Q+A: How Parents Can Manage the U.S. Baby Formula Shortage

Infant being bottle fed

The United States is in the midst of a nationwide baby formula shortage due to a U.S. Food and Drug Administration (FDA) shut down of a formula plant and pandemic-related supply chain issues. While some relief has arrived, it could be weeks before some shelves are fully stocked again.

Parents are desperate, with stories circulating of parents rationing or watering down their remaining supplies of formula, while searching high and low in stores, online and on social media for formula or alternatives.

Experts like Beth Leonberg, an associate clinical professor in the College of Nursing and Health Professions, board certified specialist in pediatric nutrition with 25+ years experience and author of “Infant Feeding Guidelines for WIC,” agree formula should not be diluted or homemade.

Leonberg shared her insight on the formula shortage with the Drexel News blog and what parents can do in the meantime.

What is infant formula?  

Although it was first developed more than 100 years ago, infant formula was further developed in the 1950s to mimic breastmilk. It is used as a replacement for breastmilk for mothers who aren’t able or choose not to breastfeed. The American Academy of Pediatrics and the World Health Organization recommend that babies are exclusively breast fed for the first six months of life and continue breast feeding until at least a year of age. Commercially manufactured infant formula is typically readily available in the U.S. and is the only recommended alternative for babies who are not breast fed.

Infant formula is very specific in terms of what its contents are. The FDA specifies the amount of protein, carbohydrate, fat, vitamins and minerals it must contain. It has all of the nutrients that would normally be found in breastmilk in the amounts that are necessary to mimic the absorption that would occur in breastmilk. For instance, the iron in breastmilk is more bioavailable than the iron in formula, so infant formula has more iron than breastmilk so the baby absorbs the same amount of iron. Most infant formula is a sprayed-dried, modified cows’ milk product.

There are also soy-based formulas for babies and very specialized formulas for babies who have severe allergies, metabolic conditions or other reasons why they can’t tolerate standard infant formula.

Why use infant formula?

Infant formula is the only appropriate breast milk substitute for babies in the first six months. Whenever a baby is not breast fed, the only safe alternative is infant formula. At about six months of age, babies can begin to drink a small amount of water; after they are twelve months of age, they can begin to drink whole cows’ milk and a small amount of 100% fruit juice. Even after they start eating solids at about six months of age, that’s really just to help them develop oral motor skills and expose them to different foods; it doesn’t provide a lot to help them meet their nutrient requirements.

Until they are a year old, only breastmilk or infant formula is nutritionally complete and provides everything that the baby needs.

Are there alternatives for parents if they can’t find formula during this shortage?

The most important thing for parents to know at this time is that any formula that is the same type as their baby has been getting is perfectly appropriate to feed. If they’ve been getting a cows’ milk-based formula, any cows’ milk-based formula that is made and sold in the U.S. is fine. If they’ve been getting a soy-based formula, any soy-based formula is fine.

The biggest issue is that parents tend to be very bonded to a specific brand. But because infant formula content is regulated, there are not significant differences between products that are made by any of the U.S. manufacturers, including store brands. In fact, store brands are typically made by the same large manufacturers as name brands and labeled differently for the store. So, any infant formula manufactured in the U.S. is required to meet the same standards and can be used.

Even during this time of shortage, there are no safe alternatives to breast milk or infant formula. Homemade formula (made from evaporated or condensed milk), which was sometimes used by low-income families in the 1900s, is not nutritionally complete and should not be used. Milk from other mammals, like whole cows’ milk or goats’ milk is not nutritionally equivalent to human breast milk or formula, so it’s not recommended.

It’s also critical that infant formula is mixed following the manufacturer’s instructions to make sure it contains the proper nutrients. Most infant formulas are available in several forms: ready-to-feed, as a concentrated liquid or a powder. The liquid and powder have to be mixed with the amount of water specified to provide the right calories and nutrients. Parents need to know that if they add more water to try to make the formula last longer, they will dilute all the nutrients, including the calories. That could lead to the baby not gaining enough weight or receiving inadequate electrolytes or minerals in the formula which could make them sick. There have been reports of infants being hospitalized because of this practice during the shortage so it should be avoided.

Another concern has been that parents are buying infant formula manufactured in another country over the internet. It’s important for parents to understand that infant formula composition is regulated by the country where it is manufactured, so infant formula manufactured in another country may not be equivalent. The U.S. government has now gotten involved and is sourcing formula made in other countries, so far Europe and Australia, that meets U.S. standards. These products are making their way to families now and are safe alternatives.

Finally, donor breast milk, obtained from a milk bank is an alternative. Many mothers donate breastmilk they don’t need for their own baby to a milk bank for other babies. Milk banks are a safe alternative because donors are screened similarly to blood donors.

Is there anything else you’d like to add that is important to this conversation on the formula shortage?

Parents should know that although there is an overall shortage, the availability varies from state to state and from store to store. Just because they can’t find it in their store, doesn’t mean it isn’t available somewhere else. We’re trying to encourage people on the internet and social media to share where there is product available so parents know where they can find it. There are areas where the shelves are very empty and then others where the shelves are completely full. It’s a matter of doing a little bit of leg work to find what you need or using the social networks to do that.

Parents should be encouraged to work closely with their health care providers through this time to make sure their baby gets what they need to grow, develop and stay healthy. Since the government has begun purchasing and distributing formula from other countries, and the main manufacturing facility is scheduled to be back online in the next week, we should see improvement in the supply of infant formula soon.

Media interested in speaking with Leonberg should contact Annie Korp at 215-571-4244 or amk522@drexel.edu.

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