Cronobacter Infection and Infants

Getting sick from Cronobacter does not happen often, but infections in infants can be deadly. Learn what steps you can take to protect your baby from getting sick.

Cronobacter sakazakii, formerly known as Enterobacter sakazakii, is a germ found naturally in the environment. The germs can live in dry foods, such as powdered infant formula, powdered milk, herbal teas, and starches. Anybody can get sick from Cronobacter, but infection occurs most often in infants.

Rare but Serious Illness in Infants

Cronobacter infections are rare, but they can be deadly in newborns. Infections in infants usually occur in the first days or weeks of life. About four to six cases are reported to CDC every year, but this figure may not reflect the true number of illnesses because state health departments are not required to report Cronobacter infections.

Cronobacter germs can cause a dangerous blood infection (sepsis) or make the linings surrounding the brain and spinal cord swell (meningitis). Infants 2 months of age and younger are most likely to develop meningitis if they get sick from Cronobacter. Other infants more likely to get sick are those born prematurely and those less able to fight germs and sickness due to illness or medical treatment, such as chemotherapy for cancer.

The first symptom of Cronobacter infection in infants is usually a fever, accompanied by poor feeding, crying, or very low energy. You should take an infant with these symptoms to the doctor.

Breastfeeding helps prevent many kinds of sicknesses among infants.

Follow these five guidelines to protect your baby from Cronobacter:

1. Breastfeed. Breastfeeding is one of the best things you can do for your baby’s health and development. Among its benefits: preventing different kinds of infections, such as ear and respiratory infections. Very few cases of Cronobacter infections among infants fed only breast milk have been reported.

2. Clean, sanitize, and store feeding items and breast pump parts safely. You can help prevent contamination with germs and keep the milk you feed your baby safe by carefully cleaning, sanitizing, and storing

Baby bottles
Other feeding items
Breast pump parts

For detailed information, visit How to Clean, Sanitize, and Store Infant Feeding Items, How to Keep Your Breast Pump Clean: The Essentials, and How to Keep Your Breast Pump Kit Clean: Science Behind the Recommendations.

If your baby is fed with powdered infant formula, there are things you can do to protect your baby from sickness.

3. Consider using liquid formula when possible. If your baby gets formula, consider using formula sold as a liquid rather than a powder. This is especially important when your baby is less than 3 months old, or if your baby was born prematurely or has a weakened immune system.

Infant formula does not need to be warmed before feeding, but some people like to warm their baby’s bottle. If you do decide to warm the bottle, never use a microwave. Microwaves heat milk and food unevenly, resulting in “hot spots” that can burn your baby’s mouth and throat.

To warm a bottle: place the bottle under running warm water, taking care to keep the water from getting into the bottle or the on the nipple. Put a couple drops of infant formula on the back of your hand to see if it is too hot

4. Prepare powdered infant formula safely. Make sure that your formula is not expired and that the container is in good condition. Keep powdered formula lids and scoops clean and close containers of formula as soon as possible. In most cases, it is safe to mix powdered infant formula following manufacturer’s instructions. But if your baby is less than 3 months old, was born prematurely, or has a weakened immune system, you may want to take the following extra steps to protect against Cronobacter:

Boil water and let it cool to no less than 158°F/70°C before pouring it into a clean and sterilized feeding cup with a lid, or bottle. Water should cool to this temperature within 30 minutes after boiling.
Add the exact amount of formula listed on the container and carefully shake the bottle rather than stirring the mixture.
Immediately cool the formula to body temperature to ensure it is not too hot before feeding your baby. Run the prepared, capped bottle under cool water or place it into an ice bath. Do not let the cooling water get into the bottle or on the nipple.
Before feeding the baby, test the formula’s temperature by shaking a few drops on your wrist to see if it’s too hot.

Use formula within 2 hours of preparing it. If your baby does not finish the entire bottle of formula, throw away leftover formula. If you do not plan to use the prepared formula right away, refrigerate it immediately. Use refrigerated formula within 24 hours.

Wash your hands carefully with soap and water, especially after using the toilet or changing diapers.

5. Keep hands clean! Always wash your hands carefully with soap and water during key times:

Before preparing and feeding bottles or foods to your baby.
Before touching your baby’s mouth.
Before touching pacifiers or other things that go into your baby’s mouth.
After using the toilet or changing diapers.

If soap and water are not available, use an alcohol-based hand sanitizer with at least 60% alcohol (check the product label to be sure). Hand sanitizer with at least 60% alcohol kills Cronobacter germs, but wash with soap and water as soon as possible after using hand sanitizer. That’s because hand sanitizer does not kill all types of germs, and it may not work as well if hands are visibly greasy or dirty. It’s also important to keep clean all objects that may enter the baby’s mouth (such as pacifiers and teethers).

Not Just Infants

Cronobacter can cause diarrhea and urinary tract infections in people of all ages. The infection can be serious for older people and for people whose immune systems are weakened by other illnesses or conditions.

More Information

Food Safety and Handwashing: