There are always safe practices to take into consideration when handling human milk and feeding a baby outside of the closed mouth-to-nipple system of direct nursing. This applies to expressing, storing, and feeding milk to one’s own baby as well as handling and feeding donor milk. When considering (private) donor milk, parents are balancing the benefits of optimal nutrition and immunity against the risk of disease transmission. This section offers information about safe handling practices, pasteurization methods, and feeding methods that can support the safe sharing of human milk.

Is human milk a biohazard?

Human milk is not included in the standard’s definition of potentially infectious materials and no special precautions exist for the handling of expressed human milk, nor does the milk require special biohazard labeling.¹ The Universal Precautions to prevent the transmission of Human Immunodeficiency Virus (HIV), Hepatitis B virus, and other blood-borne pathogens do not apply to the handling of human milk.²

This statement is, however, made in the context of breastfeeding and HIV and other blood-borne pathogens with regard to handling. It does not refer to milksharing situations and consumption of donor milk, nor does it imply that screening and/or pasteurizing are unnecessary in a milksharing situation.

How can breastmilk be expressed?

Ensure that supplies are clean and wash your hands before handling breastmilk.

Breastmilk can be expressed by hand, with a manual pump, or with an electric pump. Following are suggested steps for properly and safely expressing breastmilk:

Before beginning, make sure that your supplies are clean and dry.
Vigorously wash hands, fingers, forearms, and under nails with soap and warm water for 20 seconds, dry hands with a paper towel, and then use a paper towel to turn off the faucet.³
Inspect your breasts and make sure that the nipples are not cracked and bleeding and that there are no open sores, blisters, and/or bleeding cracks on your breast. If so, do not donate at this time.
Follow the instruction manual for your pump or consider expressing by hand.
Properly label the storage container and place it in the freezer or refrigerator.
After pumping and storing, wash, and properly store your supplies.

This video is a good tutorial on how to express breastmilk by hand:

Properly label the storage container with the name and date, and place it in the freezer or refrigerator.
After pumping and storing, wash, and properly store the supplies.

Pumps can be bought or rented, either by the donor or by the recipient, depending on their arrangement with each other. These arrangements are best discussed privately. No difference has been found in bacterial contamination when using a pump or manually expressing.⁴

Please note that there are two kinds of pump systems: open-system pumps and closed-system pumps. Open-system pumps are not suitable for multiperson usage.⁵

After the use of drugs, certain medications, and alcohol, breastmilk may need to be expressed and discarded. For more information please read Drugs, medication, alcohol, and the decision to discard breastmilk?

How can human milk be stored?

Ensure that supplies are clean and wash your hands before handling human milk

Breastmilk can be stored at room temperature, in the refrigerator, in the freezer, or in coolers depending on how long it needs to be stored. It can be stored in capped glass or plastic containers, specialized ‘breastmilk storage trays’, or in specialized milk bags.

Studies measuring the factors of size, need to recycle, ease of cleaning/sterilizing, protection of nutrients, considerations regarding bacteria, and ability to connect directly to the pump flange conclude that glass and hard clear plastic (polypropylene) are the recommended choices for milk collection/storage. Plastic bags are not sterile, not recyclable, and result in a greater loss of fat due to the adherence of fat to the sides of the bag. They also can result in easy leaking and thus milk waste.⁶ Plastic bags can however be more convenient. Plastic bags specially designed for freezing expressed human milk are available from many companies that specialize in products for human feeding.

Always handle breastmilk with clean hands⁷ and follow the manufacturer’s instructions for properly cleaning your pump.

Pump into a clean bottle connected to the pump.⁸
When finished expressing or the bottle is full, store directly in the bottle or transfer into a clean and approved breastmilk storage container.
You can add freshly expressed human milk to refrigerated or frozen milk you expressed earlier on the same day. However, be sure to cool the freshly expressed milk in the refrigerator or a cooler with ice packs for at least one hour before adding it to previously chilled milk. Don’t add warm human milk to frozen human milk because it will cause the frozen milk to partially thaw. Keep milk expressed on different days in separate containers.⁹
Store expressed milk in small amounts, and increase the amount as a baby eats more per feeding. Freezing milk in small amounts (2-4 oz) is most convenient to avoid waste.¹⁰
If milk is to be frozen for storage, this is best done immediately after expressing it.
Previously frozen milk can be stored in the refrigerator for 24 hours.¹¹
Remember that breastmilk will expand when frozen, so do not overfill the container, especially if using a glass container.
Mark the name, date, amount of milk, and age of the baby on the container.
Storage bags should be stored carefully, away from other items in the freezer to avoid any damage. Laying storage bags flat for freezing is most space-saving: simply stack them when frozen. Some parents have made clever dispensers as well.¹²
Please do not freeze milk in the door of the freezer as the temperature fluctuates too much.

For foods that have thawed in the refrigerator, it is generally safe to refreeze them without cooking within 3 or 4 days.¹³ However, there is so far little information on refreezing thawed human milk. Bacterial growth and loss of antibacterial activity in thawed milk will vary depending on the technique of milk thawing, duration of the thaw, and the number of bacteria in the milk at the time of expression.¹⁴

It is said that once breastmilk has been expressed, it is important not to shake it, especially if the milk is also to be frozen because shaking allegedly denatures the shaped molecules of the protective proteins. We have however not found any evidence-based research to support this claim. The research that does address shaking breastmilk evaluates mechanical shaking or so-called vortex shaking.¹⁵

If expressed milk will be shipped, please see How can human milk be shipped or transported.

For recipients:
Upon receiving the breastmilk, store it in the freezer or in the refrigerator as given, or use it within 6-8 hours depending on the need.

How long can human milk be stored?

Breastmilk can be kept at room temperature, in the refrigerator, or in the freezer depending on the need.

Guide to storing expressed milk¹⁶ ¹⁷

Location of Storage	Temperature	Recommended Storage Times	Notes
Room temperature	16-29ºC (60-85ºF)	3-4 hours optimal 6-8 hours acceptable under very clean conditions¹⁸	Covered containers
Insulated cooler bag	15ºC (59ºF)	24 hours	Keep ice packs in contact with milk containers
Refrigerator	≤4ºC (39ºF)	72 hours optimal 5-8 days acceptable under very clean conditions	Store milk in the back of the main body of the refrigerator
Freezer compartment inside refrigerator	-15ºC (5ºF)	2 weeks
Separate freezer	≤-18ºC (0ºF)	6 to 12 months	Store milk toward the back of the freezer These recommendations are for quality only. Foods are kept safe almost indefinitely in the freezer.¹⁹ ²⁰

Some things to consider when navigating optimal versus acceptable storage times:

The temperature of the room matters. If the surrounding temperature is on the higher end, consider the lower length of the referenced time. If the surrounding temperature is low, consider the higher length of the suggested storage time.
When storing in a refrigerator, placing items in the door versus the back, and whether a refrigerator is opened often or not also matter when it comes to consistency of temperature.
These temperatures are for freshly expressed and refrigerated milk. Previously frozen milk spoils faster since it lacks some of the properties of fresh or refrigerated milk.

How can human milk be shipped or transported?

Shipping Introduction

The financial aspects of shipping a box of human milk are best arranged before the supplies are bought and the box is shipped. This can be done via online secure payment processors, pre-paid shipping labels, and/or by calling the courier and paying over the phone. Sending (large sums) of money to strangers is inadvisable.

Overnight shipping and long distances are best done with dry ice and gel packs since regular ice melts quickly.¹⁸ The amount of dry ice per parcel is generally unlimited for ground shipments.

The courier used to ship the package will need to know that the content is a low-risk biological product and that the package contains dry ice. Shipping milk generally does not require documentation or a permit, but each shipping company and country will have slightly different requirements, all based on law, especially when shipping internationally, so call and ensure all paperwork is filled out before going to the shipping center or the courier arrives.

