Don't water it down; do talk to your pediatrician, advise Tufts experts
When the U.S. supply of infant formula first became scarce in early 2022, most people assumed that the main causes—supply chain delays, labor shortages, and a large formula manufacturing shutdown due to contamination—were temporary.
But now at mid-year, the formula shortage has grown to a crisis. Despite government efforts to address the issue by importing formula from Europe, relaxing guidelines for the federal Women, Infants and Children program, and cracking down on price-gouging, more than 40 percent of baby formula was out of stock in the U.S. as of early May.
Parents are scrambling to find ways to feed their children, and grappling with new questions: What ingredients are in formula? Can I create a substitute myself? How long should my child be on formula? What do I do if my child needs a specialized formula that’s not currently available?
Two Tufts experts who deal with these issues daily have answers: Kelly Kane, assistant professor at the Friedman School of Nutrition Science and Policy and director of nutrition at the Frances Stern Nutrition Center at Tufts Medical Center, and Kathrina Prelack, associate professor at Simmons University, director of clinical nutrition at Shriner’s Hospital for Children in Boston, and an adjunct professor at the Friedman School.
Kane and Prelack, who co-teach a Friedman School course on nutrition from pregnancy through adolescence, spoke with Tufts Now about what’s in infant formula, why it’s so important, and why you can’t just feed your baby cow’s milk instead. But don’t lose hope, they added—there are strategies and resources for those struggling with the shortage.
A Crucial Ingredient in Infant Health
Many mothers find that formula is the only viable option to keep their babies fed and healthy, agreed Prelack and Kane. Although the American Academy of Pediatrics and the World Health Organization recommend that infants exclusively breastfeed for the first six months, this is not always possible for mothers because of work or family restrictions, lactation difficulties, medication use, or other factors. And contrary to popular belief, women cannot just automatically revert to breastfeeding on demand. “Moms should not feel guilty if they’ve chosen the formula route, for whatever reason, and they can’t just switch back,” says Prelack.
Nearly half of six-month-old babies in the U.S. are fed a combination of breast milk, formula, and perhaps some food, according to reports from the Centers for Disease Control and Prevention. “The standard formulas do try to mimic breast milk,” says Prelack. “They have a full complement of the necessary requirements to grow, just as breast milk would: all the nutrients, micronutrients, vitamins, minerals, appropriate type and amount of protein, and calories that are similar to breast milk.”
There are also specialty formulas for infants who cannot digest the standard ones due to food allergies and sensitivities, poor nutrient absorption, reflux, or other gastrointestinal or metabolic problems. Parents who need these particular products have been most affected by the shortage, according to Kane. “The really specialized formulas can be hard to secure,” she said.
Formula Shortage Do's and Don'ts
Parents may be tempted to “stretch” the formula they have by adding water or creating their own formula recipes. But Prelack and Kane strongly discouraged these options. Adding water to formula will disrupt the delicate balance of nutrients, they said—and creating homemade formula can pose serious health risks. These range from a dangerous excess, or absence, of vitamins and minerals, and more risk of contamination.
Substituting cow’s milk for formula also poses risks to infants. “It’s not a complete nutrition product, and it doesn’t have any iron,” says Kane. “Also, there have been reports of GI bleeding in young infants on cow’s milk, so it’s not an appropriate substitution until after their first year.” She notes that infants less than one year of age can have cow’s milk as an ingredient (such as in pancakes), but they should not drink straight cow’s milk until after they turn one.
One option that parents may not be aware of is donor milk banks, which provide donated, pasteurized human milk to babies who are in fragile health. In Massachusetts, all hospitals with level III NICUs use donor milk from Mother’s Milk Bank Northeast.
And there is hope: children who need specialty formulas when they’re young will likely be able to transition to standard formula as they get older, said Prelack, who encouraged exploring and experimenting with the help of trusted medical professionals. “Parents should be open to working with their healthcare team and trying other types of formula that may not have worked in the past, unless there’s a very well-defined metabolic disorder or allergy,” she said.
Doctors and other health professionals may be able to connect parents with other resources, Prelack and Kane said. The Mass.Gov online resource in particular is helpful for parents in the state, providing further guidance for those experiencing challenges finding formula.
In short, there are many options, resources, and opportunities available to parents and caregivers—and in the meantime, new efforts are underway to address the shortage. Just this month, the new Operation Fly Formula—a joint effort of the U.S. Department of Health and Human Services along with the USDA and the General Services Administration—imported the equivalent of more than 55 million 8-ounce bottles of infant formula from Switzerland, Germany, Singapore, and the United Kingdom.
“I think that the light’s coming at the end of the tunnel,” said Kane. “It’s just a matter of time before this pressure will be eased.”
