By Aniruddh Setya, MD, FAAP

Formula shortages and empty store shelves have sent parents and caregivers into a panic. Some are stocking up with help from family and friends while others struggle to buy just one can.

Problems with the formula supply 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 almost all infant formulas across the United States.

The Reliance on 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 U.S. infants born in 2017 were exclusively breastfed during their first six months. There are many reasons why a mother won’t or can’t nurse. Maternal illness, absence or an infant’s own intolerance are some examples. And if a mother has to stop nursing temporarily, it can be difficult to resume breastfeeding exclusively.

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

Alternative approaches, including those suggested on the internet, can be harmful to infants. For instance, 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 formulas mimic 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 are past their “best before” date should not be used either. The product could be at risk for contamination and protein disintegration, which can cause complications.

Homemade Formulas and Other Commercial Products

The FDA, CDC, and the Academy of Pediatrics (AAP) recommend against homemade formulas since they may lack essential nutrients for proper infant growth. For example, some recipes call for unpasteurized cow or goat’s milk, which are not fit for consumption. And homemade formulas may not be prepared or stored in a sterile manner, resulting in a high risk of bacterial contamination.

Unfortunately, toddler formulas are not an appropriate alternative because, unlike products made for infants, they vary quite a bit in nutritional composition and may not meet an infant’s needs.

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

Although popular in some cultures, goat 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. This should be avoided under 12 months of age.

Purchasing formula from overseas is a gray area. Formulas from overseas are not regulated by U.S. standards and may not be completely hypoallergenic. Furthermore, most use metric measurements, making them trickier to prepare. I will consider an overseas formula for my patients but may need to verify the ingredients and modify the recipe for an individual infant.

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 manufacturers before other customers. A second government program, “Operation Fly Formula,” is using aircraft to import formulas that meet U.S. standards.

Abbott’s Sturgis plant is set to reopen, although it will take time for the new products to hit the shelves. For now, Abbott is importing 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 issued a chart listing several formulas that are comparable to the recalled brands. While the list doesn’t include every formula on the market, it serves as a good starting point to research alternatives.

Parents may also be able to find formula locally by:

* Contacting their nearest Community Action Agency.

* Calling 2-1-1 for municipal referrals to non-profits that are providing supplies.

* Reaching out to Mother’s Milk Bank of Florida (milkbankofflorida.org) which has depots throughout the state.

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

Dr. Aniruddh Setya is a board-certified Pediatric Gastroenterologist with KIDZ Medical Services.