For shipping across country lines, please inquire about the customs information of your country.

Air shipping

Dry ice is a hazardous material and as such, it is regulated for shipment by the United States Department of Transportation (USDOT) and the International Air Transport Association (IATA). Regulations require that specific procedures must be followed when shipping dry ice.¹⁹

Warning Label
For air transport, the amount of dry ice per parcel is limited to 5.5 pounds or less. Shipments containing dry ice must carry a Class 9 DOT miscellaneous hazardous material warning label, and must be clearly marked “Carbon Dioxide Solid, UN1845” or “Dry Ice, UN1845.” Biological material is often a dry ice shipment, which may have additional special requirements provided by the cold chain industry.²⁰

Caution
Eats on Feets supports the shipping of donor milk if it is necessary. However, please be cautious of shipping scams, where people offer to ship milk to you for an upfront cash payment, as these are often scams. Do not send anyone any money. Use prepaid labels or shipping accounts.

Our goal is to mobilize local families in order to foster true and safe community-based and private arrangement milksharing, where people can meet each other in person and properly screen each other.

What kind of container is milk stored in for shipping?

For basic safe storing information, please first see How can human milk be stored?

Fresh milk can be stored flat in (self-sealing) freezer bags, ideally no more than 6 ounces per bag to ensure uniform shape and freeze/thaw. When laying milk bags in the freezer, it is recommended to fold half an inch of the bag under to allow space for expansion without compromising the seal of the bag. This also provides a relatively uniform shape which makes packing easier. Do not freeze or store in the door of the freezer as the temperature fluctuates too much when opening the door.

Plastic or glass bottles or some other type of hard container used for storing milk are best sealed tightly, with several containers placed in sealable freezer bags to ensure that breakage or leakage does not contaminate the entire shipment. Some form of cushion or padding may need to be added to ensure the safety of transport.

How much is being shipped?

The following table may help in estimating the cost using dry ice, assuming the use of a Styrofoam cooler with a cardboard shipping box.²¹

Weight in US units.²²

Milk in ounces	Approximate weight in pounds	Approximate container weight pounds	Dry ice for 12 hours in pounds	Dry ice for 24 hours in pounds	Total approximate weight in pounds
100	13	0.25	5	10	18.25 - 23.25
200	26	0.25	8	13	34.25 - 39.25
300	39	0.5	12	17	51.5 - 56.5
400	52	0.5	15	20	67.5 - 72.5
500	65	1	15	20	81 - 86
600	78	1	20	25	99 - 104

Use dry ice for shipping FROZEN milk as dry ice will freeze everything in the shipping box. A combination of dry ice and gel packs will extend the shipping time by several days if the shipped items can be frozen for a short time or thawed for a short time.

If upon arrival the food is partly frozen, still has ice crystals, or is as cold as if it were in a refrigerator (4.4ºC/40 °F), it is safe to refreeze or use.²³

How can human milk be packed for shipping?

Always handle dry ice in a well-ventilated room.
Dry ice vaporizes into carbon dioxide and can cause poisoning in enclosed spaces.

The following items are needed for packing a dry ice shipment:²⁴

Styrofoam cooler(s) large enough to hold milk packages/bottles, newspaper layers, and dry ice
Cardboard or cardboard box
Duct tape for sealing coolers after inspection if needed
Shipping labels per carrier instructions
Markers
Old newspapers, paper, paper bags for grouping and added insulation
Large zip lock bags
Dry ice
Gel packs
Gloves and/or tongs
Mallet or hammer, regular screwdriver, or ice pick for breaking up the block of dry ice
Paper and paper bags

Please see the video below on how to pack milk for shipping.

Transcript.

Shipping with dry ice²⁵ ²⁶

Please review these safety precautions.
Determine the amount/weight of milk to be shipped and purchase a fitting Styrofoam or another type of insulated cooler that does not have a complete sealing lid. It is important that dry ice is able to vent the carbon dioxide gas which results from warming. It is best to then place the cooler in a cardboard shipping box for ease of labeling and reduction of the chance of the lid being dislodged and losing the contents.
Locate the nearest dry ice dealer by asking at the local convenience store, grocery store, etcetera, or by consulting the dry ice directory.
Bring an appropriate-sized cooler to carry the dry ice in. Ask or confirm the appropriate amount of dry ice needed. Be sure to have the cooler and milk ready to pack as soon as possible so that the dry ice does not evaporate while preparing the milk.
Break up a small amount of dry ice into a flat sheet or into small chunks and spread evenly in the bottom of the cooler. Begin layering the milk evenly without packing it tightly. Milk can be put in paper bags for easy grouping of milk by month or volume, for insulation, and for easy taking out of the cooler. Place the oldest milk into the cooler first, and the freshest milk on the top. This way the oldest milk is placed into the freezer last and positioned to be used first while cutting down the amount of handling and potential for thawing or damage.
If shipping a large quantity of milk, layer milk, dry ice, milk, etcetera to ensure that all the milk has an even freeze for the duration of shipment.
If the milk and dry ice do not fill the entire cooler (or if shipping glass bottles), loosely crumple packing paper or paper grocery bags and use them to fill in all remaining space to keep the milk securely packed and provide some additional internal insulation.
Break any remaining dry ice into small pieces. Spread or sprinkle it into the cooler, making sure that it is filling in the empty spaces/top of the cooler.
Once the dry ice, milk, and any necessary packing are in the cooler, place the lid securely on the cooler. Placing a piece of tape across the top of the cooler (one across the length and one across the width, making an “X”) will secure the lid adequately for shipping. Do not seal the seam of the lid.
Place the cooler in the cardboard box, again loosely packing paper to fill any space that would prevent the cooler from shifting a lot within the box. Make sure that the top of the packing box is securely shut with heavy-duty packing tape while still allowing movement of gas from within the cooler. If the shipping company does not provide a label for perishables, make one from a red piece of construction paper or note card. Clearly write “PERISHABLE – BREASTMILK” on a couple of labels and if using containers rather than bags, indicate which direction is up.

Shipping with gel packs

As with the dry ice packing, place a layer of frozen gel packs on the bottom of the cooler. Begin layering milk, starting with the oldest milk on the bottom, and the freshest milk on the top. This way the oldest milk is placed into the freezer last and positioned to be used first while cutting down on the amount of handling and potential for thawing or damage. If sending a large quantity of milk, alternate layers of frozen milk and gel packs. If there is space left on the top of the cooler or along the sides, place the loosely crumpled paper in these spaces to secure the milk for shipping.
Place the cooler in the cardboard box, again loosely packing paper to fill any space that would prevent the cooler from shifting a lot within the box. Make sure that the top of the packing box is securely shut with heavy-duty packing tape while still allowing movement of gas from within the cooler. If the shipping company does not provide a label for perishables, make one from a red piece of construction paper or note card. Clearly write “PERISHABLE – BREASTMILK” on a couple of labels and if using containers rather than bags, indicate which direction is up.

Below is a picture of the end result:

For making your own box:

Create an insulated box with a styrofoam container and a cardboard box. Cut and tape the Styrofoam box with duct tape if needed. Do not tape the lid shut!
Use styrofoam from an appliance store and cut it to fit a box. Again, do not tape the lid shut!

Transit time

Frozen milk on dry ice that will be shipped within a state, province, or region, or to a neighboring state, province, or region, can be shipped by ground. Call the local couriers for more information. They can give specific times for delivering the package to them or at home pick up for same-day shipping.

If the milk is shipped over a couple of states, provinces, or country lines, or if there is a chance that the milk needs to be stored due to weather impediments, it is especially important that the milk is packed with dry ice and/or gel packs to prevent thawing.

At the shipping center

At the shipping center, paperwork is completed declaring the amount of dry ice in the box and to identify it for special handling. Determine the type of shipping that will be used. By calling ahead, the shipping center will be able to advise as to what the best time of day for drop-off is to make sure the package ships efficiently.

Please note that not all shipping centers are able to accept a package including dry ice, so be sure that you verify this ahead of time. The goal is to have the milk in transit as soon and as efficiently as possible. Having the breastmilk package sitting on a dock for hours only increases the risk of mishandling.

Transcript Shipping with Dry Ice video

Hi, I’m Shell from EOF.org, and today Angie and I will be shipping breastmilk long distance with dry ice. You can use this short video as a visual accompaniment to the breastmilk shipping instructions that you can find on www.eatsonfeets.org.

For our breastmilk shipping project today we will need an ice cooler, cardboard box, packing paper, hammer, dry ice, packing tape, two labels, and a pair of gloves.

The first and most important part in handling breastmilk is the washing of hands. Angie will be washing her hands in the warm water for 40-60 seconds. And moving in super-duper fast forward time we can see that Angie is paying special attention to her fingers and her wrists, and no surprise here, when she’s done washing her hands she will dry them, and then put on her protective gloves. The gloves are to protect her hands from the dry ice, but we found they were also helpful in handling the ice-cold bags of breastmilk. Angie is going to break the ice up on the floor and with a hammer, attempting to keep the ice within the bag. We only needed a thin layer of ice on the bottom of the ice cooler, about a cup, and we used a total of 5 pounds of dry ice but in the end, we think that 3 pounds would have done. We also decided to put a sheet of packing paper over the dry ice, to help the bags lay a little neater in the ice cooler.

Once the ice cooler is ready for the milk, Angie will sort through them placing the oldest milk in the bottom of the cooler. That way the recipient will unpack the newest milk first, and the oldest milk will be available for first use. Notice that these bags are sitting in a cardboard box and not loose in the freezer, also this freezer drawer stays closed when the main freezer door is opened. It’s important not to pack the breastmilk in the door of a freezer. When you’re ready to put the bags of milk into the ice cooler, you’ll want to pack them end to end as Angie is demonstrating here. Also, you’ll find that the thinner bags of milk pack a little nicer than the thick ones do. Most of Angie’s milk held between 4-7oz. You’ll want your layers of breastmilk to fit nice and snug but to also have some wiggle room to accommodate breastmilk expansion.

Angie had about 250oz of breastmilk to ship, which gave us about a layer and a half of breastmilk. That meant we had to fill up the empty space with paper and more dry ice. You want to make sure that all the crevices are filled. This helps keep the breastmilk more frozen but also to keep it from being jostled. You can see that the cooler is packed to the top with the paper, and now we’re going to show you the lid placement. I know it seems simple but there’s something here that I want to show you. This cooler is nice because it has the tabs on the side. You want your lid to be snug but also have some room for the dry ice gas to expand and leave the cooler. Here we have our handmade label, nothing fancy. Because it has the clips on the side we’re only going to secure the lid with two strips of tape, and now that the lid is secure it’s ready to be placed in the cardboard box. We weren’t able to find the box exactly the size that we wanted so we just used the size we had on hand. Since this box is a little bigger we are going to have to pack it with more packing paper. This is to protect the temperature of the cooler and also to prevent jostling. Another handmade label on the outside of the box, and for the cardboard box we’re actually going to tape it very securely with several strips down each side. And that’s it, our box is ready to be shipped.

How can human milk be thawed

Expressed milk can be thawed in the refrigerator, in a container of (warm) water, or under running (warm) water. Milk does not need to be warmed. It can be served at room temperature or cold. If you decide to warm the breastmilk, keep the container sealed and place the sealed container into a bowl of warm, not hot, water or hold it under warm running water for a few minutes. Test the milk’s temperature before feeding it to your baby by putting a few drops on your wrist.²⁷ ²⁸ ²⁹

Please note that it is not advisable to defrost breastmilk in the microwave. Microwave ovens do not heat liquids evenly which could easily scald a baby or damage the milk and bottles may explode if left in the microwave too long. Microwave heating can also cause a significant decrease in the activity of anti-infective properties. Microwaving appears to be contraindicated at high temperatures and there are questions with regard to its safety even at low temperatures.³⁰

Thawed milk is safe at room temperature (up to 25ºC/77ºF) for 1 to 2 hours and up to 24 hours in the fridge.

In general, when food has thawed in the refrigerator, it is safe to refreeze it without cooking³¹ There is however little information on refreezing thawed human milk. Bacterial growth and loss of antibacterial activity in thawed milk will vary depending on the technique of milk thawing, duration of the thaw, and the number of bacteria in the milk at the time of expression.³² Please see How can breastmilk be reused for further information.

How can human milk be pasteurized at home?

Home pasteurization

When full screening is not available, donor health status is unknown, or to reduce the potential risks of exposure to HIV and/or other pathogens, how can breastmilk be pasteurized at home?

Holder pasteurization
(Low-Temperature Long Time – 62.5°C/145°F for 30 minutes)

Holder pasteurization is considered the standard³³ for human and cow’s milk pasteurization. It has been shown to inactivate pathogens while maintaining adequate nutritious properties. However, given its longer time-temperature curves, this method damages more of the antimicrobial factors³⁴ of breastmilk than would flash pasteurization.³⁵

This method of pasteurization can be done by parents or caregivers on the stovetop, or with a home pasteurizer kit for human milk. Some may decide they want to buy commercial-grade pasteurizers which are also available.

Explanation of how to perform Holder pasteurization at home.

Flash-heating
(High-Temperature Short Time – (72ºC/161.6ºF for 15 seconds)

Flash-heating is a low-tech method of pasteurizing breastmilk that was developed for those who are HIV positive in developing countries that had no safe or affordable alternatives for feeding their infants.³⁶ Studies³⁷ by a research team led by Israel-Ballard,³⁸ ³⁹ ⁴⁰ have shown that FH breastmilk inactivates HIV and 4 common bacteria.⁴¹

Explanation of how to perform the Flash-heat method of pasteurization at home.

Cooling down heat-treated milk

Cooked foods have a danger zone,⁴² a temperature range from 60ºC (41˚F) to 21.1ºC (140˚F) where bacteria like to grow. It is therefore important to cool the milk down quickly after it has been heated. Cooling the container in ice water⁴³ is the quickest way to cool milk. Depending on the amount of milk, cooling it in the refrigerator is generally not recommended as the milk may cool down unevenly,⁴⁴ leaving some milk too warm for too long. Please know that not all glass is suited for heating and rapid cooling.

Reusing heat-treated milk

In the study on bacterial safety, K. Israel-Ballard, et al. discuss that after cooling, flash-heat was successful in eliminating bacteria in the majority of samples, and prevented substantial growth for up to 8 h when stored at room temperature.

A study from 2013 concludes that “HIV-positive mothers living without access to refrigeration can be reassured that heat-treated breastmilk is safe for their infant to drink for up to 24 h after flash heating.“⁴⁵

Milk banks recommend that refrigerated pasteurized donor human milk be used within the next 48 hours.⁴⁶

Heat-treated milk can possibly be refrigerated or frozen following common food safety protocols.⁴⁷ We suggest, however, that after a first feeding, milk that was heat-treated not be refrigerated and reheated again as anti-bacteriological properties can decline with increased handling.

To date, the safety of reheating previously heat-treated milk has not, to our knowledge, been studied. It should be noted that most literature speaks in terms of heating expressed milk for feeding but that parents generally warm the (thawed) milk under running warm water or set it in a container in warm water for a short while to get the chill out of it. Gently warming should not be considered heat-treating. For optimal properties of breastmilk, reheating (warming) milk should not be done directly in a pan on the stovetop nor in a container set in boiling water on the stovetop (which would be heat-treating it unnecessarily).⁴⁸

Holder pasteurization explanation

1. Place milk in glass milk bottles or canning jars. Fill only four-fifths full to allow for expansion of milk when heated.
2. Place the bottles or jars on a rack inside a large canner. Fill the canner with warm water until the water level is slightly above the milk level in the jars.
3. Start heating. Stir the milk in each container with a long-handled spoon to achieve uniform distribution of the heat. Monitor the temperature with an accurate, metal-stem thermometer. As the temperature approaches 145ºF, stop stirring, and loosely cover all jars but one with lids. Cover the remaining jar with aluminum foil. Punch a hole in the center of the foil and insert the
thermometer.
4. Continue heating until the temperature is 145ºF or slightly above. Adjust the heat to maintain the temperature at 145ºF for 30 minutes. If at any time the temperature drops below 145ºF, reheat and hold at 145ºF or above for 30 minutes.
5. After 30 minutes, gradually replace the hot water with cold water to cool the milk. If this is not done gradually, the bottles or jars may break.
6. Continue cooling the milk until the temperature is 80ºF or less. At this temperature, ice water can be used for cooling. Cool milk to 40ºF or colder. Tighten the covers and store in the refrigerator at 40ºF or colder until used.⁴⁹

Flash heating explanation

Always wash all utensils that you will use to express and heat treat your breastmilk with clean water and soap. It is best to boil these utensils after washing to make sure that they are clean.
Put all the milk in a heat-resistant glass (not plastic) jar. The amount of milk should be between 50 ml and 150 ml. If you have more milk, you may divide it into 2 jars.
Place the jar of milk in a small pan of water. Make sure the water is about two fingers above the level of milk so that all the milk will be heated well.
Heat the water on a very hot fire or on the highest level of your stove until it reaches a rolling boil (when the water has large bubbles). Stay close by because this should only take a few minutes. Leaving the water to boil too long will damage some of the nutrients in the milk.
Remove the jar of milk from the boiling water immediately after the water comes to a boil. Place the jar in a container of cool water, or let it stand alone to cool until it reaches room temperature.
Protect the milk as it cools and during storage by placing a clean lid or small plate on it.
You can safely feed your baby this heated milk within 6 hours.
You can feed the baby using a clean open cup. Even a newborn baby learns quickly how to drink from a cup. Avoid using bottles and nipples. They are difficult to clean and may make your baby sick.⁵⁰ ⁵¹

Below is Kiersten Israel-Ballard demonstrating flash-heating on the stovetop.

❆✼❆

Flash heat and HIV
Given the specific risks for lactating parents in developing country settings, research studies focused on determining the impact of flash-heat on HIV, bacteria, and breastmilk’s protective elements, such as immunoglobulins, vitamins, and the immunoreactive proteins lactoferrin and lysozyme.

Studies⁵² by a research team led by Israel-Ballard,⁵³ ⁵⁴ ⁵⁵ have shown that FH breastmilk inactivates HIV and 4 common bacteria⁵⁶ while retaining high levels of vitamins,⁵⁷ lactoferrin,⁵⁸ ⁵⁹ and immunoglobulin,⁶⁰ ⁶¹ which are important for the health of a baby and its immunity to infections. See Why breastmilk for more information on the importance of the anti-infective components of breastmilk.

Safety of flash-heating
When researchers designed the flash-heat method for lactating parents in developing countries, it was an attempt to replicate the flash-pasteurization methodology for a low-resource setting. Flash-heating is a simplified in-home process and as such is not as controlled as the actual flash pasteurization method. Altitude, breastmilk volumes, water volumes, and human error could contribute to differences in the flash-heat process. Although researchers hypothesize that the temperatures achieved during flash-heat render breastmilk safe, it should be noted that its effectiveness to inactive all viruses and spores⁶² has not been thoroughly researched and remains theoretical.

When heat-treating human milk, many important anti-infective properties are reduced. The Holder method affects these properties in a greater way than Flash heating. Any heat treatment deactivates lipase, an enzyme that helps with the breakdown and absorption of fats, and the long-term effects of feeding heat-treated milk have not been researched⁶³ Raw (unpasteurized), fresh (not frozen when possible) human milk, from a properly screened donor, and properly handled is a better option when available.

Flash-heating vs Flash-pasteurizing

Flash-heating (FH) is a low-tech method of pasteurizing human milk that was developed for HIV-positive mothers in developing countries who had no safe nor affordable alternatives for feeding their infants.⁶⁴ Studies⁶⁵ by a research team led by Israel-Ballard,⁶⁶ ⁶⁷ ⁶⁸ have shown that FH breastmilk inactivates HIV and 4 common bacteria. ⁶⁹ The World Health Organization supports expressing and heat-treating milk of those who are HIV positive for temporary feeding during an emergency and when no other safe options are available.⁷⁰

Flash-heating is however not to be confused with flash-pasteurizing (FP), which is a commercial process. Both are forms of High-Temperature Short Time (HTST) Pasteurization, but flash-pasteurizing requires special equipment whereas flash heating does not.⁷¹ FP involves heating to exactly 72ºC/161.5ºF for 15 seconds. This process is followed by the dairy industry and is an officially accepted method of pasteurization.⁷² ⁷³ Flash-pasteurization of human milk has been demonstrated to inactivate bacteria as well as certain important pathogenic viruses, specifically HIV, HTLV, HBV and HCV, and CMV.⁷⁴

While the temperature of milk when FH typically reaches 72ºC/161.5ºF,⁷⁵ this is not as accurate as with the FP process. In a home setting, the time and temperature are not easily controlled, nor are milk and water volumes.

For instance, the temperature of human milk when using FH will greatly vary depending on altitude and atmospheric pressure. Water boils at 100ºC/212ºF at sea level, but the higher the altitude, the lower the boiling point of water.⁷⁶ Using FH at home and removing the milk from the heat when the water boils will thus not always result in the milk attaining exactly 72ºC/161.5ºF, the safe temperature needed for flash pasteurization. We do not know how heat-treating milk at 71ºC for instance affects the viral load, except for HIV (see below).

Another aspect is that, contrary to FP where the temperature is held for 15 seconds, the whole process of FH takes about 5 minutes. Holding the milk at a precise temperature for a specific amount of time is not feasible in a home setting. Both temperature and time are important however when flash-pasteurizing.

While FH has been researched and is proven to deactivate HIV, its effectiveness on other viruses is theoretical. We, as a milksharing network, cannot make assumptions and tell our community that both processes do the same thing. HIV is destroyed at low temperatures (57ºC/134.5ºF) and so boiling water anywhere for any time will result in milk that is hot enough to deactivate the virus. While the positive results of FH might be comparable to those of FP, when it comes to the other viruses, more research is needed to address this directly.

Currently, there is no clear evidence on whether heat-treating breastmilk should be used as a permanent solution.⁷⁷

For more information on infant feeding and HIV, please see Human Immunodeficiency Virus (HIV) and HIV and the global context of infant feeding

Pretoria pasteurization

Pretoria pasteurization is another form of low-temperature long-time (LTLT) stovetop heat-treating that has been used for breastmilk from HIV-positive lactating parents in developing countries.⁷⁸ This method has however not been shown to be as effective as Flash-heating.⁷⁹

How do I feed the milk to my baby?

Ensure that supplies are clean and wash your hands before handling breastmilk.

Babies have been fed milk by an at-the-breast tube system, cup, finger, (curved tipped) syringe, saucer, spoon, dropper, or bottle.

