Over the last several months, you undoubtedly have heard about, or been directly affected by, the infant formula shortage. One of the most common questions I get is, “Why did this happen?” That’s a bit of a loaded question, but here goes:
It appears that a combination of factors caused the shortage. In the face of global supply chain issues caused by the pandemic, the situation was acutely worsened by Abbott Pharmaceuticals’ sudden, voluntary recall of their formula lines, including Elecare and Alimentum. This unexpected withdrawal reduced the country’s formula supply by more than 40 percent. Other companies delayed increasing production to fill the void, likely because there was no information about how quickly Abbott might be back online, leaving the other companies with a sudden glut of perishable product. This decision allowed the void to persist longer than it might have otherwise. Also, the widespread panic (which was completely understandable) by families needing formula for their infants led to mass purchasing, further eroding supply. The situation has been even more problematic for children who require specialized formulas, such as those with intestinal failure, kidney disease and food allergies.
For the families of Mississippi infants, this shortage is just one more crisis in a long list of problems surrounding formula and food access. In April of 2021, the state began the permanent closure of all freestanding WIC distribution centers. This move began and proceeded with little to no notice to families, or even providers. In Mississippi, roughly 90,000 residents utilize the WIC program, which is critical in providing formula and food for children and families in need. These centers generally were in communities where they were needed most, and the closures caused families, many with limited means, to have to spend additional time and resources to travel to supermarkets designated by the state.
That protocol change, coupled with the pandemic’s economic impact, caused a cumulative effect in terms of the difficulties caused by that lack of access. If that weren’t bad enough, now there’s the formula shortage. At my practice, Kids and Tummies, the shortage has hit my youngest infants and families with limited means the hardest.
Infants should remain on formula until they are a year old. In these unprecedented times, if necessary, older infants (roughly 10 months and up), temporarily can be managed with toddler formula, or even cow’s milk. However, we recommend transitioning them back to formula as soon as it becomes available. For younger infants, it is unsafe to give them cow’s milk at their very young age. Instead, we recommend trying to transition to a different brand of formula. Another option, if no infant formula is available, is to use toddler formula, but only for a few days until an alternative becomes available.
These recommendations only apply to infants on regular formula. Those who require a hypoallergenic formula, depending on the severity of their cow milk and/or soy protein allergy, can’t safely go from a hypoallergenic formula like Elecare, Neocate or Puramino to a regular formula. Milk- and soy-allergic infants can switch to a different formula within the hypoallergenic category — for example, from Elecare to Neocate or Puramino. Babies with a milder allergy sometimes can be switched temporarily from a truly hypoallergenic formula like Elecare, Neocate or Puramino to a partially broken-down formula like Nutramigen or Alimentum as tolerated.
Parents, if your infant, regardless of age, shows any signs of intolerance to a new formula, discontinue it immediately and notify your pediatrician or pediatric gastroenterologist.
Recently, I’ve received countless calls from parents, as well as practitioners and pediatricians, throughout the state asking for advice about what to feed babies in need. At my practice, we give patients, and sometimes providers, sample cans of formula whenever we can get our hands on them. I’ve told pediatricians who have called me to send us their patients in need, and they’re welcome to what we have. Ultimately, it’s going to take all the physicians in the state banding together and pooling resources to ensure that Mississippi’s children get what they need.
HERE IS SOME OTHER ADVICE I GIVE PATIENTS AND PROVIDERS:
1. If you are breastfeeding, now is not the time to transition to formula. Work to maintain your milk supply by allowing your baby to feed frequently and pumping several times per day and once at night. Store the breastmilk when possible.
2. If you have been feeding your baby breastmilk but supplementing with formula, try to increase your breastmilk supply so you can rely less on formula until the shortage ends.
3. For moms of recently delivered babies (3 months or younger), or babies who only recently have discontinued breastfeeding, consider relactation. Lots of resources and information about this phenomenon are available online. This also can help ease the reliance on formula.
4. To help reduce the impact of shortages, we recommend buying no more than a 10-day to two-week formula supply at a time.
There are some bits of good news. First, Abbott has resumed production and anticipates that within the next two months, things should be back to normal.
Also, WIC has begun making it easier for parents to receive an alternative formula that is appropriate, even if it is not the formula their provider originally prescribed. They also have begun to stock, and have been approved to acquire, alternative formulas as that previously were not available or approved at WIC. The request for an alternative formula can be made by calling the WIC call center at (800) 388-6747 or completing a participant complaint form online.