How long can expressed breast milk stay at room temperature

Journal List
BMJ
v.327(7427); 2003 Dec 6
PMC286329

BMJ. 2003 Dec 6; 327(7427): 1338.

Table of Contents Show

Here are some helpful guidelines for storing your breast milk safely.
The Rule of 4's
Where We Stand:
About Dr. DiMaggio:

Q&A

Question

How long does expressed breast milk last? Should it be kept in a refrigerator?

Priyankara C D Atapattu, registered medical officer, Wlasmull, Sri Lanka

Answer

The Breastfeeding Network (BfN) recently investigated this issue (Hands A. Safe storage of expressed breast milk in the home. MIDIRS Midwifery Digest, 2003;13: 378-85 [Google Scholar]).

“Current guidelines for the safe storage of expressed breast milk (EBM) were found to be inconsistent and confusing, ranging from 24 hours to 8 days in the fridge. Primary research showed EBM could delay bacterial growth, keeping it safer for longer than processed milk. Freezing affects these antibacterial properties.

Careful handling during collection and accurate storage temperature is stressed to prevent bacterial contamination and minimise bacterial growth. Studies showed EBM to be safe for up to 8 days below 4°C and up to 3 days at 4-10°C. It has not been shown if milk is safe (or unsafe) at either refrigeration temperature. There is evidence to suggest that contaminated milk is safer stored at 4°C for 8 days than frozen; and that previously frozen breast milk should be kept for as short a time as possible before use.”

Anabel H Hands, former dairy microbiologist and BfN trustee, Paisley

Answer

The following guidance is taken from Guidelines for the Collection, Storage and Handling of Breastmilk for a Mother's Own Baby in Hospital, published by the UK Association for Milk Banking, 2nd edition, 2001. As it is intended for use with babies who have been born preterm or are unwell, it incorporates a margin of safety. The storage times are therefore less generous than those sometimes used for well babies at home.

“Breastmilk should be kept at room temperature for as short a time as possible and refrigerated immediately after expression. If a mother is expressing at home and has no access to a fridge, the milk can be kept at room temperature for up to 6 hours. If milk is to be used within 48 hours it should be stored in a refrigerator at a temperature of 2-4°C. Milk which has not been used after 48 hours should be stored frozen (-20°C) for a maximum of 3 months if it is to be fed to sick preterm infants.”

Gillian A Weaver, chair of the United Kingdom Association for Milk Banking, Queen Charlotte's and Chelsea Hospital, London

Answer

Searching the web using Google and the phrase “storing expressed breast milk” gives a good set of results. Quality of information is obviously an issue; however, a quick scan shows that there seems to be a degree of consistency among the guidelines and some are published by well respected organisations. See www.ich.ucl.ac.uk/factsheets/misc/breastfeeding_and_expressing/

John C Platt, senior nurse lecturer, Northern General Hospital, Sheffield

Articles from The BMJ are provided here courtesy of BMJ Publishing Group

By: Dina DiMaggio, MD, FAAP

When it comes to breast milk, how you store it depends on how soon you want to use it.

Here are some helpful guidelines for storing your breast milk safely.

Before expressing or pumping: Wash your hands and all storage containers thoroughly. Label the date the breast milk was expressed on each container and include your child's name if you are giving the milk to a child care provider. Talk with your child care provider about how they require breast milk be stored and labeled.
Store breast milk in small batches. 2 to 4 ounces is recommended to prevent waste. Any remaining breast milk left in a bottle after your baby is finished with a feeding should be used within 2 hours, or, if quickly refrigerated, used for the next feeding. You can always thaw an extra container if needed.
Refrigerate or chill milk right after it is expressed. Freshly expressed milk can remain at room temperature (up to 77°F or 25°C) for 4 hours (or up to 6 to 8 hours if very cleanly expressed), but it is best to chill as soon as possible.
Breast milk can be placed in the back of the refrigerator (39°F or 4°C). It is best to use refrigerated breast milk within 4 days, but it can be refrigerated for up to 8 days.
To warm breast milk from the refrigerator: Place the bottle in a bowl of warm water or run it under warm water. Microwaving breast milk is not safe due to the risk of scalding your baby with hot milk.
Freeze breast milk if you will not be using it within 24 hours. Breast milk expands as it freezes, so do not fill the milk all the way to the top of the storage container. Again store the milk in the back of the freezer, not the door.

If freezing the milk inside a refrigerator with a freezer that has a separate door (0°F or −18°C), milk may be frozen for up to 9 months.
If the freezer is a chest or a deep freezer (−4°F or −20°C), milk may be frozen for up to 12 months.

To thaw breast milk from the freezer: Put the bottle or bag in the refrigerator overnight, hold it under warm running water, or set it in a container of warm water. Remember that heating breast milk in microwaves is not safe.
Once breast milk is thawed: It can be stored in a refrigerator and must be used within 24 hours.

The Rule of 4's

We know breast milk storage can be confusing, so here is a more conservative approach that you can also go by (and easily remember): 4 hours at room temperature and 4 days in the refrigerator!

Editor's Note: Although these breast milk storage guidelines are appropriate for babies born premature and those who are hospitalized, hospitals may have their own rules. If you have specific questions, discuss these guidelines with your baby's pediatrician and/or hospital.

Where We Stand:

The American Academy of Pediatrics recommends breastfeeding as the sole source of nutrition for your baby for about 6 months. When you add solid foods to your baby's diet, continue breastfeeding until at least 12 months. You can continue to breastfeed after 12 months if you and your baby desire.

Additional Information & Resources:

Expressing Breastmilk On the Job
Breastfeeding and the Use of Human Milk (AAP Policy Statement)
Effects of Extended Freezer Storage on the Integrity of Human Milk (The Journal of Pediatrics)

About Dr. DiMaggio:

Dina DiMaggio, MD, FAAP, is a board certified pediatrician at Pediatric Associates of NYC and at NYU Langone Medical Center. She is the co-author of The Pediatrician's Guide to Feeding Babies and Toddlers, a comprehensive manual written by a team of medical, nutrition, and culinary experts. Follow her on Instagram @Pediatriciansguide.

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.