Hospital news

Feeding baby when formula is hard to find

By Aniruddh Setya, MD, FAAP

Formula shortages and empty store shelves have caused panic among parents and caregivers. Some get their supplies with the help of family and friends while others struggle to buy just one.

Infant formula supply problems began when an Abbott Nutrition facility abruptly closed after Similac, Alimentum and EleCare formulas were suspected of bacterial contamination. This led to a shortage of nearly all infant formula in the United States.

The use of the formula

Breastfeeding is not something we can take for granted. According to the Centers for Disease Control and Prevention (CDC), only about a quarter of American infants born in 2017 were exclusively breastfed for their first six months. There are many reasons why a mother is unwilling or unable to breastfeed. Maternal illness, infant absence or intolerance are some examples. And if a mother has to temporarily stop breastfeeding, it can be difficult to resume exclusive breastfeeding.

Infants and children with artificial feeding tubes, metabolic disorders, or protein allergies may not thrive on breast milk and need specialized formulas, which are limited.

Alternative approaches, including those suggested on the Internet, can be harmful to infants. For example, adding extra water to the formula is dangerous. During the first 1,000 days of life, nutrition is vital for a child’s health and development. Powdered infant formula mimics human milk, so every nutrient, vitamin, mineral, protein and carbohydrate is measured for optimal growth and brain development. Diluted formulas can lead to malnutrition, electrolyte abnormalities and other serious complications.

Cans of formula that have passed their expiration date should also not be used. The product could be at risk of contamination and protein disintegration, which can lead to complications.

Homemade formulas and other commercial products

The FDA, CDC, and Academy of Pediatrics (AAP) advise against homemade formulas because they may lack essential nutrients for healthy infant growth. For example, some recipes call for unpasteurized cow’s or goat’s milk, which is unsuitable for consumption. And homemade preparations may not be prepared or stored in a sterile manner, leading to a high risk of bacterial contamination.

Unfortunately, toddler formulas are not a suitable alternative because, unlike products intended for infants, their nutritional composition varies widely and may not meet the needs of the infant.

Almond milk, oat milk and similar products are beverages, not milk. Most don’t have adequate amounts of nutrients, vitamins, carbohydrates, and fats, and some could cause other problems. For example, 10-20% of children allergic to cow’s milk are also allergic to soy milk. Almond milk should not be given due to nut allergies. Oat milk contains phytic acid, which prevents the body from absorbing iron, zinc and calcium.

Although popular in some cultures, goat’s milk is deficient in vitamin B12 and folate and is very high in protein, which puts extra pressure on the baby’s kidneys to eliminate them. This should be avoided before 12 months of age.

The formula for buying abroad is a gray area. Overseas formulas are not regulated by US standards and may not be completely hypoallergenic. Additionally, most use metric measurements, which makes them more difficult to prepare. I will consider a foreign formula for my patients, but may need to check the ingredients and modify the recipe for a particular infant.

The shortage may end soon – things are looking up

I see a light at the end of the tunnel since President Biden invoked the Defense Production Act, which requires suppliers to direct resources to formula makers before other customers. A second government program, “Operation Fly Formula”, uses aircraft to import formulas that meet US standards.

Abbott’s factory in Sturgis is set to reopen, although it will take time for new products to hit shelves. For now, Abbott imports the formula from its FDA-registered facility in Ireland.

In the meantime, it’s important for parents and caregivers to communicate openly with their doctor, who can guide them to the best option for their baby. The North American Society for Pediatric Gastroenterology, Hepatology & Nutrition has published a chart listing several formulas comparable to the recalled brands. Although the list does not include all formulas on the market, it is a good starting point for researching alternatives.

Parents may also be able to find formula locally by:

* Contact the nearest community action agency.

*Call 2-1-1 for municipal referrals to nonprofits providing supplies.

* Reach out to Mother’s Milk Bank of Florida ( which has deposits statewide.

Finally, while online research is helpful, it’s essential to speak with the baby’s doctor first before making any decisions about your child’s nutritional needs.

Dr. Aniruddh Setya is a Board Certified Pediatric Gastroenterologist by KIDZ Medical Services.

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