People at risk

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Infants and young children under five years old are especially vulnerable to foodborne illness because their immune systems are not fully developed. Their stomachs also produce less acid making it easier for harmful germs to cause harm in their bodies.

There is detailed advice on infant and young children feeding on the National Health and Medical Research Council’s (NHMRC) website

Foods to avoid

The following foods should not be fed to young children because of their potential to cause serious foodborne illness:

• Raw or undercooked meat (particularly minced meat), poultry, fish and shellfish
• Raw seed sprouts—such as alfalfa, clover and radish
• Uncooked fermented meats, such as salami—check the label: ‘heat treated’ or ‘cooked’ products are safe. Do not feed young children products labelled ‘not heat treated’
• Unpasteurised milk and products made from unpasteurised milk—such as raw-milk, cheese and other dairy foods made from unpasteurised milk
• Unpasteurised fruit juices – except if you have freshly squeezed them yourself. Only buy such products from established reputable suppliers or squeeze the juice yourself. To determine if a juice is pasteurised, check the label or contact the manufacturer. All commercially freshly squeezed juices are unpasteurised.
• Honey do not feed honey to infants aged under 12 months because of the risk of botulism
• Raw eggs to prevent salmonella poisoning, cook all eggs thoroughly
(i.e. until the white is completely set and yolk begins to thicken) and do not use uncooked products containing raw eggs such as home-made ice cream or mayonnaise.
• Hard, small, round and/or sticky solid foods are not recommended because they can cause choking and aspiration.

The NHMRC also recommends that infants and toddlers are always supervised during feeding and you should avoid feeding an infant using a ‘propped’ bottle which can increase the risk of choking, dental caries and ear infections.

Good hygiene

Before you prepare food wash your hands, rinse and dry them thoroughly. Make sure the food preparation area chopping board and utensils have been washed with hot soapy water and well rinsed and dried before use. Check out how to wash your hands properly.

Also start teaching your child good hygiene as soon as possible. Teach children to wash and dry hands before touching or eating food; after touching chicken or raw meat; after using the toilet; after blowing their nose and after playing with a pet. Teach children not to pick up food from the floor and eat it.

If you have gastro

If you have gastroenteritis, you don’t want to pass it on to the baby so, if possible, don’t prepare any solid food or formula yourself. Ask someone else to help or use commercially produced solid food in can or jar. Ask someone else to do the actual feeding if possible. Continuing to breastfeed is fine.

Sterilising bottles and equipment

All equipment, including bottles or cups, used to feed the baby must be sterilised before use, particularly in the first three months. Sterilising equipment and tablets for making sterilising solution are widely available and effective, provided manufacturers’ instructions are followed carefully. Sterilising solutions can be used for 24 hours before being changed. Equipment can also be sterilised by boiling it in water for five minutes.

All pieces of breast pumps should be washed with warm water and a mild detergent. If the pump has clear plastic tubing connected to an electric motor, check the manufacturer’s guidelines for washing and sterilising the tubing. Most such tubing needs to be washed and sterilised only if breast milk has accidentally been drawn up into it. The outside of the tubing should be wiped with a clean, moist cloth then dried with a towel or allowed to air dry.

Breast milk

Breastfeeding is strongly recommended where possible as it is has benefits for both mother and baby. Here are some tips if you express breast milk:

• milk can be expressed and placed in a sterile container with a lid
• expressed milk can be stored in a fridge for up to 48 hours
• frozen breast milk can be stored in a freezer for up to three months
• each time milk is expressed it should be stored in a different cleaned container, rather than being added to already stored expressed milk
• frozen milk should be thawed in the refrigerator or placed in its container in warm water and gradually heated until thawed. Leave the milk in the warm water only until it is thawed.
• heat the milk gradually to warm it by placing the bottle or other container of milk in hot water. Avoid overheating the milk as this can affect the immunological properties
• test the temperature of the milk before feeding the baby. Microwave ovens can cause variations in temperature throughout the milk. When testing the milk the temperature may feel correct, but the core may be sufficiently hot to scald the baby
• any partially consumed milk should be discarded.

If you use a breast pump follow its cleaning instructions to make sure the equipment is kept clean and safe.

Infant formula

Always check the date mark on the label and follow the instructions on the infant formula packaging for storage and preperation. Powdered formula should be prepared fresh each day. It can be stored in the fridge for a maximum of 24 hours.

Baby bottles containing formula or milk should be stored in the fridge and warmed up immediately before use by placing the bottle of milk in hot water. Heating the milk in a microwave oven can cause variations in temperature throughout the milk and burn young mouths. Test the temperature of the milk before feeding the baby. Any partially consumed milk or formula should be discarded immediately.

