Foodborne illness (also foodborne disease and colloquially referred to as food poisoning) is any illness resulting from the food spoilage of contaminated food, pathogenic bacteria, viruses, or parasites that contaminate food.[1] Infant food safety is the identification of risky food handling practices and the prevention of illness in infants. Foodborne illness is a serious health issue, especially for babies and children.Infants and young children are particularly vulnerable to foodborne illness because their immune systems are not developed enough to fight off foodborne bacterial infections. In fact, 800,000 illnesses affect children under the age of 10 in the U.S. each year.[2] Therefore, extra care should be taken when handling and preparing their food.
Handwashing is the first step in maintaining the safety of infant food.[3] Caregivers hands can pick up bacteria and spread bacteria to the baby. Situations in which one can encounter high levels of bacteria are:
Handwashing can remove harmful bacteria and will help to prevent foodborne illness. Instructing other children in a family on good handwashing will help to limit the spread of bacteria that cause illness.[2]
Handwashing is most effective in providing safe food for the infant during 'key times':
Though breastfeeding helps prevent many kinds of sicknesses among infants, caregivers often choose to use infant formula. Promoting food safety in infants requires safe preparation and use.
Infant formula should be used within two hours of preparation. If the infant does not finish the entire bottle, the remainder is thrown away. If the prepared feed is not used right away, refrigerating it immediately will slow the growth of microorganisms, however it must be used within 24 hours.
Cronobacter, formerly known as Enterobacter sakazakii, is a group of bacteria that can be found in the environment. The germs can also live in dry foods, such as powdered infant formula. Anybody can get sick from Cronobacter, but the infection occurs most often in infants. Cronobacter infections are rare, but they can be deadly in newborns. Infections in infants usually occur in the first days or weeks of life. Cronobacter germs can cause dangerous blood infections (sepsis) or infections of the linings surrounding the brain and spine (meningitis). Infants up to two months of age are the most likely to develop meningitis if they get sick with Cronobacter. Infants born prematurely and infants with a lower ability to fight germs and sickness due to illness (such as HIV) or medical treatment (such as chemotherapy for cancer) are also more likely to get sick. The first symptom of Cronobacter infection in infants is usually a fever, coupled with poor feeding, crying, or very low energy. Parents or caregivers should take an infant with these symptoms to see a doctor.[4]
Cronobacter infections can be prevented by:
Recommendations from health organizations for the preparation of infant formula are:
If soap and water are not available, an alcohol-based hand sanitizer with at least 60% alcohol should be used. Hand sanitizer with at least 60% alcohol is effective in killing Cronobacter germs. But using soap and water as soon as possible afterwards is imperative because hand sanitizer does not kill all types of germs and may not work as well if hands are visibly greasy or dirty.
Cronobacter can also cause diarrhea and urinary tract infections in people of all ages. The infection can be serious for older people and for people whose immune systems are weakened by other illnesses or conditions. They are also more likely to get sick.
Caregivers can prepare infant formula safely by:
There are two ways to heat bottles with disposable inserts or hard plastic, and glass bottles. A bottle can be placed under hot, running tap water until the desired temperature is reached. This should take one-to-two minutes. A bottle can be placed in a pan after the water has been heated on a stove. The pan can be removed from the heat and set the bottle in it until it is warm. It is safer to shake milk or formula to even out the temperature. Heating breast milk or infant formula in the microwave is not recommended. This results in "hot spots" that can scald a baby's mouth and throat.
Cow's milk by itself is not appropriate for infants less than one year old. Cow's milk does not have the correct balance of nutrients for infants to grow and develop normally, and it can cause problems with anemia and kidney function. Raw milk is never appropriate for infants – or anyone else. It should not be consumed by anyone at any time for any purpose. Raw milk can harbor dangerous microorganisms, such as Salmonella, E. coli, and Listeria, that can pose serious health risks. Most infant formula is made with cow's milk, but it has been modified and supplemented with additional nutrients. As a result, the formula is more nutritious and easier for the baby to digest than cow's milk. Other formula options include soy-based formulas and hypoallergenic (or protein hydrolysate and amino acid-based) formulas. Special formulas are available for babies who are premature or have other health problems.
Infants put anything within reach into their mouths. It is also important to keep all objects that enter baby's mouths (such as pacifiers and teethers) clean. Though research into five-second rule has been done, results are inconclusive.
Infants are introduced to solid foods at different ages. Breast milk alone is sufficient to support optimal growth and development for approximately the first six months after birth. For very young infants water, juice, and other foods are generally unnecessary. Even when babies enjoy discovering new tastes and textures, solid foods should not replace breastfeeding, but merely complement breast milk as the infant's main source of nutrients throughout the first year. Beyond one year, as the variety and volume of solid foods gradually increase, breast milk remains an ideal addition to the child's diet.[6] Parents and caregivers can reduce choking hazards in a child's environment. Special attention should be given to food and nonfood items (e.g., candy, nuts, and coins) commonly involved in choking. Younger children are particularly at risk because of their tendency to place objects in their mouths, poor chewing ability, and narrow airways compared with those of older children. Recommendations are available to guide parents and caregivers about the types of food items that are inappropriate for children aged less than four years. Removal of nonfood choking hazards also is important for infants and children aged less than five years because approximately one third of all choking episodes involve nonfood items.[7]
When baby food is microwaved in a jar it often heats unevenly. The hottest places are in the center of the foods. The coolest places are next to the glass sides, which could lead you to believe that the food is not too hot. Safe practices for microwaving food for infants are:
Early and effective treatment is crucial to prevent morbidity and mortality from childhood choking. Methods taught routinely in courses on cardiopulmonary resuscitation (CPR) or first aid can be lifesaving when instituted early by trained parents and caregivers. Opening the airway quickly by ejecting the foreign body can avoid potentially severe injuries. The American Academy of Pediatrics recommends that all parents and caregivers participate in the American Heart Association's Basic Lifesaving Course or the American Red Cross' Infant/Child CPR Course.[7] To prevent infant choking, be sure your child has adequate motor skills to swallow food.[9] Do not offer babies or young children high-risk foods, such as chunks of meat, cheese, grapes, or raw vegetables, unless they are cut up into small pieces.[10] Avoid hard foods, such as nuts, seeds, and popcorn.
Infant food safety includes the evaluation of commercially prepared baby food before feeding it to a baby. Examining each jar of commercial baby food before using it and noting the position of the safety button on top of the jar will indicate whether or not the jar has been opened. Unopened baby food in jars will have a safety button that is down. A jar of baby food that is swelling, leaking, contain chipped glass is probably not safe to feed to a baby. Some baby food comes in pouches. If the pouch is leaking or swelling it may not be safe to feed to a baby.[3]
The Food and Drug administration has published the following do's and don'ts regarding commercial baby food safety:
Handwashing prevents spreading infection. Washing before and after handling food, after using the bathroom, changing diapers, or handling pets.[2]
Caregivers of infants less than four months old: