Navigating infant formula shortages

Infant formula shortages in the U.S. have occurred in the past two years largely due to widespread pandemic-related supply-chain problems. A national shortage of infant formula is undoubtedly alarming for families since infants require formula when human milk is not accessible or not available in adequate amounts. Although breastfeeding is encouraged, it is not always a feasible option for mothers who return to work early or do not have access to a lactation support system. Human milk and breastfeeding may also not be possible in infants who have allergies or metabolic or gastrointestinal disorders that require special infant formulas, or who have disabilities that limit breastfeeding.

What you can do now:

• Consult first with your child’s pediatrician, especially if your child has allergies or special formula needs. They can inform you of safe alternative brands.
• Be flexible in trying different brands, including generic. Many brands advertise special health benefits that have more to do with marketing than an actual difference in their nutrition content.
• The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) offers guidelines for alternatives to brand name infant formulas and for special sensitivities in the event of a shortage.
• If your child is older than 6 months, encourage a mixture of both infant food and formula. If they are closer to one year of age, they may be able to use toddler formula if approved by your pediatrician. After one year of age, babies no longer need formula and can be weaned off.

What not to do:

• Avoid hoarding commercial infant formulas, which only prolongs a shortage. The American Academy of Pediatrics advises buying no more than a 10-day to 2-week supply of formula. [1] In addition to regular supermarkets, check drugstores, smaller store chains, and reputable online sites.
• Do not make homemade infant formulas. The U.S. Food and Drug Administration (FDA) warns that they carry a risk of bacterial contamination and may not provide appropriate amounts of nutrients and fluids required for an infant’s growth. [2] Infants have been hospitalized or even died due to use of homemade infant formula recipes lacking nutrients.
• Do not add extra water to formula to extend its use. This will dilute the nutritional content of the formula and increase the risk for deficiencies.
• Avoid infant formulas from other countries unless they are approved by the FDA. FDA approvals are expected soon for formulas manufactured in Europe, for instance, so contact your health care provider (pediatrician, registered dietitian) with specific questions.

Future Directions

Policy changes are needed to prevent a recurrence of severe formula shortages in the future. An article from the American Journal of Clinical Nutrition outlines the following action steps: [3]

1. Completion and release of all investigative documents about formula recalls and public hearings to communicate the findings.
2. The FDA and U.S. Department of Agriculture should create specific rules for formulas that are identified as critical for specialized use to be produced at multiple sites and preferably by multiple companies (as opposed to the current situation of specialized formulas that are produced by a small handful of companies).
3. Establishment of a national plan related to assessment of formula needs and response to shortages, including those caused by natural disasters or recalls, especially in rural communities and for specialized and medical formulas. This should include considering the use of formulas made by reliable international manufacturers.
4. Creation of a database of “similar” formulas (e.g., amino acid-based or partial hydrolysate formulas) easily accessible to both consumers and health care providers, so that families can easily identify similar products if their usual formula is out of stock.
5. Changing of WIC rules to increase flexibility for families to purchase formula alternatives when a shortage occurs, with re-evaluation of the WIC state contracting processes.
6. Strong advocacy for workplace and postpartum rules to enhance breastfeeding and increase time for breastfeeding at work and before return to work.
7. A national policy allowing reimbursement for donor breast milk for families, especially when it is medically indicated or when formulas are in short supply.