). HealthyChildren.org. Accessed January 9, 2024. https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Baby-Bottles-And-Bisphenol-A-BPA..

How to Sterilize and Warm Baby Bottles Safely. HealthyChildren.org. Accessed January 9, 2024. https://www.healthychildren.org/English/ages-stages/baby/formula-feeding/Pages/How-to-Sterilize-and-Warm-Baby-Bottles-Safely.

Sripada K, Wierzbicka A, Abass K, et al. A Children’s Health Perspective on Nano- and Microplastics. Environ Health Perspect. 2022;130(1):015001. doi:10.1289/EHP9086

Street ME, Shulhai AM, Rotondo R, Gianni G, Caffarelli C. Current knowledge on the effects of environmental contaminants in early life nutrition. Front Nutr. 2023;10:1120293. doi:10.3389/fnut.2023.1120293

Nutrition C for FS and A. Bisphenol A (BPA): Use in Food Contact Application. FDA. Published online October 19, 2023. Accessed January 9, 2024. https://www.fda.gov/food/food-packaging-other-substances-come-contact-food-information-consumers/bisphenol-bpa-use-food-contact-application

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa

Published