Strategies for coping with a baby formula shortage

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. With the ongoing shortage of baby formula in America and fears that this will not resolve quickly, I'm turning to Upstate pediatrician Winter Berry for suggestions for what parents can do.

Welcome back to "The Informed Patient," Dr. Berry.

Winter Berry, DO: Thanks so much for having me.

Host Amber Smith: Now, Abbott Nutrition recalled three types of infant formula several months ago. That, coupled with more general supply chain issues, has left many parents worried about feeding their babies. What are you telling parents to do?

Winter Berry, DO: The first thing I tell parents is that it is normal to be nervous about this. And this is sort of an unprecedented shortage, that parents haven't had to approach similar circumstances in therecent past. So it's OK to feel unsure about what to do, but there are a lot of solutions out there.

The big-picture answer is that there is support available to you. There is always advice through your pediatrician. So if you're unsure, feel free to ask, that's what we're here for. And also creativity, as far as where to get your feeding for your baby from, and how to acquire it, is required at this time.

But there's always a solution that can be sought.

Host Amber Smith: Is it OK to switch brands if the one that you've been using is not available?

Winter Berry, DO: Yes, absolutely. So there are some online resources. I would caution to use a reputable source for the online resources, but there are absolutely safe switches that can be made and that can be within brands, different types of, say, the same brand Enfamil formula or Similac, but there can also be substitutions between brands.

You could switch from Enfamil to Similac or to a generic formula, and there are many equivalent options for what is most accessible in your area or in your circumstance. That substitution becomes a little bit more complicated with certain children, certain underlying conditions. But the majority of children can safely make switches to other types of formulas.

Host Amber Smith: So generic versus store brand is OK. What about switching from milk-based to soy-based?

Winter Berry, DO: So, yes, generic is an equivalent product with the same safety profile and nutritional profiles. So if that is an option for your family, it is often a more cost -effective option. And it's absolutely a switch that can be made, and thankfully most generics have a spot on the label that say, "equivalent to X." So you can tell that you're getting an equivalent substitution to the formula that you're used to. As far as soy-based goes, there's a very narrow group of children with underlying medical conditions that we would not advise soy for, but that's something you'd likely already know from your pediatrician.

And I know this will sound repetitive, but if you're unsure, always feel free to call us and ask about the substitution. There is a small percentage of children with milk-protein intolerance who would also be intolerant to soy. So if you know that milk protein is something your child is sensitive to, I would ask your doctor before you make a switch to soy.

Host Amber Smith: When can babies start drinking regular milk?

Winter Berry, DO: I want to give two answers to that question. Under usual circumstances, when formula and breast milk are readily available, we recommend introducing cow's milk at 12 months of age. As this formula shortage has continued to widen, we are also widening the availability of temporary use of cow's milk. That is to say, we advise cow's milk as a substitute only in certain situations or emergent situations where no formula substitute is available, and only over 6 months of age. We do not recommend other milk substitutes such as plant-based milks or other animal milks, and if you are going to use cow's milk, we advise using it for as short a period of time as possible, not more than 24 ounces in a day, and you need to be sure to supplement iron, in addition to that cow's milk because cow's milk is not a good source of iron. That can be some dietary sources, but it also may mean you need advice from your pediatrician for either a vitamin or a prescription for iron itself to adequately supplement your baby.

So if you're planning to use cow's milk in place the formula even briefly, you need to check in with your doctor about that first. And to be perfectly clear, as soon as formula becomes available again, we recommend switching back to formula.

Host Amber Smith: What about transitioning a baby to regular food? How soon can that be done?

Winter Berry, DO: So again, in usual circumstances, we advise waiting until about 6 months of age. Some babies are ready a little bit earlier, and that's a developmental milestone when they're able to handle food off of a spoon. That's somewhere between 4 to 6 months of age. In these circumstances, some parents may be tempted to offer more and more complementary foods as formula is less available.

