TThe U.S. continues to suffer from an unprecedented shortage in infant-formula. The pandemic began to affect baby formula supply chains in summer 2021. Inventory was further constrained after Abbott recalls certain formula products in February and more in March.
Families facing empty shelves are terrified that their children will go hungry, since breast milk or formula—or a combination of both—is a main source of nutrition for babies from birth until about age one.
“It’s not fair that families have to be even worried about this on top of being a new parent,” says Dr. Shweta S. Namjoshi, medical director of intestinal rehabilitation and nutrition support at Stanford Children’s Health. “It’s unacceptable.”
However, pediatricians have the expertise to help parents find formula in their area, guide them to various brands, and support them during this time of stress. “I’m sorry that it feels so scary, but there’s no need for panic quite yet,” Namjoshi says.
Here’s what pediatricians say about how to safely navigate the formula shortage.
Consider a brand you don’t know.
For parents of full-term, healthy infants, it’s very safe to switch to different brands of infant formula, including generic versions.
“The way formula is marketed makes it so that parents feel fear and pressure, like ‘Oh, I can’t switch brands,’… but that’s just not true,” Namjoshi says. Even when products say that they are formulated for certain issues—like anti-gas or anti-reflux—they will work just fine for most babies without diagnosed issues, she says. “Enfamil, Gerber—they’re all basically the same. They use the same mix of sugars, the same proteins, the same fats.”
Children may be a little fussy as they go through an adjustment period with a new brand, but often “it’s just a child acclimating to something different,” she says.
However, children with special needs and medical conditions—such as some immune-compromised children, those with allergies or gastrointestinal issues, and premature babies, for instance—may require specialized formulas, such as hypoallergenic or lactose-free formulations. Patients with these conditions should consult their physician before exploring new formula options.
“For babies who are on typical formulas, they’re able to find something,” says Dr. Rachel Dawkins, medical director of the pediatric and adolescent medicine clinics at Johns Hopkins All Children’s Hospital. “But it’s those children with special health-care needs that might be on a specialized formula—they’re really having a struggle.”
Some parents buy specialized formulas because it’s difficult to find every kind of formula. Doctors say that infants with no medical conditions can use these formulas safely. However, they shouldn’t do it if there isn’t another option. Some babies cannot use these specialized formulas.
Make use of the government’s options
Families receiving formula from WIC—the national nutrition program for low-income women, infants, and children that serves nearly half of all infants in the U.S.—now have additional options. In an effort to provide more formula cans for emergencies, President Joe Biden signed on May 21 the Access to Baby Formula Act of 20022.
U.S. has begun to import formula from other nations. Food and Drug Administration (FDA), is currently looking at changing its rules for international shipments.
Several international companies “are seeking urgent approval for those types of formulas,” says Dr. Steven Abrams, professor of pediatrics at the University of Texas at Austin Dell Medical School and past chair of the nutrition committee at the American Academy of Pediatrics (AAP). He expects the FDA to grant rapid approval for international brands “in the next week or two.”
“People are beginning to understand that the system didn’t have enough safety points,” Abrams says. “We need to have a lot more backup,” he says, and a system that doesn’t just rely on just a few companies to make nearly all of the country’s formula.
Don’t hesitate to ask your pediatrician for help
If you can’t find formula or are nervous about running out, or if your baby is fussy from trying different brands, your pediatrician can help guide you through this stressful time.
Pediatricians can access backup supplies of formula—children’s hospitals still have formula, for instance, though that should be nobody’s first stop—and they are also closely attuned to where formula is in stock. Family members who want to breastfeed or improve their supply of formula can consult doctors for advice.
“Your baby’s going to be okay,” Namjoshi says. “No pediatrician will ever let your child just go hungry. We have backups.”
Don’t replace formula or water it down
Cow’s milk and plant-based milk alternatives are not acceptable substitutes for breast milk or formula. The liquids may not contain the essential nutrients babies require for good nutrition. This could lead to health problems for infants. U.S. Centers for Disease Control and Prevention recommends that infants start drinking whole milk from cows by their first birthday. Drinking too much milk from cows before that time could lead to intestinal bleeding and kidney issues.
To make cans last for longer, parents should not water down formula. Hyponatremia is a condition in which sodium levels fall too low. This can result in seizures. Insufficient nutrition can cause a person to fail to thrive.
Experts say it’s a terrible idea to make your own recipe. “There’s plenty of recipes and old wives’ tales out there, but they’re not safe,” Dawkins said. “They don’t supply the necessary nutrients for babies and may cause some electrolyte problems and nutritional deficiencies.”
Be cautious when obtaining formula or breast milk that’s not from a store
“It’s okay to crowdsource in your local communities or on different mommy groups online, but I would just make sure that the cans of formula aren’t expired and they’re not open,” Dawkins says. “Sometimes people have extra, and I think it’s great to be able to help out your neighbor.”
Be careful not to share breast milk that you have frozen. “What we would prefer is for people who have extra milk to donate it to their milk banks,” Abrams says. The banks screen milk donors for health conditions, pasteurize the milk, and distribute it to the babies who need it most—often those in neonatal intensive care units.
Informal milk sharing networks aren’t regulated the same way milk banks are, and the milk could be adulterated or unsafe. “We have to be cautious about direct milk sharing or wet nursing, and especially cautious about anything from a donor you don’t personally know,” Abrams says.
It might be tempting to fill your pantry with formula if you’re able to find it, but it’s important to leave some on the shelves for other families who need it.
“Don’t worry excessively if you have plenty of supply,” Dawkins says. “Hopefully the end is in sight for the formula shortage.”
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