At-the-breast lactation aid
The act of nourishing a baby at one’s breast (breastfeeding) is ideally not separated from the sustenance the baby is receiving (milk). Therefore, when someone does not produce (enough) milk, an already latching baby would preferably get all additional breastmilk via an at-the-breast system.⁸⁰ See this video for an explanation:

Expensive equipment is not required for this. It does not have to be an official at-the-breast system that you purchase/use. All that is needed is a long length of No. 5 French feeding tube (which can be purchased or ordered at your local pharmacy), and some sort of container (like a bottle) to hold the breastmilk in.⁸¹

Benefits of at-the-breast feeding
Using an at-the-breast feeding system keeps your baby at the breast, thus minimizing the risk of jeopardizing supply (as the breasts and supply are still being stimulated while the baby is latched on and drinking).⁸² ⁸³ This type of supplemental feeding can also be used for someone who is re-lactating, inducing lactation, and/or chestfeeding.

Cup-feeding
When at-the-breast feeding is not possible, or until breastfeeding and/or feeding with an at-the-breast system can be established, other methods have benefits to feeding with a bottle, like using a cup or a curved tipped syringe. Avoiding bottle feeding can be important in order to prevent nipple confusion and nipple pain if someone hopes to fully breastfeed their baby eventually.⁸⁴

Newborns can easily drink from a cup, as can premature babies. Cup-feeding can help premature babies maintain a more stable blood oxygen level than bottle-feeding.⁸⁵ ⁸⁶

Benefits of cup-feeding
Cups are easy to clean with soap and water if boiling is not possible. They are less likely than bottles to be carried around for a long time, giving bacteria time to breed. A cup cannot be left beside a baby, for the baby to feed itself. The person who feeds a baby by cup has to hold the baby and look at the baby which allows for close eye contact as well as physical proximity. Just like an at-the-breast system, a cup does not interfere with suckling at the breast.

How to cup-feed

Hold the baby sitting upright or semi-upright on your lap.
Hold the small cup of milk to the baby’s lips.
Tip the cup so that the milk just reaches the baby’s lips.
The cup rests lightly on the baby’s lower lip, and the edges of the cup touch the outer part of the baby’s upper lip.
The baby becomes alert and opens his mouth and eyes.
An LBW [Low Birth Weight] baby starts to take the milk into his mouth with his tongue.
A full-term or older baby sucks the milk, spilling some of it.
Do not pour the milk into the baby’s mouth. Just hold the cup to the lips and let the baby lap up the milk.
When a baby has had enough, they close their mouth and will not take any more. If they have not taken the calculated amount, they may take more next time, or you may need to feed them more often.
Measure the intake over 24 hours –not just at each feed.⁸⁷

Bottle feeding
If choosing to use a bottle, there are some very important things to consider:

Watch the baby. Babies will cue us when they are hungry. Hunger cues include (but are not limited to) rooting, chewing on their fists, and rapid eye movement as they are about to wake. Respond to the baby’s hunger cues and not the clock.
Hold the baby in an upright, seated position. It is very important that babies not be fed from a bottle while lying on their backs. Having a baby in a more upright position allows them to better control the flow of milk into their mouths.
Just like switching sides while nursing, switch sides while nursing, switch baby from one arm to the other. It is important that the baby has the opportunity to develop both eyes and both sides of their body.
Never push or force the bottle nipple into the baby’s mouth. Allow them to explore and draw the nipple in on their own.
Pace baby’s feeding. Even with a low-flow or slow-flow nipple (preferable for all babies), the milk can enter the baby’s mouth much quicker than they are able to take it in. If a nursing session would take 20 minutes, expect that a bottle-feeding session would take the same amount of time.
Babies breastfeed with a certain suck and swallow rhythm. Often they suck 2 or more times before swallowing. We can mimic this by encouraging frequent pauses. Allow the baby to suck and swallow according to their rhythm and then tip the baby forward a bit (to empty milk out of the bottle nipple) to simulate the pause. Tip them back slightly and allow the suck and swallow rhythm to happen again.
Watch the baby. By allowing them control over the feeding rhythm, we allow them to let us know when they are finished. Never force a baby to finish a bottle. Allow them to dictate when the feed is over.

It is critically important that babies and their caregivers are able to engage together during feeding. It is never safe to ‘prop’ a bottle for a feeding. It is not only unsafe but contrary to our human nature.

For support and guidance with implementing any of these alternative feeding options, please find a professional lactation consultant⁸⁸ or look in Resources for support for referral suggestions.

How much expressed milk does my baby need?

It is best to follow the baby’s lead and use paced bottle feeding practice.⁸⁹ Volume needs will change from feeding to feeding, from day to day, and from baby to baby. Learning a baby’s unique communication style is an important part of the early bonding process.

General Guidelines⁹⁰

For babies weighing 2.5 kg or more

150 ml milk per kg of body weight per day
Divide the total into 8 feeds, and give 3-hourly

For babies who weigh less than 2.5 kg (Low-birth-weight)

Start with 60 ml per kg of body weight
Increase the total volume by 20 ml per kg per day, until the baby is taking a total of 200 ml per kg per day
Divide the total into 8-12 feeds, to feed every 2-3 hours
Continue until the baby weighs 1,800 g or more, and is fully breastfeeding

Check the baby’s 24-hour intake. The size of individual feeds may vary.

This calculator⁹¹ can be used as a guideline for babies that are receiving feeding from an at-the-breast system, a cup, or a bottle. Again, always follow your baby’s hunger and satiation cues

Calculate the approximate amount of milk needed in 24 hours⁹²

Baby's Weight lbs	Intake gr	oz	ml	Ounces/feeding (if 8/day)
5lbs	2265 gr	13.0 oz	390 ml	1.6 oz
5lbs 8oz	2491 gr	14.3 oz	429 ml	1.8 oz
6lbs	2718 gr	15.5 oz	467 ml	1.9 oz
6lbs 8oz	2944 gr	16.9 oz	507 ml	2.1 oz
7lbs	3171 gr	18.3 oz	546 ml	2.3 oz
7lbs 8oz	3397 gr	19.5 oz	584 ml	2.4 oz
8lbs	3600 gr	21.3 oz	639 ml	2.7 oz
8lbs 8oz	3850 gr	22.3 oz	664 ml	2.8 oz
9lbs	4000 gr	24.0 oz	720 ml	3.0 oz
9lbs 8oz	4303 gr	24.8 oz	741 ml	3.1 oz
10lbs	4500 gr	26.7 oz	801 ml	3.3 oz
10lbs 8oz	4756 gr	27.3 oz	819 ml	3.4 oz
11lbs	4900 gr	29.3 oz	879 ml	3.7 oz
11lbs 8oz	5209 gr	29.9 oz	897 ml	3.7 oz
12lbs	5400 gr	32.0 oz	960 ml	4.0 oz
12lbs 8oz	5662 gr	32.5 oz	976 ml	4.1 oz
13lbs	5889 gr	33.8 oz	1015 ml	4.2 oz
13lbs 8oz	6115 gr	35.0 oz	1053 ml	4.4 oz
14lbs	6400 gr	37.3 oz	1119 ml	4.7 oz
14lbs 8oz	6704 gr	38.5 oz	1155 ml	4.8 oz
15lbs	6795 gr	39.0 oz	1172 ml	4.9 oz
15lbs 8oz	7021 gr	40.3 oz	1210 ml	5.0 oz
16lbs	7300 gr	42.7 oz	1280 ml	5.3 oz

How can donated breastmilk be used?