Solid food

Commercially prepared food

Read the labels carefully on commercially prepared food and follow any preparation or storage instructions and check the date marking on the labels. Listen for a popping sound when opening vacuum-sealed jars as this shows that the jar’s seal was intact and check pouch seals are intact. This is particularly important with commercial baby foods; if the jar fails to pop when opened or a screw cap or seam on a pouch are not intact, do not use the food. Swollen or leaking cans, pouches or jars indicate that harmful bacteria may have grown and their contents should not be eaten.

All commercially prepared foods, once opened, should be stored in the fridge, preferably not in the can id=f a canned product. Throw out the contents of any product if there is an unusual odour. Remove the amount of food to be fed immediately to a separate dish rather than feeding directly from the container, can or jar using a spoon or squeeze food in pouches onto a spoon or into a dish for the child to eat. This way, unused food from the container, can (transfer cans to a clean container), pouch or in a jar can be covered or recapped and refrigerated for later use without the risk of contamination. If you choose to allow the child to suck the contents from a pouch, do not recap and store a pack the child has had in their mouth. Throw out any unused food left in a serving dish and use a fresh clean spoon for every feed.

When transporting food for feeding your baby outside the home, keep any opened jars or pouches that need to be refrigerated, chilled by using ice packs. If using chilled or frozen commercial infant foods, only purchase such foods from established, reputable suppliers and that are within their use by dates and are appropriately stored in fridges and freezers. If home delivered, make sure you are home to receive the delivery, ensure it is chilled or frozen and within its use by date, and place in the refrigerator or freezer immediately. If you’ve bought chilled or frozen baby food at the supermarket, refrigerate/freeze as soon as you arrive home. Allowing the temperature of such foods to rise into the temperature danger zone for extended periods can allow harmful bacteria to grow.

Home prepared food

All general rules for safe food handling are especially vital when cooking for a young child so keep hot food steaming hot, keep cold food refrigerated, cook food properly, separate raw and ready to eat food, keep kitchen and utensils clean and wash hands with soap, rinse and dry thoroughly. Make sure you follow these Food safety tips to clean, cook, chill and separate.

If preparing food in bulk, cool it quickly by refrigerating. Don’t keep it in the fridge for more than about three days. When you make pureed vegetables or soup for your baby, you can make enough for several meals. Use a covered ice-cube tray to freeze small quantities which you can defrost one cube at a time for a single serving.

As with commercially produced baby food, keep home prepared food chilled by using an ice pack when transporting for feeding outside the home. Ensure any container, spoon etc is washed thoroughly with hot soapy water, rinsed well and thoroughly dried between one use and the next.

Fill food container with just enough food for one serving. Harmful germs from a baby’s mouth can be introduced into food or bottle where it can grow and multiply even after refrigerating and reheating. Throw away any leftovers. Do not feed any later meals from the same container or spoon.

Packed food for child care centre

Food can safely be made ahead of time (the previous night) provided it is then kept in the fridge. Ensure food preparation surfaces, hands and utensils are clean when preparing and packing the food. Wash all fruits and vegetables thoroughly. Food should be kept cool. Pack something cold such as a frozen drink or ice pack with the food. Pack perishable foods such as cold meats, chicken or egg sandwiches between the frozen items. Child care centres usually refrigerate food, especially for very young children. Placing food in an insulated bag into a day care refrigerator is not likely to add additional benefit over a couple of hours until morning tea or lunch and could take up valuable refrigerator space. Ask your older pre-school children to keep their lunch box away from heat sources such as direct sunlight or room radiators. Throw out any leftovers they may bring home. Warn children against sharing drink bottles.

Listeria and pregnancy, the elderly and people with weakened immune systems

What is listeria?

Disease caused by Listeria infection is a comparatively rare form of foodborne illness, but it can be a very serious disease in:

• pregnant women and their unborn babies
• people who have diabetes, cancer or suppressed immune systems due to other chronic diseases such as leukaemia, HIV, diabetes, liver or kidney disease, cirrhosis or ulcerative colitis
• older people (generally considered to be over 65 to 70 years) depending on their state of health and especially if they have an underlying health issue like those above
• people taking a medicine that suppresses their immune system e.g. prednisone or cortisone
• organ transplant patients.

All these at risk groups for Listeria infection are advised to avoid the foods listed below. Listeria has also caused occasional outbreaks of mild gastroenteritis in healthy people.

If you’re not sure whether your condition or medication puts you in one of these at risk groups check with your GP on your next visit and follow this advice if you are. You can test your knowledge about Listeria by taking our quiz.

