BELLINGHAM, Wash. – Since the outbreak of COVID-19, there have been significant shortages of infant formulas in some stores. Current shortages have been largely caused by supply chain issues and a recall of several contaminated baby formula products. The local PeaceHealth primary care teams have been following this problem and working to identify regional resources for families.

With recent national media attention around the formula shortage, PeaceHealth Medical Group pediatricians Lessli Putney, MD, and Rachel Westerfield, DO, offer some safety tips and possible resources for families. Most importantly, anyone with questions about safe infant feeding practices should contact their baby’s primary care provider for guidance.

Worrying about how to safely feed your infant is a frightening experience. Putney shared, “I am hopeful the formula shortages will be alleviated soon. In the meantime, please reach out to your pediatric team if you have questions about alternate feeding options until your preferred formula is restocked.”

TIPS FOR FAMILIES DURING THE FORMULA SHORTAGE:

• Ideally, infants should be fed breast milk or iron-fortified infant formula.
• Consider trying a similar version of a different brand, generic versions or different versions of the same formula.
• If eligible, work with your local Women, Infants and Children’s (WIC) services provider to access formula resources through their supplemental program.
• To help ease the impact of the shortage, buy only 10 days to 2 weeks’ worth of formula at a time.
• Check smaller stores and drug stores, which may not be out of supply when the bigger stores are.
• If you can afford it, buy formula online until store shortages ease. Purchase from well-recognized distributors and pharmacies rather than individually sold or auction sites. Do not import formula from overseas, since imported formula is not FDA-reviewed.
• For most babies, it is OK to switch to any available formula, including store brands, unless your baby is on a specific extensively hydrolyzed or amino acid-based formula such as Elecare (no store brand exists). If you are unsure, talk with your pediatrician.
• Check social media groups. There are groups dedicated to infant feeding and formula, and members may have ideas for where to find formula. Make sure to check any advice with your pediatrician.
• If no formula can be found, consider borrowing a can from a friend.

FAMILY EDUCATION and SAFETY:

• Cow’s milk may be substituted for not more than one week for infants who are older than six months, but should not be a long-term solution, and should be supplemented with iron containing solid foods like infant cereal.
• Goat’s milk formula is not approved in the U.S. for babies. However, there are goat milk-based baby formulas registered in other countries that may be among those considered for accelerated import approval by the FDA. Goat’s milk should be avoided entirely in the first 12 months of life, as it can be associated with metabolic acidosis, electrolyte abnormalities and poor weight gain. Unpasteurized milk products can also be associated with risk of infectious complications from pathogens like Salmonella, E. Coli O157, Campylobacter, along with viruses and parasites.
  • High protein levels cannot be processed well by infant kidneys.
  • High sodium levels can lead to electrolyte imbalances.
  • The electrolyte profile in goat’s milk can also lead to acid/base imbalance and metabolic acidosis in infants.
  • Low folate can lead to anemia.
• Plant-based milk alternatives are not recommended for babies under 1 year and are not a safe alternative for babies requiring certain hypoallergenic formulas. Soy milk may be an option for babies who are close to 1 year of age for a few days in an emergency, but always buy the kind that is fortified with protein and calcium. Make sure to change back to formula as soon as possible. Be especially careful to avoid almond milk or other plant milks often low in protein and minerals.
• Always mix formula as directed by the manufacturer, and never put more water than recommended in formula. Always follow label instructions or those given to you by your pediatrician. Watering down formula is dangerous and can cause nutritional imbalances and lead to serious health problems including electrolyte disturbances.
• The AAP strongly advises against homemade formula. Although recipes for homemade formulas circulating on the internet may seem healthy or less expensive, they are not safe and do not meet infant nutritional needs. Infant deaths have been reported from use of some homemade formulas.
• Toddler formulas are not recommended for infants. However, if you absolutely have no other choice, toddler formula is safe for a few days for babies close to a year of age. Whole cow milk can also be a reasonable temporary substitute for infants close to 12 months old.
• Honey should not be added to food, water or formula that is fed to infants, because it can be a source of spores that cause botulism poisoning in infants. Processed foods containing honey should not be given to infants.

POSSIBLE RESOURCES FOR FAMILIES:

• Additional information for parents in this article on HealthyChildren.org: With the baby formula shortage, what should I do if I can't find any?
• WIC (Local WIC offices across the system have validated they can provide formula per their policies for families who are eligible).
• United Way’s 2-1-1 (https://www.211.org/about-us/your-local-211)
• Gerber may also be able to help identify a similar formula that is more readily available: https://www.gerber.com/mygerber-baby-expert
• Mead Johnson Reckitt’s Service line: call 1-800 BABY-123 (222-9123)

The US Department of Health & Human Services Fact Sheet: Helping Families Find Formula During the Infant Formula Shortage (https://www.hhs.gov/formula/index.html) has a website that is helpful.

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About PeaceHealth: PeaceHealth, based in Vancouver, Wash., is a not-for-profit Catholic health system offering care to communities in Washington, Oregon and Alaska. PeaceHealth has more than 15,000 caregivers, a group practice with more than 1,200 providers and 10 medical centers serving both urban and rural communities throughout the Northwest. In 1890, the Sisters of St. Joseph of Peace founded what has become PeaceHealth. The Sisters shared expertise and transferred wisdom from one medical center to another, always finding the best way to serve the unmet need for healthcare in their communities. Today, PeaceHealth is the legacy of the founding Sisters and continues with a spirit of respect, stewardship, collaboration and social justice in fulfilling its Mission. Visit us online at peacehealth.org.