With proper care and timely use, donated breastmilk can be reused as follows:

Fresh milk
Fresh human milk can safely stand at room temperature for 6 to 8 hours and need not be discarded if the first feeding attempt is incomplete.⁹³

After feeding
Regarding reusing milk after a feeding, Dr. Ruth Lawrence writes that “whether you can use the remaining milk really depends on how long it sits around. Once the baby takes the bottle, there is a certain amount of saliva that gets in the bottle that creates bacteria and gets saliva enzymes in the milk. This is why it isn’t good to give milk that has been sitting around. But, if it sits for only a half-hour or so, this is fine.”⁹⁴ There can be confusion as to what ‘sits around’ means. Eats on Feets assumes that in this context ‘sits around’ means ‘stand at room temperature.⁹⁵

See How do I feed the milk to my baby? for efficient, cleaner, and thus safer feeding options.

After refrigeration
Doctors recommend unfinished portions of expressed milk be thrown away when infants do not finish a bottle.⁹⁶ A small study that examined bacterial levels in expressed, partially consumed breastmilk that was stored for 48 hours at 4-6°Cº showed no significant difference between bottles that were partially consumed and those that were not exposed to the baby’s mouth for 5 out of 6 participants. All milk samples had colony counts in the acceptable range.⁹⁷

Most caretakers reheat leftover and refrigerated milk. If the milk is warmed up but not used, it is OK to reheat the milk once. But the more you reheat the more you decrease some of the valuable immunologic properties of the milk.⁹⁸

After freezing
Regarding previously frozen raw milk, it is generally accepted that thawed milk can be kept in the refrigerator for up to 24 hours. See How can expressed milk be thawed?

Most caretakers reheat (warm) previously frozen raw milk as well (after a first feeding). It is not advisable to leave previously heat-treated milk out for longer than necessary because heat-treating affects the anti-bacterial properties of breastmilk.

In general, when food has thawed in the refrigerator, it is safe to refreeze it without cooking⁹⁹ There is however little information on refreezing thawed human milk. Bacterial growth and loss of antibacterial activity in thawed milk will vary depending on the technique of milk thawing, duration of the thaw, and the number of bacteria in the milk at the time of expression.¹⁰⁰

Breastmilk, previously frozen or not, can be re-frozen after it has been heat-treated. This is the process that milk banks follow: frozen donated breastmilk is pasteurized, after which it is stored in the freezer.

Reusing heat-treated milk
Research shows that after cooling, flash-heat was successful in completely eliminating bacteria in the majority of samples, and prevented substantial growth for up to 8 h when stored at room temperature.¹⁰¹

To date, the safety of reheating previously heat-treated milk¹⁰² has not, to our knowledge, been studied. It should be noted that most literature speaks in terms of heating expressed milk for feeding but that caretakers generally warm the (thawed) milk under running warm water or set it in a container in warm water for a short while to get the chill out of it. Gently warming should not be considered heat-treating. For optimal properties of breastmilk, reheating (warming) milk should not be done directly in a pan on the stovetop nor in a container in boiling water on the stovetop (which would be heat-treating it unnecessarily). However, it is suggested that after a first feeding, milk that was heat-treated should not be refrigerated and reheated again.

How do I clean or sterilize supplies and pump parts?

Washing feeding equipment¹⁰³

Fill the sink with warm soapy water:

use the bottle brush to clean the bottles inside and out
use the teat brush to clean the teats inside and out
wash any other items used (eg, bottle caps, kitchen tongs, measuring jug)
make sure you remove all traces of milk when cleaning the bottles and teats

Rinse everything well in hot water and leave them to air dry.

Sterilizing by boiling or steaming or with chemicals

If sterilizing by boiling:
- fill a large pot with water
- place all the washed items in the water, ensuring no air is trapped and everything is covered with water
- put the lid on and heat the water until it comes to a rolling boil
- turn the stove off and keep the pot covered until you need the items

When you need to make up a feed, wash and dry your hands thoroughly and use the sterilised tongs to lift items out of the pot. If you remove items before you need them, cover and store them in a clean place – assemble bottles with a teat inside and a lid on.

If sterilizing by steam or with chemicals
- follow the manufacturer’s instructions when using steam (in an electric or microwave steam sterilizer) or chemicals (sterilizing tablets or solution)

The CDC recommends sanitizing pump parts at least once daily for extra germ removal. ¹⁰⁴ Sanitizing is especially important if your baby is less than 3 months old, was born prematurely, or has a weakened immune system due to illness or medical treatment (such as chemotherapy for cancer). Daily sanitizing of pump parts may not be necessary for older, healthy babies if the parts are cleaned carefully after each use. Sanitize all items (even the bottle brush and wash basin!) by using one of the following options.
Note: If you use a dishwasher with hot water and a heating drying cycle (or sanitizing setting) to clean infant feeding items, a separate sanitizing step is not necessary.¹⁰⁵

We encourage recipients to discuss their needs and their baby’s needs with potential donors.

❆✼❆

When using #5 French feeding tubes for at-the-breast feeding or finger feeding, rinse the tubes with hot, soapy water and use a syringe to force soapy water through the tubes, followed by clear water after each feeding. Dry the tubes by pushing air through the tubes. The longevity of these tubes is not known. The tubes should be replaced when they become gummy, discolored, brittle, etcetera.¹⁰⁶

How do I protect expressed milk during a power outage?

Knowing how to protect expressed milk during a power outage ahead of time can prevent losing a freezer stash. For recipient families, knowing how to protect expressed milk during a power outage can be crucial for feeding their baby. This infographic can be helpful to have on hand in case of a power outage. It can be downloaded and printed to keep handy. (4×9).¹⁰⁷

Adding dry ice to the freezer is a good way to make sure that foods stay frozen longer. Know ahead of time where to buy this.¹⁰⁸

Please remember that as long as there are ice crystals in the milk or the temperature of the milk is 4.4ºC/40°F or below, you can safely refreeze it.

Community-based milksharing and wet nursing can be vital in times of emergency. Identifying local human milk resources, whether through private donation or wet nursing, can help provide milk to the most vulnerable in a time of need. Formula and ways to prepare formula may not be available or safe. Human milk will protect infants and young children against diseases.¹⁰⁹ ¹¹⁰

Stay warm and be safe!

_______________

OHSA – Breast milk does not constitute occupational exposure as defined by standard ↩︎
CDC – Perspectives in Disease Prevention and Health Promotion Update: Universal Precautions for Prevention of Transmission of Human Immunodeficiency Virus, Hepatitis B Virus, and Other Bloodborne Pathogens in Health-Care Settings ↩︎
CDC – When and How to Wash Your Hands. ↩︎
Anne Eglash, et al. BREASTFEEDING MEDICINE Volume 12, Number 7, 2017. ABM Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants ↩︎
Open vs Closed System Breast Pump ↩︎
Nancy Hurst. 2007. The 3 M’s of Breast-feeding the Preterm Infant ↩︎
CDC –When and How to Wash Your Hands ↩︎
OASH – Pumping and storing breastmilk ↩︎
Mayo Clinic – Breast milk storage: Do’s and don’ts ↩︎
AskDrSears – Transporting and Storing Breast Milk ↩︎
OASH – Pumping and storing breastmilk ↩︎
GreenLightBites – Breast Milk Storage ↩︎
USDA – Freezing and Food Safety ↩︎
Anne Eglash, et al. BREASTFEEDING MEDICINE Volume 12, Number 7, 2017. ABM Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants ↩︎
BT&C, Inc. – Maintenance of Protein Stability ↩︎
OASH – Pumping and storing breastmilk ↩︎
CDC – Proper Storage and Preparation of Breast Milk ↩︎
For shipping with dry ice in the US, please visit dryiceInfo and ShipStation ↩︎
FedEx – Shipping Dry Ice ↩︎
DryIceInfo – Shipping ↩︎
100 ounces of milk weighs about 13 pounds (0.13 pounds per ounce, based on the weight of a gallon of cow’s milk). This is an assumed estimate and will allow you to roughly estimate shipping costs. In addition to the weight of the milk, you will have to account for the weight of the dry ice or frozen packs used to keep the milk frozen and the weight of the container. ↩︎
Unit Converter

