What Hong Kong Families Need to Know about Buying and Using Baby Formula Milk

Parents across the world have been affected by the most recent infant formula milk recalls, understandably worried about their babies and anxious about how this affects their health.

Unfortunately, recalls of infant formula milk due to contamination are not uncommon. Since 2020 alone, there have been multiple international recalls involving the world’s largest infant formula manufacturers, affecting families across all over the world. For example:

• In 2022, Abbott Laboratories recalled batches of Similac, Alimentum, and EleCare infant formula milk due to contamination with cronobacter sakazakii and salmonella bacteria. Multiple infants were reported to have become unwell, and two infant deaths were associated with infection. The recall led to a national infant formula milk shortage across the USA.

• In 2025, ByHeart recalled all infant formula milks in the USA due to contamination with botulinum toxin from clostridium botulinum bacteria. The contamination was traced back to suppliers of whole milk powder used in the production of the infant formula milk. A reported 23 infants were hospitalized, and many more reported unwell due to botulism infection.

• In 2026 the two largest manufacturers of infant formula milk in the world (Nestle and Danone) recalled multiple batches of different brands of formula due to contamination of cereulide toxin (produced by Bacillus cereus). Brands recalled internationally include Danone’s Aptamil and Cow & Gate, Nestle’s and Nestle Weyth Nutrition’s SMA, NAN, S26, Illuma brands. Ongoing investigations have traced the contamination back to a manufacturer of a raw ingredient (ARA oil) in China. There have been multiple reports of babies becoming unwell across the world:

  • UK Health Security Agency (UKHSA) has reported 36 clinical notifications of children developing symptoms (such as vomiting and diarrhoea) after consuming infant formula batches later linked to cereulide contamination.

  • The Belgian Food Safety Agency is investigating around 20 reports of babies becoming unwell after consuming recalled Nestle infant formula milk

  • The death of two infants in France are under investigation following consumption of Nestle infant formula milk.

  • Hong Kong’s Centre for Health Protection (CHP) is investigating a case of cereulide toxin poisoning in an infant who consumed a recalled batch of Nestle infant formula milk.

While the numbers may appear small, the consequences of contamination in infant formula can be severe, particularly for newborns and young infants. With so many families in Hong Kong using infant milk formula to feed their babies – we’ve put together everything you need to know about using baby milk formula safely – and debunked some of the most common myths so you can make informed evidence-based decisions!

Fact 1: Paying more money for infant formula will not buy better nutrition for your baby

The nutritional composition of infant formula is strictly regulated and standardised internationally. All standard infant formula milks must meet specific requirements for energy, protein, fat, carbohydrate, vitamins, and minerals.

Because of these strict regulations on the composition of infant formula milks – it means that paying more money for infant formula will not buy you better nutrition for your baby - they all contain the same core ingredients.

You may notice that some brands advertise additional ingredients such as “added B12” or “HMOs”. It also means that you can switch and swap brands at any time. If you turn up at the supermarket and the brand you normally use isn't there, or has been recalled – don’t worry, just chose another Stage 1 infant formula milk off the shelf. Your baby will still get the same standardised nutrition.

MYTH: Swapping brands can make my baby sick

Swapping brands will not make your baby sick. This was a marketing message created by infant formula manufacturing companies to make sure parents developed brand loyalty.

Fact 2: Powdered infant formula milk must always be prepared with hot water that is at least 70c or more

When preparing powdered infant formula, it must be mixed with boiled water that is at least 70°C at the moment the powder touches the water. This is because powdered infant formula is not sterile.

As recent outbreaks have shown, infant formula milks can contain harmful bacteria, including: Cronobacter, Salmonella, and harmful strains of E. coli. Using water at 70°C or more is crucial because this temperature is high enough to kill these bacteria, significantly reducing the risk of serious infection.

