Cleaning Methods and Microbial Safety of Child Feeding Equipment: A Systematic Review.

Microbial contamination of child feeding equipment (CFE) includes feeding bottles, teats, and breast pumps. This contamination is a recognized pathway for enteric pathogen exposure during early childhood, particularly during the complementary feeding period (6-24 months). Inadequate or inconsistent cleaning of CFE has been associated with increased diarrheal risk. Many cleaning approaches are practiced globally. However, comparative evidence on their effectiveness remains fragmented. This systematic review (CRD420251058230) aimed to evaluate the effectiveness and efficacy of commonly used CFE cleaning methods. We included studies that assessed microbial contamination on CFE. Each study compared at least one cleaning method with another method or a control. We included all epidemiological study designs conducted globally. PubMed, Web of Science, and Embase were searched from January 1970 to January 2025. Two reviewers independently screened 18,415 records and included 17 studies. Risk of bias was assessed by ROBINS-E and ROBINS-I. Feeding bottles and teats were the most frequently assessed equipment. Rinsing with water alone was consistently ineffective. Washing with soap and brushing achieved greater contamination reduction than washing without brushing. Chlorine-based disinfection substantially reduced contamination, with effectiveness varying by concentration and contact time. Sterilization by boiling or steaming, particularly when preceded by mechanical washing, achieved near-complete microbial elimination. The evidence base was limited by the small number of experimental studies. Study quality was variable, and outcomes were heterogeneous. These limitations emphasize the need for more rigorous and context-specific research to inform effective, scalable cleaning interventions.