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↩︎
USDA – Freezing and Food Safety ↩︎
Stanford Medicine – Shipping Breastmilk ↩︎
For insulated shipping boxes in the US, please visit Uline – Insulated Shipping Kits, Cameron Packaging – Foam Insulated Boxes, or ask friends, family, and local Buy Nothing groups as there are usually plenty there. ↩︎
For shipping with dry ice in the US, please visit dryiceInfo and ShipStation ↩︎
Please note: Some parents have experienced leakage with their storage bags when thawing them. Thawing storage bags of breastmilk is best done by handling them with clean hands, wiping the outside of the bag clean, and putting them in a bowl to collect any potentially leaked breastmilk. ↩︎
OASH – Pumping and storing breastmilk ↩︎
CDC – Proper Storage and Preparation of Breast Milk ↩︎
Richard Quan, et al. 1992. Effects of Microwave Radiation on Anti-infective Factors in Human Milk ↩︎
USDA – Freezing and Food Safety ↩︎
Anne Eglash, et al. BREASTFEEDING MEDICINE Volume 12, Number 7, 2017. ABM Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants ↩︎
Kim Updegrove, MSN, MPH, APRN, CNM, et al. 2020. HMBANA Standards for Donor Human Milk Banking: An Overview ↩︎
Douglas B. Tully, et al. 2001. Donor Milk: What’s in It and What’s Not ↩︎
Dr. John May, et al. 2005. La Trobe Tables ↩︎
Please see Human Immunodeficiency Virus (HIV) and HIV and the global context of infant feeding for more information. ↩︎
HIV in breastmilk killed by flash-heating ↩︎
Mduduzi N. N. Mbuya, et al. 2010. Heat Treatment of Expressed Breast Milk Is a Feasible Option for Feeding HIV-Exposed, Uninfected Children after 6 Months of Age in Rural Zimbabwe ↩︎
Kiersten Israel-Ballard, MPH, et al. 2007. Flash-Heat Inactivation of HIV-1 in Human Milk ↩︎
Letter to the Editor. Mylene L. Volk, MS, Carl V. Hanson, PhD, Kiersten Israel-Ballard, PhD, Caroline J. Chantry, MD. J Acquir Immune Defic Syndr. Volume 53, Number 5, April 15, 2010. Inactivation of Cell-Associated and Cell-Free HIV-1 by Flash-Heat Treatment of Breast Milk ↩︎
K. Israel-Ballard, et al. 2006. Bacterial Safety of Flash-heated and Unheated Expressed Breastmilk during Storage ↩︎
King County – Food safety in your home kitchen ↩︎
New York City Department of Health and Mental Hygiene. Food Matters, Spring 2017, Issue No 19. Food Keeping Your Customers Safe by Cooling Food Properly ↩︎
Ovesen L, et al. Int J Food Sci Nutr 1996. The effect of microwave heating on vitamins B1 and E, and linoleic and linolenic acids, and immunoglobulins in human milk. ↩︎
Maxwell Bressler, et al. 2013. How Long Does Flashe-Heated Breastmilk Remain Safe for a Baby to Drink at Room Temperature? ↩︎
Mothers’ Milk Bank Northeast – Storing, Defrosting, and Warming Pasteurized Donor Human Milk ↩︎
↩︎
It should be noted that most literature speaks in terms of heating expressed milk for feeding but that parents generally warm the (thawed) milk under running warm water or set it in a container in warm water for a short while to get the chill out of it. Gently warming should not be considered heat-treating. For optimal properties of breastmilk, reheating (warming) milk should not be done directly in a pan on the stovetop nor in a container set in boiling water on the stovetop (which would be heat-treating it unnecessarily). ↩︎
Ohio State University Extension Sheet. Archived. Preserving Beverages: Water, Juice, and Milk The method of heating milk to 62-63ºC/145ºF and holding it there for 30 minutes is the Holder or Batch method of pasteurization, the standard for human and cow’s milk pasteurization. ↩︎
Source Unknown – How can you safely heat treat breastmilk ↩︎
For more information on cup feeding, please see ‘How do I feed the milk to my baby?’ ↩︎
UCBerkelyNews – HIV in breastmilk killed by flash-heating ↩︎
Mduduzi N. N. Mbuya, et al. 2010. Heat Treatment of Expressed Breast Milk Is a Feasible Option for Feeding HIV-Exposed, Uninfected Children after 6 Months of Age in Rural Zimbabwe ↩︎
Kiersten Israel-Ballard, MPH, et al. 2007. Flash-Heat Inactivation of HIV-1 in Human Milk ↩︎
Letter to the Editor. Mylene L. Volk, MS, Carl V. Hanson, PhD, Kiersten Israel-Ballard, PhD, Caroline J. Chantry, MD. J Acquir Immune Defic Syndr. Volume 53, Number 5, April 15, 2010. Inactivation of Cell-Associated and Cell-Free HIV-1 by Flash-Heat Treatment of Breast Milk ↩︎
K. Israel-Ballard, et al. 2006. Bacterial Safety of Flash-heated and Unheated Expressed Breastmilk during Storage ↩︎
Kiersten Israel-Ballard, et al. 2008. Vitamin Content of Breast Milk From HIV-1–Infected Mothers Before and After Flash-Heat Treatment ↩︎
Kiersten Israel-Ballard, MPH, et al. 2007. Flash-Heat Inactivation of HIV-1 in Human Milk ↩︎
Lactoferrin is a round multifunctional protein with antimicrobial activity (bacteriocide, fungicide) and is part of the innate defense, mainly at mucoses. Lactoferrin is found in milk and many mucosal secretions such as tears and saliva. ↩︎
Caroline J. Chantry, et al. 2009. Effect of Flash-heat Treatment on Immunoglobulins in Breastmilk. ↩︎
Immunoglobulins are a class of proteins produced in lymph tissue in vertebrates and that function as antibodies in the immune response. ↩︎
Please see Bacteria for more information. ↩︎
Please also see ‘What about premature babies? ↩︎
The terms flash-heating and flash-pasteurizing are often used interchangeably. Flash-heating refers to the at-home method of pasteurizing as demonstrated in the Kiersten Ballard-Israel studies. Please see Flash heating explanation for information on how this is done. ↩︎
UCBerkelyNews – HIV in breastmilk killed by flash-heating ↩︎
Mduduzi N. N. Mbuya, et al. 2010. Heat Treatment of Expressed Breast Milk Is a Feasible Option for Feeding HIV-Exposed, Uninfected Children after 6 Months of Age in Rural Zimbabwe ↩︎
Kiersten Israel-Ballard, MPH, et al. 2007. Flash-Heat Inactivation of HIV-1 in Human Milk) ↩︎
Letter to the Editor. Mylene L. Volk, MS, Carl V. Hanson, PhD, Kiersten Israel-Ballard, PhD, Caroline J. Chantry, MD. J Acquir Immune Defic Syndr. Volume 53, Number 5, April 15, 2010. Inactivation of Cell-Associated and Cell-Free HIV-1 by Flash-Heat Treatment of Breast Milk ↩︎
K. Israel-Ballard, et al. 2006. Bacterial Safety of Flash-heated and Unheated Expressed Breastmilk during Storage ↩︎
World Health Organization. 2016. Guideline. Updates on HIV and Infant Feeding ↩︎
Dr. John May, et al. 2005. La Trobe Tables ↩︎
FDA – GUIDE TO INSPECTIONS OF DAIRY PRODUCT MANUFACTURERS ↩︎
Legal pasteurization is a combination of time and temperature as per the 2017 FDA – Grade A Pasteurized Milk Ordinance item 16p Administrative procedures section 1. ↩︎
Fokke G. Terpstra, et al. 2007. Antimicrobial and Antiviral Effect of High-Temperature Short-Time (HTST) Pasteurization Applied to Human Milk ↩︎
Kiersten Israel-Ballard. 2007. Flash-Heat Inactivation of HIV-1 in Human Milk Flash heating typically reached temperatures greater than 56Cº for 6 minutes 15 seconds and peaked at 72.9C.º ↩︎
Manitoba Food Safety Program. Thermometer Calibration Guide Thermometers need to be calibrated when used at higher altitudes if one needed to precisely measure the temperature of the milk. ↩︎
