What can you do about formula shortages?

Facing a formula shortage is an incredibly stressful situation for any family to find themselves in. We hope that this article can help families navigate these difficult times. When in doubt, please get in touch with your pediatrician for further support and guidance.

What is driving the formula shortages?

Many families are currently facing formula storage in the United States. The reason is multifactorial—supply chain issues coupled with an Abbot Nutrition facility shutting down and product recalls. Abbot Nutrition, the parent company for Similac, Pediasure, and others, recently closed a facility in Michigan after an FDA investigation into complaints of bacterial infections in infants who had consumed powered formula produced by the company. Concerns over bacterial contamination lead to Abbott voluntarily recalling formula products like Similac, Elecare, and Alimentum, further driving the shortage.

Where can you get baby formula?

First: Seek additional sources

Ask your pediatrician for samples. We are often provided samples from formula representatives and may be able to help until you can secure a new source or formula brand.

Consider looking for formula at smaller stores like local pharmacies. Some small family grocery stores may also have stores of formula. Also, consider online sources. Do not purchase from auction sites or not well-organized distributors.

Second: Consider a different form of the same formula

It is preferable to first switch the form instead of the type of formula your baby is used to being fed.

Many brand formulas come in at least two, but sometimes three forms:

1) Powder

2) Ready-to-feed

3) Concentrated

For infants under the age of 3 months, some families prefer ready-to-fed as they may be more sterile compared to powered. Using purified water and boiling water before use can help reduce the risk of contamination. However, if you are using powdered formula, you will want to read the label carefully for mixing ratios. If your baby is less than three months old, immunocompromised, or premature, you may wish to discuss this with your pediatrician before switching to powered.

This article by the CDC provides information on preventing the bacteria found in the recent formula outbreak, including how to prepare powdered formula to decrease the risk of contamination. https://www.cdc.gov/cronobacter/prevention.html

Third: Consider switching the formula brand

Look into similar formulas from other brands. For example, if your baby is on a cow’s milk-based formula like Similac, consider Enfamil Neuropro or Gentalease. You may also seek generic store versions (see helpful reference chart from Perrigo below). Note that your baby may experience gas, fussiness, or spitting up when switching formulas. Contact your pediatrician if your child is bloated, in pain, vomiting yellow or green, has a fever, is less active, or peeing less than usual.

Gradually switch brands—Mix small amounts of the new formula with your baby’s usual formula. Your pediatrician should be able to aid you in a specific transition plan.

Families with infants with specific metabolic needs should contact a pediatrician as soon as possible.

Additionally, families with infants less than three months should also contact their pediatrician.

This article is also helpful for families considering switching formulas. NASPGHAN is regarded as the leading authority on infant nutrition, https://naspghan.org/recent-news/naspghan-tools-for-hcps-affected-by-formula-recall/.

Fourth: Toddler formula and cow’s milk

For babies near a year old, as a last resort, the American Academy of Pediatrics (AAP) has stated infants can be given toddler formula for a few days. Only do this in conjunction with a discussion with your pediatrician.

The AAP has also announced that children older than six months can be given cow’s milk for less than one week. This choice should only be employed as a lost resort. Cow’s milk is low in iron. Iron deficiency can cause anemia, associated with poor neurocognitive outcomes. Consider discussing iron supplements or iron-rich food with your pediatrician if your family is in this situation.

How about making baby formula?

Homemade formula is hazardous. There is significant concern regarding contamination and improper electrolyte/nutrient balance. Babies have very immature brains, kidneys, and organs, which need time to mature and learn to handle different amounts of electrolytes and nutrients. A homemade formula can lead babies to be hospitalized for seizures, brain swelling, and even death related to a proper balance of electrolytes in the formula. Additional risks include heart failure, kidney failure, and sepsis. There have already been reports of this. Further, there can be long-term effects on your child’s abilities to learn and grow from even a few days of homemade formula.

Can I add water to my formula to make it last longer?

Adding extra water to formula can lead to lower levels of electrolytes such as sodium, glucose, and calcium, to name a few. Imbalances of such electrolytes can cause severe brain swelling, seizures, and ultimately death. Always follow label instructions precisely on your formula.

What about imported formulas?

In general, formula that is imported is not regulated by the Food and Drug Administration (FDA) and is therefore discouraged. However, the FDA has been working to put into place procedures to ensure production standards, shipping, and labeling of brands imported from outside the US. Formulas that the European Food Safety Agency regulates may be regulated similarly to the FDA regulation standards and would be the most reliable second choice.

What about cow’s milk alternatives?

Goat’s milk is not safe for babies due to its higher concentration of proteins and certain minerals. Additionally, it does not have enough folate, a vitamin that, if in deficit, can lead to anemia.

Plant-based milk alternatives similar do not contain the correct amount of electrolytes and nutrients like vitamin D and calcium and can lead to poor growth outcomes. Soy milk may be ok for a few days in an emergency but should be avoided. Almond milk is deficient in fat, protein, and minerals essential for an infant’s brain and growth and should never be used. If your family considers plant-based alternatives, call your pediatrician before initiating.

Resources:

Blair A. Rolnick MD, FAAP