The formula shortage: Where we currently stand, and how physicians can help

If you’re a pediatrician or FM, chances are you’re fielding calls from parents trying to cope with the baby formula shortage. In early May 2022, 43% of stores reported their stocks had dwindled close to zero, heightening parental anxiety.^[]

Amid the ongoing media coverage has been a common refrain: If you have questions or concerns about formula scarcity, consult your child’s physician.

Federal interventions

The Biden administration announced two executive actions on May 18. The first is an invocation of the Defense Production Act.^[] It will require companies that supply formula ingredients to send them to formula manufacturers before other customers, hopefully ramping up production and distribution.

The second action is what the administration is calling “Operation Fly Formula,” which will import formula from overseas that meets FDA safety standards.

Previous media coverage had cautioned parents against sourcing formula from overseas. But FDA oversight changes things, according to Jennifer L. Brull, MD, director of the American Academy of Family Practice in an interview with MDLinx. She said that physicians should deter patients from sourcing their own formula.

“The possibility that you may not get what you think you’re getting is greater in that instance than if you source formula more locally here in the United States,” she added.

The FDA issued a news release on May 16 announcing that Abbott Nutrition (the subject of an FDA warning and safety recall viewed as a major cause of this shortage) will make mandated safety improvements that will restore production and increase formula supply.^[]

Abbott must follow FDA regulations and report any future contamination, identify the source, and carry out an investigation before production can resume.

Finding formula

In emergency situations, FMs and pediatricians can point parents to local food pantries, houses of worship, shelters, ERs, and even private practices, Brull said, noting that many maintain stocks of formula. She also suggested trying smaller local stores and pharmacies, which may not get as much foot traffic as big-box chains.

Doctors should also advise patients that when buying online, they should stick to well-known distributors and pharmacies rather than individuals or auction sites.

“And then in this lovely day of social media, there are often Facebook groups and other groups dedicated to infant feeding and formula that have local sources that they’re aware of,” Brull added.

Doctors can tell parents that if their baby doesn’t have special nutritional needs, they don’t need to worry about switching formula brands if their usual one isn’t in stock.

Finally, Brull was unequivocal: Parents should not try to make their own formula.

“This is consistent with both the FDA and the American Academy of Pediatrics, which have also similarly advised against making your own formula,” she said.

Sourcing special formula

According to Brull, doctors should advise parents to use the same tactics mentioned in the “Finding formula” section of this article to find special products such as soy-based, amino acid-based, or extensively hydrolyzed formulas.

She also made another suggestion regarding children who may have switched to non-dairy-based formula early in their lives after experiencing increased spit-ups or GI distress.

“That may not preclude you from trying to switch back to a more widely available formula,” she said, emphasizing that a parent-physician conversation is mandatory before such an attempt.

The situation is different for children who need extensively hydrolyzed or amino-acid based formula, Brull added.

“Usually those children have a pediatric specialist, and sometimes those folks have access to these supplies in greater numbers,” she said. “For family medicine doctors or pediatricians, I think getting in touch with our colleagues who are pediatric specialists in growth and development may help us identify where our patients can find those very specialized formulas.”

Other nutrition sources

According to the American Academy of Pediatrics, children older than 6 months who do not use special formula can drink whole milk “for a brief period of time” until the shortage improves.^[]

“Although we don’t have a specific amount of cow milk that infants 6–12 months should drink in this situation, follow the limits of no more than 24 ounces a day for children over a year of age,” wrote Steven A. Abrams, MD, on HealthyChildren.org.

Brull added that doctors can advise parents to split bottle, half-milk/half-formula, to stretch supplies, but iron deficiency is still a concern.

Finally, goat’s milk is not approved, and milk alternatives such as soy or almond milk are not recommended.

Breast milk

Brull said that infants should be able to handle a switch from formula to breast milk, but doctors should tell parents to proceed with caution when sourcing it.

“You should not buy it off the internet,” Brull said, adding that parents should stick to accredited milk banks that follow strict safety guidelines, such as the Human Milk Association of North America.

Accepting milk from a friend or family member may be OK, Brull said, but only if parents are certain of the donor’s health history, including medication use, substance use, and infectious disease history—all of which can be sensitive subjects.