From JHL: How US Mothers Store and Handle Their Expressed Breast Milk

Written by Robin Kaplan, M.Ed., IBCLC

Image via Mistel de Varona

Breast milk storage guidelines can be incredibly complicated for mothers to decipher. With each pump company and breastfeeding website having its own storage and handling recommendations, how’s a mother to know which one to follow? Plus, throw in whether the baby is full-term, pre-term, healthy, or in the NICU, and we have quite a confusing situation.

In the most recent online publication in the Journal of Human Lactation, How US Mothers Store and Handle Their Expressed Breast Milk, Judith Labiner-Wolfe and Sara B. Fein analyze the data they collected from over 2,000 pumping mothers in the United States. Their findings will probably not shock any lactation consultants, yet the authors bring up very valid conclusions for how we can educate the breastfeeding and pumping mothers that many of us work with.

Here are some of the significant results of the study:

  • 95% of mothers either never stored their milk at room temperature or did so for less than 4hrs. Recommendations range from 1-10 hours.
  • Roughly 50% of mothers never refrigerated their milk for less than 1 day and no more than 4% left it in the fridge for more than 5 days. Recommendations range from 1-8 days.
  • 10% of mothers heated their breast milk in a microwave, a practice that can cause uneven heating, as well as destroy some of the nutrient and anti-infective factors in breast milk. The professional consensus is to never microwave breast milk.
  • 17% of mothers with babies under 6.5 months old reported that they occasionally only used water to rinse the bottle nipples, which the authors stated could cause the baby to ingest harmful bacteria. Recommendations range from rinsing in warm, soapy to sterilizing daily.

What are our professional guidelines?

There are also some discrepancies as to how long pumped milk stays fresh and viable, even in our own professional guidelines. While these recommendations are similar to one another, there is still enough variability to cause confusion for even the most educated lactation consultant. Here are the recommendations, for a healthy infant, according to the newest edition of the Core Curriculum for Lactation Consultant Practice (2012):

Room Temperature 77 º: < 6 hrs.
Refrigerator: < 8 days
Insulated cooler with ice pack: < 24 hrs.
Completely thawed in the refrigerator: < 24 hrs.
Freezer compartment in 1-door refrigerator: 2 weeks
Freezer door in 2-door refrigerator: < 6 months
Deep freezer: < 12 months

The Academy of Breastfeeding Medicine Clinical Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants states:

Room temperature 16-29ºC (60-85ºF): 3-4 hrs. optimal; 6-8 hrs. acceptable under very clean conditions
Refrigerator ≤4ºC (39ºF): 72 hrs. optimal; 5-8 days under very clean conditions
Freezer < -17ºC (0ºF): 6 months optimal, 12 months acceptable
Reusing stored human milk – There is little information regarding the issue of refreezing thawed human milk or the duration of time that human milk can be used once a baby has begun drinking from the bottle or cup.

Both resources recommend washing human milk storage containers in hot soapy water and
rinsing or washing in the dish washer. Sterilization is not necessary.

How do these findings impact our practices when we work with breastfeeding and pumping mothers?

When we are discussing safe storage guidelines for breast milk, it is important to review our professional recommendations, as well as include warming, safe handling, and pump/bottle cleaning recommendations to protect the integrity of the breast milk, as well as the health of the child.

Recommendations should be accompanied by rationale, so that the mother understands WHY her breast milk is less compromised following these standards.

Where do we go from here?

This study’s findings highlight the need for a more systematic, researched-based recommendation for the viability of breast milk and what constitutes safe handling and storage. With so many variables (temperature of the storage space, type of storage equipment, handling, feeding, and cleaning procedures, etc.) there are just too many options, which I, myself, find incredibly confusing. While there are many factors that go into keeping breast milk viable for consumption, there has to be some way that we can create guidelines that are easier for new parents, and lactation consultants alike, to navigate and follow.

Robin Kaplan received training to be a Certified Lactation Educator and an International Board Certified Lactation Consultant from UCSD. She holds a Masters in Education from UCLA, a multiple-subjects teacher credential from UCLA, and a BA in Psychology from Washington University in St. Louis, MO. In 2009, Robin started her own business, the San Diego Breastfeeding Center, where she offers in-home breastfeeding consultations, free weekly support groups, breastfeeding classes, and online support through her business blog.  In addition to her private practice, Robin was the founding Co-editor of theInternational Lactation Consultant Association’s (ILCA)blog, Lactation Matters, and a regular contributor toILCA’s E-Globe newsletter.  She also is the host/producer of The Boob Group online radio show and the Director of Marketing for  Robin lives in her native San Diego, where she enjoys cooking, hiking, trying new trendy restaurants, and traveling with her family.

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6 Responses to From JHL: How US Mothers Store and Handle Their Expressed Breast Milk

  1. Monique 18 September 2012 at 10:23 #

    Great article, thanks!

  2. Marina 18 September 2012 at 12:35 #

    In my very limited experience, it seems that different mothers may have milk that spoils at slightly different rates as well. My own milk seems to spoil after about 2.5 months in the freezer, while I know others who have defrosted 6, 7, or 8 month old milk with no evidence of spoilage. Are there any professional guidelines about telling whether spoilage has occurred based just on smell/taste?

  3. Gina 18 September 2012 at 15:47 #

    Marina, I doubt your milk spoiled in the freezer. You probably have an excessive amount of Lipase.

  4. Vicki 18 September 2012 at 16:15 #

    To further confuse the situation, we should keep up with April Fogleman, PhD, IBCLC’s research at NC State University in Raleigh. She is studying how FFA’s change in refrigeration and room temp among other things. She thinks milk may be stored longer than the current recommendations once an infant has partially consumed milk from a bottle. Research ongoing.

  5. Amy Wolff 18 September 2012 at 16:25 #

    I have smelled my own milk after four or five days in the refrigerator. It does not smell good, let me assure you. That being said, I’m sure there’s a huge range in both refrigerator temperature maintenance and spoilage from mother to mother.

  6. Ginny 20 September 2012 at 18:07 #

    my milk stores well in the fridge, for about 7 days.. i never leave it longer than that.. i pump almost daily at work or in the early am for my 18 month old while i am working.. I suspect i have high amounts of lipase as my milk smells bad after its been frozen, and both my children refused to drink it once thawed..

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