Dietitian and pediatrician weigh in on baby formula shortage

Mother of two Ellen Burnette has developed a ritual during the baby formula shortage. Her younger son, Hayden, is almost 9 months old and needs hypoallergenic formula. Burnette works full time.

“Basically, every single day, several times a day, I check Target.com for the formula because obviously I don’t have the time to go into a bazillion stores. And from what I hear, there’s nothing on the shelves anyway. So I just check Target.com every single day. And then I order; I think the max is four. So if any come in stock, like it could be two, or it could be four, then I’ll add it to my cart and order it. And then half the time I get an email that says, ‘Oh, sorry, we have to cancel your order.’” 

She has enough formula for now but worries she’ll run out. “It’s definitely stressful.”

 

The federal government is working with manufacturers to get more formula in the pipeline and help families find the formula that’s out there. But pediatricians say the shortage may last a while longer. The trouble is tied to supply chain issues and a recall by the baby food maker Abbott Nutrition.

A dietitian and a pediatric intensivist at MUSC Children’s Health weighed in on what needs to happen from here – and what parents need to know about formula substitutions, homemade formula and breast milk.

Suggestions for what should happen next

First, dietitian Kristi Fogg said red tape needs to be peeled away during the shortage – and it’s starting to happen. “WIC serves a large percentage of our population, and they are liberalizing their formulary,” she said, referring to the federal Special Supplemental Nutrition Program for Women, Infants, and Children.

 

"There’s certain products that they can provide because of contracts, and they have already started to open that bandwidth and supply more. But they need to do all-encompassing, cover every formula right now for an emergency relief issue. You should be able to get formula covered if you order it online, not just if you go to a certain WIC vendor. During this time, we should open up the availability and what we’re able to get for WIC participants,” Fogg said.

Elizabeth Mack, M.D., said relief is coming – but not as quickly as she’d like. She’s a division chief in the College of Medicine at the Medical University of South Carolina, specializing in pediatric critical care and patient safety.

“Abbott just had a press release saying that the FDA is approving the reopening of the Michigan plant that was the focus of the recall. So it hopefully should be starting to produce in the next two weeks, which will help, but it doesn’t resolve the supply chain issue for now.” 

Formula flexibility

With that ongoing supply chain issue in mind, Mack said babies who don’t have any health conditions that limit which formula they can use can shift to different types and brands if their regular supply is out. “Right now, you should take what you can get.”

Fogg agreed. “For the most part, if you’re getting a standard cow’s milk-based formula, they can be pretty interchangeable. That’s where utilizing a generic can come in.”

 

She explained what goes into most formulas. “They take cow’s milk, and they modify it. That’s why it’s not interchangeable with cow’s milk. Cow’s milk is a lot higher in fat and protein, and by itself, it doesn’t have enough iron and vitamin C in it for a baby. So the formula just takes cow’s milk as the bones of it but then modifies it to make it more comparable to breast milk.”

There are also specialty formulas – like the type Burnette’s baby drinks. “Some babies have a cow milk protein allergy, and they do different modifications to it to make it more hypoallergenic,” Fogg said.

Those babies’ parents have to be more careful, she said. Some have brought their children to the hospital after formula substitutions didn’t go well.

Homemade formula

While a lot of recipes for homemade formula are circulating online, Mack and Fogg strongly advised against trying them. Commercial baby formula is regulated by the Food and Drug Administration to ensure its safety. Homemade versions such as evaporated milk mixed with corn syrup and water are not. They will not give a baby the nutrition it needs – and can lead to serious health problems.

Donor/purchased breast milk

When it comes to getting breast milk from someone else, Fogg said it needs to be screened. “Breast milk is a human fluid that can transmit infections. So if you do not have a reliable source, if you do not know their infectious disease status and what medications they’re taking, you shouldn’t be taking their milk.”

She also said some “breast milk” for sale isn’t as advertised. “Some people sell you cow’s milk to make money. And it’s really cow’s milk and not breast milk. There’s been a lot of data to support that – that it’s cut with non-breast-milk-containing fluids. So you have to just be very careful with your source.”

That was a lot of “no.” But there are things to say yes to.

Mack said if you’re having trouble finding formula, call your pediatrician’s office for help. Nutrition specialists such as dietitians and WIC can also be good resources.

If you have formula close to its expiration date that has not expired, use it, Mack said.

And if you’re about to have a baby, get help from lactation support services to help you breastfeed.

Meanwhile, Fogg said it’s important to keep in mind that others are scrambling, too. “People get very brand specific. But you can’t hoard all these Gerber products because that’s what you want for your child. You need to be open-minded and just remember that we need to feed everyone, and that’s of the utmost importance.”

Burnette, the mom who hits the Target site every day to search for formula, said other parents’ struggles are definitely on her mind. “I’m just grateful that he is almost 9 months old and not a little, tiny brand-new baby. I sometimes feel like I should give my formula to someone who has a brand-new baby because he doesn’t need it as bad as they do, you know?”