Warming feeds is unnecessary and hazardous

Editor—Having read Jeffery et al's account of scalds in children, I agree that the cases that they have seen are probably only the tip of the iceberg.¹ Between 1994 and 1997, 10 children under the age of 2 years (range 3-19 months) were admitted to Frenchay Hospital in Bristol with scalds sustained when hot water spilled from a jug in which it was being used to heat a bottle of infant formula. This is equivalent to 6% of children aged under 2 in Bristol being admitted for scalds. The extent of the scald ranged from 1% to 13% of the body surface. Seven of the scalds healed spontaneously, and three required split skin grafts. Complications developed in two cases: the toxic shock syndrome and hypertrophic scarring.

In seven of the accidents children pulled themselves up to stand or reached out and pulled the jug over themselves; in one incident a mother's dressing gown caught the jug. In another a child in a babywalker was able to reach the kitchen counter, and in another the jug was knocked over as the bottle was being taken out. In none of the cases were there any concerns about child abuse. The number of injuries and their subsequent complications are cause for concern.

Not only has the effect of the temperature of feeds on gastric emptying been studied¹ but full term and preterm infants have been given cold milk from the refrigerator and their sleep patterns, food intake, weight gain, and frequency of crying and regurgitation have been compared with those of infants given warm milk; no differences were found.²

The practice of using a jug of hot water to heat the feed is common, and it may be that it is recommended as being safer than using a microwave oven. Children who are just able to crawl, pull themselves to stand, and begin to explore are at particular risk of these accidents. A number of children in the group seen in Bristol had reached a new developmental milestone, which was first observed at the time of injury.

Warming feeds is unnecessary and it should not be recommended since both common methods of warming seem to be hazardous. Carefully prepared formula can be given at room temperature or from the refrigerator. Health professionals caring for mothers and their babies should be aware of these hazards so that appropriate education can be given regarding feeding.