The minimum we recommend of formula, in addition to those complementary foods, is about 24 ounces per day. And you can increase the amounts of complimentary foods, if you're having to pull back a little bit on the formula you're giving. Really a broad variety of foods are safe for infants, complementary foods, the only things we caution against are choking hazards, or if you know your child has a specific sensitivity to a certain food, obviously you would avoid that as well.

Host Amber Smith: Now there are a lot of recipes online for "make your own baby formula." Why is that not a good idea?

Winter Berry, DO: So many of the formulas circulating, for starters, are relatively dated, for lack of a better term. Those were formula recipes that were used decades ago and in place of what is now commercially available, much more comprehensive nutrition that's in formula. The formula that is commercially available today has very complex nutritional contents and meets the specific needs of an infant in their first year of life.

And that is impossible to replicate with a home recipe. The home formula recipes also have risk for electrolyte imbalances, iron deficiency, as I mentioned, an inadequate nutrition broadly and can lead to serious illness or complications for a child. So as reassuring as some of those social media posts can be, that is not something that should be used to substitute for formula.

Host Amber Smith: Is there a safe way to cobble something together using your blender at home to take regular food and blend it or anything like that?

Winter Berry, DO: Anything you'd be using at home would fall under the category of complementary foods and wouldn't replace formula. If parents are in the situation where they feel like they're ready to make their own formula, based on a recipe they've found, I would suggest reaching out to a community agency or your pediatrician to find a way to come across formula instead of that.

Or as I mentioned before, consider, if your child is over 6 months, using cow's milk for a short period of time and then trying to get back to formula. And there's a breadth of supports available for families who are struggling with finding formula. There are social service and safety-net agencies, your family may qualify for WIC, which is Women, Infants and Children, a nutritional supplemental program. There is a program called Help Me Grow, which helps parents navigate available resources in the community, and they can help find creative sources. And then we also recommend families trying smaller stores, things like pharmacies or corner stores, which might not normally be a place they buy formula, but may have a little bit more of a supply

Host Amber Smith: if you have some formula, but you want to make sure that it lasts, is it OK to thin it out a little bit and not use as much of it as you normally would?

Winter Berry, DO: That's a great question. And it's very tempting to do, because it seems like, well, if it's complete nutrition, I could just make it a little less potent, and it would be fine. The problem with that is that the safety and nutritional content of the formula has been safety tested with the recipe that's on the can.

So by diluting it, you, again, especially in younger infants, can risk things like inadequate calories, proteins, fat and electrolyte abnormality. So we recommend mixing it exactly as it said on the can. There are, again, are some infants in special situations who need to mix it even more concentrated than it says on the can, but that's something that your doctor would have told you ahead of time. And if that's the case, we again recommend continuing to mix the formula as directed by your doctor.

Host Amber Smith: Breastfeeding might be an option for some moms, but if a woman has stopped breastfeeding, or she never started when her baby was born, is she able to go back to breastfeeding?

Winter Berry, DO: That is an option for some moms. I want to be clear that there should be no value judgment made for parents who choose to formula-feed their children or cannot breastfeed their children. There has been some rhetoric online that this problem would be solved if everyone just breastfed their babies.

And I want to be clear that that is not an option for all parents and that's OK. However, if parents wish to breastfeed, and have either taken a break or did not initiate, it is possible to initiate that process, called relactation, that usually requires the support of a physician or a lactation specialist.

And that is absolutely something that can be supported, but I would recommend families reach out for assistance in that process to be sure that they have enough support to do so successfully, but yes, that can be an option for families.

Host Amber Smith: Well, Dr. Berry, thank you for this important information.

Winter Berry, DO: Thank you so much.

Host Amber Smith: My guest has been Dr. Winter Berry. She's an associate professor of pediatrics at Upstate. "The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at upstate.edu/informed.

This is your host, Amber Smith, thanking you for listening.