World Health Organization. 2016. Guideline. Updates on HIV and Infant Feeding Those who are HIV positive may consider expressing and heat-treating breastmilk as a temporary feeding strategy under the following circumstances: In special circumstances such as when the infant is born with low birth weight or is otherwise ill in the neonatal period and unable to breastfeed; When the lactating parent or caretaker is unwell and temporarily unable to breastfeed or has a temporary breast health problem such as mastitis; To assist lactating parents and caretakers to stop breastfeeding; If antiretroviral drugs are temporarily not available. ↩︎
B. S. Jeffery, K. G. Mercer. 2000. Pretoria Pasteurization: A Potential Method for the Reduction of Postnatal Mother to Child Transmission of the Human Immunodeficiency Virus ↩︎
Kiersten Israel-Ballard, et al. 2005. Viral, Nutritional, and Bacterial Safety of Flash-Heated and Pretoria-Pasteurized Breast Milk to Prevent Mother-to-Child Transmission of HIV in Resource-Poor Countries ↩︎
Please know that the company that manufactures one of the at-the-breast systems is not WHO code compliant. World Health Organization – International Code of Marketing of Breast-milk Substitutes ↩︎
Breastfeeding Committee for Saskatchewan – Breastfeeding with a Feeding Tube ↩︎
Other important benefits of feeding at the breast include proper jaw and facial development which reduces both ear infections and bite issues, by preventing malocclusion. The skin-to-skin contact that breastfeeding provides helps babies acquire the beneficial bacteria that protect them from diseases and builds their immune system. Skin-to-skin also provides relaxation for both parent and child due to the effects of oxytocin. There are also long-term benefits of breastfeeding that affect blood pressure, type-2 diabetes, serum cholesterol, overweight and obesity, and intellectual performance. Bernardo L. Horta, Cesar G. Victora. World Health Organization. 2017. Long-term effects of breastfeeding ↩︎
Please also see Why breastmilk? ↩︎
Jay Moreland, Jennifer Cooms. 2000. Promoting and Supporting Breast-Feeding: Nipple confusion occurs when a baby has not had the opportunity to establish the correct mouth movements for proper breast-feeding. Early and subsequent use of pacifiers, water, glucose water, and formula supplementation have been shown to promote early weaning and nipple confusion. The frequent use of an artificial nipple early in life has been shown to promote a less effective mouth movement; this was demonstrated with ultrasonography over a decade ago. For this reason, the physician should encourage the staff and the patient to address breast-feeding problems first, with direct observation of breast-feeding, before considering the use of supplementation. ↩︎
International Breastfeeding Center – Finger and Cup Feeding ↩︎
AskDrSears – Bottle Alternatives to Consider ↩︎
How much expressed milk does my baby need? ↩︎
There can be vast differences in training and expertise. Not every lactation consultant is an IBCLC. IBCLCs are International Board Certified Lactation Consultants who work in lactation clinics attached to hospitals and/or in private practice. They are healthcare professionals who specialize in the clinical management of breastfeeding. IBCLCs are certified and regulated by the International Board of Lactation Consultants Examiners. Find/verify an IBCLC. ↩︎
How do I feed the milk to my baby? ↩︎
WHO/UNICEF – Breastfeeding Counselling A Training Course ↩︎
A Baby’s Best Start Nursing Center – Amount of milk needed by baby in 24 hours ↩︎
These are approximate amounts. Follow your baby’s cues first.
Oz/feeding = oz/day divided by the number of feedings.
Example: A 9lb 8oz baby needs 24.8 oz/day. If feeding 8 times a day: 24.8 divided by 8 equals 3.1 oz/feeding. If feeding a baby breastmilk with a bottle, place the calculated amount of milk per serving in separate bottles.
Daycare:
Use the chart to calculate how much to take to daycare for the day.
Example: A 9lb 8oz baby needs +/-24.8 oz/day or 3.1 oz/feeding.
If daycare requires 3 feedings or 9.3 oz/day or 3.1 oz/bottle/day.
Pump 9.3 oz at work for the next day at daycare, or use frozen or refrigerated milk. ↩︎
Lawrence, Ruth. Breastfeeding, A Guide for the Medical Profession. P. 438. Print. ↩︎
Ruth Lawrence, MD. The Bump. ↩︎
This reference is for a room temperature of 10–29ºC, 50–85ºF). Studies suggest different optimal times for room temperature storage because conditions vary greatly in the cleanliness of milk expression technique and the room temperature. Anne Eglash, et al. BREASTFEEDING MEDICINE Volume 12, Number 7, 2017. ABM Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants ↩︎
Anne Eglash, et al. BREASTFEEDING MEDICINE Volume 12, Number 7, 2017. ABM Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants ↩︎
Brusseau, R. Bacterial Analysis of Refrigerated Human Milk Following Infant Feeding. May 1998. Web. “When infants do not finish a bottle of expressed breastmilk, doctors recommend unfinished portions be thrown away. This study examined bacterial levels in expressed, partially consumed breastmilk that was stored for 48 hours at 4-6°C. A portion of unconsumed milk was examined as a control. Samples were taken every 12 hours for bacterial analysis. Tests were performed to identify total colony counts, pathogenic Staphylococci, coliforms, and b-hemolytic Streptococci. This study showed no significant difference between bottles that were partially consumed and those that were not exposed to the baby’s mouth for 5 out of 6 participants. All milk samples had colony counts in the acceptable range of < 105 colony-forming units per milliliter (CFU/ml). Although this project provides evidence that it may be safe to re-feed a child a bottle of breastmilk, due to the small sample size, further tests should be performed.” ↩︎
Lawrence, Ruth. Breastfeeding, A Guide for the Medical Profession. P. 438. Print. ↩︎
USDA – Freezing and Food Safety ↩︎
Anne Eglash, et al. BREASTFEEDING MEDICINE Volume 12, Number 7, 2017. ABM Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants ↩︎
K. Israel-Ballard, et al. 2006. Acceptability of Heat Treating Breast Milk to Prevent Mother-to-Child Transmission of Human Immunodeficiency Virus in Zimbabwe ↩︎
This can be the case if a donor heat-treats the milk because of high lipase or after a recipient heat-treats the milk and there is milk leftover after a feeding for instance. ↩︎
KidsHealth – How To Wash & Sterilise Feeding Equipment ↩︎
Canadian Institue of Food Safety – Understanding the Difference Between Cleaning, Sanitizing & Sterilizing ↩︎
CDC – How to Keep Your Breast Pump Kit Clean: The Essentials ↩︎
Breastfeeding Committee for Saskatchewan – Breastfeeding with a Feeding Tube ↩︎
Guidelines used: USDA and FoodSafety ↩︎
For dry ice information in the US, please visit dryiceInfo and ShipStation ↩︎
AAP – Infant Feeding in Disasters and Emergencies ↩︎
CDC – Infant and Young Child Feeding in Emergencies ↩︎

Resource for the Informed Sharing of Human Milk

Eats on Feets™ – Connecting Babies and Breastmilk: A perfect match!

Handling Milk

Introduction