The Pediatrics Commentary mentions the dangers of adding boiling water to powdered formula. All instructions say to measure the water first, then add the powdered formula to the water. The potential of clumping is easily handled by anyone who has ever made gravy from flour and drippings. Preventing clumping is a "training issue" - to use a business term. Teach it to mom and staff along with teaching asceptic preparation.

If using boiling water is too dangerous for a new mother, or anyone else preparing the feed, who is going to cook dinner for her family? Shall we not cook our meals any more because heat destroys nutrients?

WHO recommends using COOLED boiled water, NOT boiling water. The writer's allegation that using boiling water, (or cooled boiled water) will destroy too many table nutrients is easily testable in a laboratory. 
ADA: can't you do this? What are the nutrient levels straight from the manufacturing plant? Mid way? The day before expiration? How much is destroyed by using boiling water? By using cooled boiled water?

Phyllis
 
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Phyllis Adamson, IBCLC, RLC
Glendale, AZ.
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