Breastmilk storage and handling

Recommendations and benefits The World Health Organization (WHO), UNICEF, and the American Academy of Pediatrics (AAP) recommend exclusive breastfeeding for infants up to 6 months, and continuing to breastfeed along with the introduction of safe complementary foods for up to 2 years or beyond, as desired by parent and child. Breastfeeding initiation, and length of exclusivity, are associated with health benefits for infants, including lower risks of Sudden Infant Death Syndrome (SIDS), infant and neonatal mortality, infections, asthma, obesity, and diabetes. When direct feeding at the breast is not possible, expressed breast milk retains many unique nutritional and immunological qualities, and as such remains the gold standard for feeding infants. The practice of feeding infants expressed milk is common in neonatal intensive care unit (NICU) settings, where it is challenging for parents to breastfeed, but it has also expanded to other contexts and situations which allow parents to be able to offer breastmilk for more sustained periods, especially given the increased prevalence of commercial manual and electric breast pumps. In the United States about 85% of birthing parents express milk at some point during the first four months of the infant's life. Estimates of parents who exclusively express breast milk range from 5% of breastfeeding parents in the United States, to 18% in Singapore. In some situations, the ability to express breast milk is linked to longer duration of breastfeeding. To ensure the safety and continued benefits of expressed breastmilk, proper handling and storage of breastmilk are essential. == Breast milk expression ==

Cleaning procedures for handling breast milk Hand washing with antibacterial soap is recommended before expressing and handling breast milk. To properly clean breast pump parts, each piece that came into contact with breast milk should be rinsed with cool water as soon was possible after pumping. Afterwards, each piece should be washed separately with dish soap and warm water, and then rinsed with hot water 10-15 seconds. Drying pump parts with cloth towels should be avoided because they can transmit bacteria - instead, pump parts should be placed on a paper towel or clean drying rack and allowed to air dry. Hand expression can also help relieve engorgement, as well as stimulating milk production when parents want to increase their supply of breast milk. Breast pumps Breast pumps remove breast milk through suction instead of compression. Manual pumps require a handle or lever be squeezed by the user which creates a vacuum that extracts the breast milk. Battery-powered and electric pumps rely on a small motorized pump which creates suction to collect milk. Electric pumps can also be separated into mini-electric, double electric, and hospital grade electric. == Breastmilk storage ==

Impact of storage on breast milk Storing milk in a refrigerator or freezer has been found to have an impact on different aspects of breast milk, including bacterial contamination, immunological components, and the nutritional quality. Further, the proportion of triglycerides to free fatty acids in the expressed breastmilk also vary, which is likely to enzymatic activity. The loss of fat content is important to take into consideration when calculating caloric density and energy intake for preterm and/or low-birth weight infants, and may be addressed by adding milk fortifiers to expressed breast milk. Containers and bags that are not intended for storing breast milk should be avoided. When bottles have the recycling symbol number 3 or 7 this indicates that the container may have BPA, thus these should be avoided for breast milk storage. Polypropylene plastics (recycling symbol 5) are safer, as are glass containers. Many different health entities and organizations recommend different ranges for optimal temperatures and time spans for storing breastmilk. The table below provides acceptable ranges from a variety of sources included in different systematic reviews and health authority guidelines, which are recommendations provided for families with healthy, full-term babies. While there is variability on the recommendations for temperature and duration of storage, there is agreement across all sources that thawed milk should never be re-frozen. Breast milk from different pumping sessions may be safely combined, as long as the freshly expressed milk is properly chilled in the refrigerator before adding it to a container with previously expressed milk. If expressed breast milk will not be used within the next 4 days, it should be frozen as soon as possible. The best way to freeze breast milk to minimize waste is by freezing in 2-4 ounce increments, and leaving about one inch of space at the top of the bag or container since the breast milk will expand when it freezes. When storing frozen breast milk, the door of the freezer should be avoided as this can subject the breast milk to temperature changes when the door is opened and closed. The best spot in the freezer for storing breast milk is away from the sides and toward the back where the temperature remains the most constant. Breast milk can be safely transported in insulated coolers with frozen ice packs for up to 24 hours, after which it should be used immediately, stored in a refrigerator, or frozen. The frozen ice packs must be in constant contact with the milk containers, and the cooler should not be opened unless absolutely necessary. == Preparing breast milk for consumption ==

Thawing frozen breast milk Frozen breast milk should be consumed in the order it was expressed; always using first the oldest milk available. Frozen breast milk should be prepared for consumption in one of three ways: slow thaw in the refrigerator, rapid water bath thaw at a temperature under 37 °C, or running lukewarm water; it should not be thawed in a microwave. Once frozen breast milk has been thawed, it should not be re-frozen. If the breast milk was thawed in the refrigerator, it can be kept in the refrigerator for up to 24 hours. The 24 hours start counting from the moment the breast milk is completely thawed, and not the moment it was taken out of the freezer. Milk from different frozen batches (that come from the same person) can be pooled once they have been thawed. Some handling practices have an impact on the reduction of total fat content, such as water bath thawing (8.5-18% total fat reduction) and microwave warming (8.5-31% total fat reduction), while room temperature thawing has been found to have no statistically significant change on total fat content. Regardless of the technique, fat often separates in breast milk, so it should be swirled prior to serving to mix the fat back in. Warming breast milk Despite the widespread availability of breast milk warmers, breast milk does not need to be warmed - it can be served at room temperature or cold, if the baby accepts it. If breast milk is warmed prior to consumption, the temperature must always be checked to ensure it is at a safe temperature for the baby. This can be done by putting some drops of the breast milk on one's wrist. The CDC recommends that if there is leftover milk from a feeding (baby did not finish the bottle), it should be used in the 2 hours after the baby finished feeding, or it should be discarded. == See also ==