Didn’t clean surface before bottles put down, especially teats put face down on dirty worktop

Didn’t wash hands before handling bottles initially 

Didn’t clean surface properly and got chemicals on the bottles

Didn’t sterilise bottles before use

Didn’t check water levels

Used water from the kettle but unclear whether it had been boiled and left to cool for half an hour or was not clean

Didn’t level off mixture or check how much needed to be in bottles - seemed too much

Handling teats

Didn’t close bottle well

Second time didn’t wash hands well, then dirtied them on top

Didn’t level first scoop, second was levelled into bottle anyway, third with finger, unhygienic 

Didn’t boil kettle or check proper water amounts

Coughed over bottles

Handling teats

Didn’t close bottles well

Unsterilised water around bottle then opened again, which could contaminate it

Dirtied hands wiping them on clothes and petting dog

Didn’t make up bottle when needed which is the ideal (although milk can be left in the fridge for up to 24 hrs)

Unclear how long milk left in fridge - not labelled or anything

Microwaved - can cause heatspots

Not tested on inner wrist for body temp

Dog around bottles

Baby on back without bottle supported- could choke. Not responsive feeding

Not paying attention to feeding

Left around dirty dishes that could contaminate when washing up

Washed in dirty water with same bottle brush as pans

Not soapy water

Teats left face down on unclean worktop after washing

Not placed face down in dishwasher for effective washing

Dishwashed but not sterilised

2.       The surface was not clean which can lead to further contamination.

3.       Didn’t wash hands before handling the bottles

4.       Didn’t boil the kettle, if it was boiled, it was unclear how long it had been left to cool before use.

5.       Bottles, lids and teats set down on the outer surface where the baby’s mouth touches, rather than the inner surface of the bottle.

6.       The water was not measured out correctly

7.       Leaky bottles

8.       The milk temperature was not checked

9.       Responsive feeding was not shown.

Emily Howell

2)     Surface was not wiped before hand – not a sterilised area

3)     Wash hands before completing anything or holding the bottles- your hands can bring bacteria into the sterile area

4)     Wiping hands on herself and touching the dog, brings in bacteria in a before sterile environment

5)     Didn’t boil properly, just touched the kettle to see if it was hot, not boil – this is important because only at boiling point bacteria can leave

6)     The water was put in before the powder – I would always put the powder in first to ensure that the whole of the powder is mixed with water

7)     Water and powder were not measured out correctly – one bottle had three heaps and the other had one

8)     Temperature was not checked

9)     Should be made every time and not stored in the fridge

10)  Should not be microwaved but instead put in hot water – microwave can increase bacteria

11)  The bottle lid and the bottle were not put on properly – this led to the milk coming out when shaking – this could be harmful as if it was when she was feeding, her and the child could have been hurt

12)  The baby was feeding alone, all aspects like eye contact, skin-to-skin would not be happening as well as the most important part is that the child is at a risk as they could choke on the milk, move positions or get milk over themselves.

13)  Babies should be held in the semi-upright position and held close with eye contact and skin-to-skin if possible – this creates a bond between the adult and child and can increase the likelihood of the child drinking

14)  There was more the two people feeding the child – up to 2 people should be feeding the child, this is to make sure that the baby can create a relationship with the 2 individuals as primary care givers but also associate them with feeding. It also allows the two individuals to familiarise themselves with early signs of hunger, so it can decrease the likelihood of unnecessary crying.
Macey Stone

- Sprayed antibac over bottles

- unsure if water used was fresh water in kettle
- Temperature of water didn’t appear to be at the boiling point when mixing with formula (You should always boil water before using it to make formula milk. Powdered infant formula milk is not sterile. Even though tins and packets of milk powder are sealed, they can still contain bacteria. Water that hasn't been boiled can also contain bacteria) 
- incorrect amount of formula to water ratios (follow instructions listed on the packaging ) 

- Heaped/unlevelled scoops (this changes water to formula ratios )
- bottles placed in fridge (unsure of the temp at the time they were stored) 

- 2nd attempt at making formula was made with formula first and water second (this method distorts formula to water ratios and can cause babies to become poorly) 
- Water not boiled fully (inadequate boiling of water for formula feeding is potentially harmful for baby.
infant formula is not sterile and Water that hasn't been boiled can also contain bacteria) 

- Heated feed in microwave (Studies have shown that microwaves heat baby's milk and formula unevenly. This results in "hot spots" that can scald a baby's mouth and throat.) 

- Not tested temp before feeding

- baby left unsupervised for feed (this hinders attachment and bonding) 
- Baby not fed in optimal positions
- nor was baby winded following his/her feed

- Washed bottles with other dishes and no soap and placed bottles back in dishwasher ( this isn’t a sufficient form of sterilisation for bottle feeding) 

Zee xoxo

2.      Dishwasher can wash the bottle, but not sterilise it. In this case I would wash the bottles, teats, etc. without any other dishes as they can leave a residue (tomato sauce, pulses etc.).

3.      The water in the kettle should have been discarded, fresh cold water must be used and freshly boiled.

4.      Only one bottle should have been prepared (it is fresh for up to 2 hours).

5.      When the hands were finally washed, they weren’t dried properly with a towel (shaking them to get rid off excess water is not enough).

6.      Formula spoon must be levelled not heaped.

7.      There is an instruction on the formula packet how to measure the feed, in this case this was not checked. 

8.      When assembling the teat into the screw ring, you must be careful not to touch inside or top of the teat.

9.      The screw ring wasn’t properly screwed onto the bottle (or the teat into the screw ring).

10.   The hands haven’t been washed properly with soap and dried with a clean towel.

11.   The freshly boiled water must be put in first (then formula). 

12.   When levelling the formula spoon (with a clean knife), it was done above the bottle.

13.   Levelling the formula spoon was done with a finger and the powder was pushed in.

14.   Water wasn’t freshly boiled.

15.   Teat wasn’t assembled correctly into the screw ring and the teat was touched again.

16.   The bottles were made up without using them immediately after the preparation (up to 2 hours). Also, they cannot be put to the fridge if they are hot.

17.   The bottle in the formula was heated up in the microwave oven.

18.   The dog has been stroked a few times, which is lovely, but the hands must be washed afterwards.

19.   The baby was left unattended with a formula bottle in their mouth.

20.   Whoever was feeding the baby was not paying too much attention to the baby.

21.   When cleaning the bottle, it wasn’t done with a hot soapy water and designated brush. The bottle, teat etc. must be then put on a clean surface.

22.   The remaining formula must be discarded away from the bowl where the washing of the bottle is going to take place.

23.   The bottle, teat etc. were loaded into the dishwasher with other dishes in a careless manner.

24.   The hands were not washed and dried properly.

Stratum granulosum

Stratum spinosum

Stratum basalis (inner most).

how would i answer this question please?

•       Heart rate – 110 – 160 beats per minute

•       Respirations - 40 – 60 breaths per minute

•       Temperature – 36.5 – 37.3 degrees Celsius

•       Urine -  by 24 hours

•       Stool – meconium  by 24 hours, totally excreted by 48 – 72 hours

however i have read 
  

•       Heart rate – 100 – 160 beats per minute

•       Respirations - 30 – 60 breaths per minute

•       Temperature – 36.6 – 37.2 degrees Celsius

•       Urine -  by 24 hours

•       Stool – meconium  by 24 hours, totally excreted by 48 – 72 hours

which is correct ...??? or what is the significance for  this discrepancy ?

please clarify -