Thursday, July 26, 2012

Breastmilk Storage Guidelines for Pinay Moms

A handful of working moms asked me on milk storage guidelines. Different sources would have different guidelines, and I thought somebody should put down a localized guideline for a temperate country like ours.

Months ago, I tagged along one of my mentors in a breastfeeding lay forum and she shared the one laid out by Philippine National Committee on Human Milk Banking. Credits to Dr. Jessa Sareno for this table.

Here it is:

Recently, I underwent the UNICEF/WHO module on Breastfeeding Management for health-workers in Dr. Jose Fabella Memorial Hospital. The guidelines are pretty much simplified. Here is the set of guidelines for a healthy term baby at home:

Milk should NOT be stored above 37 degrees.
4 hours at 25-37 degrees Celsius
8 hours at 15-25 degrees Celsius
8 days refrigerated (2-4 degrees Celsius)
However, many refrigerators do not keep a constant temperature. Thus, it's safer to use refrigerated milk within 3-5 days of storage and freeze* milk that will not be used within 5 days  right away.
Source:  Unicef/WHO Baby Friendly Hospital Initiative Section 3: Breastfeeding Promotion and Support in a Baby-Friendly Hospital, Jan 2006

* Do not fill up a container completely, only up to 3/4 full because milk expands when frozen.

* You may refrigerate milk collected over 24 hours and then batch freeze.
 Author's note: If you are pumping milk in the office, or elsewhere you still need to transport milk you plan to store, it is best to store temporarily in a REFRIGERATOR and then just batch freeze when you get home. Why? If your milk partially or completely froze, and   you transport home, then there is a chance of it thawing to some degree. This can affect the quality of your milk.

*If you must, COOL freshly obrained milk before adding to the frozen batch.
Author's note: Again remember the principle of thawing. If you add freshly express milk (usually warm from our breast), it may thaw the frozen milk it gets into contact with. The viability of this combined milk will then take on the oldest milk collected.

*If you are using the cooler transport your pumped milk home, make sure that the milk is in contact with the ice/frozen gel packs. Frozen gel packs are better than ice cubes to keep milk cold or frozen.

*Domestic refrigerators are the ones that we usually have at home or the office. One-door types have more fluctuating temperatures so the two-door types keep milk longer. It's important to keep milk where the temperature is most constant (at the back, NOT on the door especially if you are using your office refrigerator to temporarily store).

*Preparing a Container of Expressed Breastmilk at Home
1. Wash the container with warm soapy water and thoroughly rinse.
2. Drip dry on a clean towel.
3. Pour hot water into the container.
4. When ready to express milk, pour the water out of the container.

*Preparing to Express Milk with a Breast Pump
1. Read the instruction sheet in the pump prior to first use.
2. Wash the parts of the pump that touch the breast or milk with clean warm soapy water. Thoroughly rinse and air dry.

(*Source: Strengthening Human Milk Banking Practices: A training manual for human milk bank personnel on the best practices of handling human milk and educating breast milk donors). Created by the UNICEF Technical Working Group on Human Milk Banking, reviewed by the Philippine National Committee on Human Milk Banking)
Here are some more practical tips:
  1. As a rule, wash your hands properly before you collect milk. 
  2. If you plan to store your milk, store it in the coldest storage RIGHT away. If you are placing milk on a temporary cold storage, you may keep it cold and then freeze it within 24 hours. 
  3. Once frozen milk is thawed, NEVER freeze it again. If kept in the refrigerator, it should be consumed within 24 hours. 
  4. Left over thawed milk should be consumed on the next immediate feeding. When in doubt, it's better to just discard it than give spoiled milk to your child. Thus it's very practical to freeze and thaw in small portions to prevent wastage or overfeeding (1-2oz blocks).  
  5. Do NOT shake or overheat human milk, as this will destroy the nutrients - particularly the proteins that are supposed to protect your baby. Did you know that antibodies are actually tiny intricately folded proteins? Shaking and microwaving/overheating will actually cause them to unravel so they loose their protective powers. It's normal for milk to separate into layers, and you may swirl gently before offering it to your child. NEVER shake vigorously.
  6. It's actually ok to give cold milk to babies :) To date, there is  no evidence that cold milk causes harm or colic. But for those who wouldn't want to give cold milk, be careful not to overheat (as this may cause scalding) and stay away from the microwave as much as possible. 
  7. It's best to store milk in small cloudy-colored BPA-free plastics. Leukocytes may stick to the sides of some bottles. For short-term storage, there are special commercially available milk bags. In a milk bank I know, they use recycled BPA-free containers of a commercially available sterilized water brand.
There, that's it for now. Will try to come up with more practical guidelines and sources soon :)

Have a great weekend!

Dr. Lei


  1. thanks jenny! hope it helps moms :)

  2. Lei, this is wonderful! So many people ask me too. Will refer them to this post. :)

  3. I think this is an enormously helpful post. I answer questions on you are/you were a breastfeeding an lc and childbirth consultant and we get so many questions about milk storage. There are so many different guidelines that it is refreshing to see this!!! I recommend to all our mommies that they post the guidelines on their refrigerator at home and at work - having them handy and eventually memorizing them makes pumping and storage much less confusing and stressful. What do you recommend about washing in tap water? I have heard mixed things about the water in the Philippines. Is it necessary to boil the breast pump and how often? Thanks you for a great article! Annie Pfeiffer Gower, NYC

  4. hi annie :) thanks for dropping by. i understand the concern regarding the pumps and cleaning techniques. i have just updated the post to put down additional tips. there is no recommendation from experts to boil or sterilize containers and pumps, however the instruction sheet from the manufacturer should be heeded. there is a difference between sterile and clean. and it's enough for these pumping gadgets to be clean prior to use :)

  5. Thank you for your kind reply...I agree that since boiling is not real sterilization (as in autoclave) it is probably unnecessary but I just had a mom post on the You are/were a breastfeeding mother...(owned by Nanay Nona) that tap water is not clean in the Philippines. What do you think of this?

  6. thanks for this post

  7. hi again annie! :) sharing with you recent developments in the tap water system in metro manila...
    in most urban places here, tap water is actually potable. most mothers also have access to water purifying stations if they still doubt the cleanliness of their tap source. but if it would give them peace of mind, by all means, they can go ahead and sterilize! :)

    to give you another personal insight, as one who used to practice in a remote place where cholera outbreaks happen, we don't teach mothers in these community to use breast pumps. manual hand expression is an invaluable skill for mothers (as manual expression can be more/as effective, and breast pumps are not easily available and quite difficult to clean in low-resource situations).