More than 40% of formulas are out of stock at stores around the country — a crisis that has been building for months and stems from pandemic supply issues that were exacerbated by the February closure of a major production plant.
President Joe Biden announced this week that the federal government is working with manufacturers to increase production of formula and help families access existing stock. But paediatricians are bracing for the possibility that the current shortage does not resolve anytime soon.
“Realistically, I think we’re looking at several more months,” said Dr Steven Abrams, a spokesman for the American Academy of Paediatrics. “Even once that factory restarts, I don’t think the situation will get better super rapidly because the shortages have been developing for so long.”
The New York Times asked several experts about how parents can navigate this next stretch of the baby formula shortage, and where they can turn for help.
WHAT SHOULD I DO IF I CAN’T FIND MY BABY’S USUAL FORMULA ANYWHERE?
If you cannot find your baby’s typical formula, your first call should be to their paediatrician. Health care providers might be able to help you find samples, connect you with a local formula representative or point you toward a charity that can help, Abrams said. Your local Women, Infants and Children, or WIC, office might also be able to help you find options.
Local parenting groups can also be an important resource. As the shortage continues, regional Facebook groups helping parents find their preferred formula have been popping up.
“Other parents in a similar position can be a resource, maybe telling you where they found formula or sharing extra cans of formula,” said Dr Katie Lockwood, an attending physician at Children’s Hospital of Philadelphia Primary Care.
If you cannot find your brand, it is safe for most healthy babies to switch to any Food and Drug Administration-approved baby formula parents can find on the shelves or online from a reputable distributor or pharmacy. (The AAP warns against buying formula on auction sites, or from overseas, which is not monitored or regulated by the FDA.)
“If your child is healthy and has a normally-functioning GI tract, they can usually be switched among the ‘standard’ infant formulas pretty readily,” said Dr Christopher Duggan, director of the Center for Nutrition at Boston Children’s Hospital.
For babies with allergies or medical conditions that require a specialised formula, “substitutions may be more complex,” said Dr Dale Lee, medical director of Clinical Nutrition with Seattle Children’s. “In particular, formulas with broken-down proteins, or that are amino-acid based may be used in unique situations — and need to be carefully substituted.”
In recognition of the challenges that children with special nutritional needs face, the FDA recently allowed Abbott Nutrition (which manufactures the amino-acid based formula EleCare, for which there is no store-brand alternative) to release “urgent, life-sustaining supplies” of certain specialty formulas on a case-by-case basis.
Contact your child’s paediatrician for help submitting an urgent request for specialty formulas.
WHAT IS THE SAFEST WAY TO SWITCH FORMULAS?
If your baby does not have any specific dietary needs — and you are unable to find your usual formula — look for an alternative that is in the same category as what they typically drink.
“The main groups are: milk-based, soy-based and then there are ‘sensitive’ varieties,” said Rebecca Romero, clinical leader for the Department of Clinical Nutrition and Lactation at Nationwide Children’s in Columbus, Ohio.
So if your baby typically drinks a name-brand milk-based formula, a good swap would be whatever store-brand milk-based formula you are able to find, Romero said, though going from a milk-based to soy-based or vice versa is fine too, unless they have an underlying allergy.
If your baby drinks a sensitive formula that has been partially hydrolysed to help with digestion or colic, it is worth talking to your child’s paediatrician about your options, Romero said.
If you are running out of formula, it is OK to make the swap right away, but be aware it may cause some minor gastrointestinal issues (like gas, stool changes or fussiness). So if you have a bit of breathing room, try easing into the switch.
“It’s not a bad idea to introduce the new formula by mixing 25% and 75% for a day, then 50% for a day or two, then 75% and 25% to make it more gradual,” Duggan said.
WHAT HAPPENS IF BABIES DON’T GET ENOUGH FORMULA?
This is the big fear many parents have right now, and it is a serious one.
“For infants, breast milk or formula is the sole source of nutrition until solid foods are introduced,” Lee said. “Infants have unique nutritional needs, because of rapid growth, and appropriate intake of calories and nutrients directly translates into physical growth and neurological development.”
Babies who do not get the recommended vitamins and other nutrients they need to help their tissues and organs grow and function face significant short and long term health risks. Paediatricians pay particular attention to babies’ weight and height changes over the first few months of life as they can be an important marker of development.
Experts also recommend against diluting baby formula, even for a short stretch. Doing so can reduce the amount of nutrients a baby receives, and can upset the balance of electrolytes and minerals — which can lead to potentially serious complications, like seizures, the AAP warns.
“Parents may see that as an easy way to make a can of formula last a little longer,” Romero said. “But deficiencies can happen relatively quickly, even in a matter of days or weeks.”
IS IT OK TO MAKE MY OWN FORMULA?
The AAP, Centers for Disease Control and Prevention, and FDA all strongly advise against homemade formula, which poses significant health risks.
It is challenging, if not impossible, for parents to make a formula that has sufficient nutrients (especially protein and minerals) without too much salt or water — and to make sure it is in a form babies’ rapidly developing bodies can process.
If you are unable to find an alternative formula, and your baby is older than 6 months, it is preferable to give your baby pasteurised whole-milk cow’s milk for a brief period of time, Abrams said. Ultimately, that is safer than going the do-it-yourself route or diluting formula with water, he added.
CAN I USE OTHER PEOPLE’S BREAST MILK?
Using donor breast milk is definitely an option for parents, though not necessarily an easy one logistically. “There are human milk banks that I’m sure are getting a lot of calls right now, but supplies have never been very high and insurance reimbursement is on a state-by-state or insurance-plan-by-insurance-plan basis,” Duggan said. Estimates as of 2018 suggest donor milk costs anywhere between $3 and $5 per ounce.
Your child’s paediatrician may be able to help you identify milk banks near you, and the website of the Human Milk Banking Association of North America can also be a good place to start. Its member milk banks are subject to rigorous safety guidelines. Also, bear in mind that most donor milk is distributed through neonatal intensive care units for high-risk babies who need it, so supplies can be limited.
As for more informal milk-swaps, the AAP has long said they are unsafe. Parents could unwittingly expose their baby to bacteria or viruses, or to medications or herbs they did not realise the donor was taking.
HOW MUCH FORMULA SHOULD I HAVE ON HAND?
It is understandable that you might get excited if you come across a store or website carrying large quantities of your preferred formula. But experts say it is important to resist the urge to buy too much.
“If you’re hoarding formula, just keep in mind that’s causing other families not to have access to it,” Lockwood said. “Be sensitive to the fear and anxiety that may cause others.”
The AAP advises that in the current shortage, parents should have no more than a 10-day to two-week supply of formula on hand. Many major retailers are also limiting the number of cans that can be purchased at one time.
All FDA-approved formulas also have a use-by date. Beyond that point, ingredients can start to degrade, Romero said, so you cannot be certain your baby is getting the nutrients they need.
If you are feeling anxious that you do not — or soon will not — have enough on hand, reach out to your child’s doctor.
“I recommend that families contact their paediatrician for guidance and support in this difficult time,” Lee said. “Nutrition is a core building block of growth and development and we, as your paediatricians, are happy to help you navigate this.”
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