The symptoms of Listeria infection are mild and often are described as ‘flu-like’, although vomiting and diarrhoea can occur. If a pregnant woman is infected, it can lead to miscarriage, premature birth or the still birth of her baby even if she doesn’t show the symptoms. The time from infection to symptoms can be anywhere between 3 days and 3 months.

How to avoid Listeria infection

Listeria are bacteria that are widely found in the environment so most raw foods are likely to be contaminated. You don’t have to miss put on your favourite foods as Listeria is easily killed by cooking so, for example, you can easily add ham to a pizza, feta to a quiche or smoked salmon to fully cooked scrambled eggs. Just remember that cooked foods can easily become re-contaminated through poor food handling after cooking. For foods that can’t be cooked you can make other choices such as using fresh whole lettuce for salads rather than bagged lettuce.

If you are at risk of Listeria infection you need to avoid, or where possible cook, the following foods:

• Unpackaged ready to eat meats from delicatessen counters and sandwich bars; packaged, sliced ready-to-eat meats; cold cooked chicken purchased ready to eat, whole, diced or sliced and refrigerated paté or meat spreads
• All soft, semi soft and surface ripened cheeses e.g. brie, camembert, ricotta, feta and blue (pre-packaged and delicatessen), unpasteurised dairy products (e.g. raw milk or cheeses) and soft serve ice cream
• Pre-prepared or pre-packaged cut fruit and vegetable salads e.g. salads sold in bags or containers or from salad bars, shops or buffets, etc; pre-cut fruit and vegetables that will be eaten raw; frozen fruit or vegetables that may not be further cooked (e.g. berries, peas, sweet corn); rockmelon/cantaloupes (whole or cut); and bean or seed sprouts
• Raw seafood (e.g. oysters, sashimi or sushi); smoked ready-to-eat seafood; ready-to-eat peeled prawns (cooked) e.g. in prawn cocktails, sandwich fillings; and prawn or seafood salads; and seafood extender.

It’s important you maintain a healthy and varied diet if you are pregnant, elderly or immune compromised so we recommend you also talk to your GP or an accredited practicing dietitian about how to eat well while avoiding foods at risk of Listeria.

Also follow these food safety tips to reduce your risk of Listeria infection as well as other forms of food poisoning:

• Always wash your hands with soap and running water and dry thoroughly before handling food and keep food utensils and cooking areas clean
• Unlike most other food poisoning bacteria, Listeria can grow at refrigeration temperatures, so ready to eat food or leftovers should never be stored in the fridge for more than 24 hours. Since Listeria grows slowly in the fridge, it will do so only very slowly at cold temperatures so make sure your refrigerator is keeping your food at or less than 5°C.
• Avoid refrigerated foods that are past their ‘use by’ date
• Refrigerate leftovers promptly and use within 24 hours or freeze
• Always look for cooking and storage instructions on the food package label and follow them when provided.
• Cook high risk foods such as poultry, minced meat, sausages, hamburgers and leftovers to 75°C
• Cook egg dishes, such as quiche, to 72°C in the centre (or until the white is firm and the yolk thickens)
• cook frozen fruit and vegetables.

For more information about listeriosis see Healthdirect

Check this advice from our members Catercare’s Listeria-take it seriously brochure and Food Standards Australia New Zealand on making safer food choices  and this useful list of foods to avoid and alternatives from the NSW Food Authority.

The Cancer Council has a range of useful publications for people with cancer, their family and friends

Transplant Australia has food safety advice for transplant recipients.

Watch these short videos about listeria

Toxoplasmosis advice for pregnant women and those with a weakened immune system

Toxoplasmosis is an infection caused by a parasite known as Toxoplasma gondii (T. gondii). This single-celled organism is commonly found throughout the world with cats playing an important role in its spread. The parasite forms egg-like structures called oocysts that can be found in the animal’s faeces.

People can become infected with the toxoplasmosis parasite through contact with infected animal faeces (poo).

Another way of catching this infection is touching or eating raw or undercooked lamb, pork or kangaroo meat. The parasites can be stored in small pockets (cysts) in the muscle tissue of these meats. Drinking contaminated unpasteurised milk can also cause infection with toxoplasmosis parasites.

Other practical ways to minimise the chance of infection include:

• Freeze meat for several days before cooking
• Peel or wash fruits and vegetables thoroughly before eating
• Wash cutting boards, dishes, counters, utensils, and hands with hot soapy water after contact with raw meat, poultry, seafood, or unwashed fruits or vegetables
• Avoid drinking untreated water.

Check out this advice from the Better Health Channel