MYTH: Making formula with very hot water destroys the nutrients in infant formula milk

This is not true. The core ingredients of infant formula milk (i.e., proteins, fats,

carbohydrates, minerals etc) remain stable at temperatures between 70°C and 100°C. Fat soluble vitamins (A, D, E, K) also remain stable at these temperatures. Water soluble vitamins may be mildly affected by heat, but the brief exposure time during formula preparation is not enough to meaningfully reduce the nutritional value of infant formula milk.

Preparing formula with hot water keeps your baby safe from harmful bacteria without compromising nutrition.

MYTH: Making formula with very hot water “denatures” the pre and probiotics in formula

Many formulas now advertise they have added prebiotics and probiotics, often including so-called Human Milk Oligosaccharides (HMOs). However, it’s very important for parents to understand that these “HMOs” added to formula do not come from human breast milk. They are manufactured in laboratories, often derived from microorganisms such as E. coli or yeast. These HMOs are not live and are not the same as the living pre and probiotics naturally found in breast milk.

There is no evidence that including these “HMOs” in infant formula milk provide any health benefits to babies. Because there is no evidence of benefit, by international regulation they are optional ingredients (companies can choose whether to include the or not). Because these ingredients are not live, not essential and have no proven health benefits, using hot water does not meaningfully affect their function or benefit.

If parents want to give their babies meaningful pre- and probiotics to support their baby’s gut health, this can be done by:

- Feeding your baby breastmilk – either exclusively or mixed-feeding – and breastmilk offered adds health benefits to your baby

- Using probiotics separately (for example, liquid drops), if advised by a healthcare

professional.

Fact 3: Formula Preparation Machines Are Not Recommended

Despite manufacturer claims, multiple independent studies have found that many formula preparation machines do not consistently heat water to 70°C.

This means that any bacteria present in powdered formula may survive, and the risk of infection is not adequately reduced. For safety reasons, preparing formula manually with freshly boiled water remains the recommended method.

Fact 4: Imported or Overseas Infant Formula Milk is Not Safer

Many parents in Hong Kong believe that imported infant formula—especially products made in Europe or the United States—is safer. Unfortunately, recent outbreaks show that this is not necessarily true.

Infant formula production relies on a complex global supply chain and raw ingredients are sourced and distributed internationally. This means that many of the brands across the world, are using the same core ingredients from the same sources. As shown in the most recent global recall of infant formula milks, brands from across every continent were affected and recalled due to contamination.

Importing formula from overseas does not guarantee safety and does not eliminate contamination risk.

Fact 5: Follow-on or Toddler milks are not necessary

Stage 1 infant formula milk is suitable for the first year of life. At around one year, your baby should be eating a varied diet of family foods and no longer relies on milk as the main source of their nutrition. The World Health Organization has made a clear statement that follow-on formula or ‘toddler milks’ are not needed.

The reason these products exist is due to the strict marketing regulations set out in the International Code of Marketing of Breastmilk Substitutes where companies are restricted from advertising any infant formula milks designed for young infants (under 36months). To get around this restriction, companies developed ‘follow-on’ or ‘toddler’ milks to be able advertise their products.

A practical guide for the safe preparation of infant formula milk

• Always add water first, then powder: Measure the water accurately before adding the correct amount of formula powder as per the manufacturer’s instructions. This helps to make the right ratio. Over or under-concentrated formula over time can affect your baby’s growth and development.

• Discard after 1 hour: Once your baby has started drinking from a bottle or cup, any remaining formula must be thrown away after one hour.

• Prepare fresh whenever possible: Formula should not be frozen, stored, or

  reheated. Make a new feed each time.

• Use boiled tap water or distilled bottled water: Avoid mineral water, which may contain excessive sodium, sulphate, or other minerals unsuitable for infants.

• Stage 1 formula is sufficient for the first year of life: ‘Follow-on’ formulas are not necessary.

If you're worried about formula preparation or have any questions about mixed feeding or how to introduce formula, please get in touch with our team for a consultation.