The U.S. is in the middle of a severe baby formula shortage, forcing some parents to turn to dangerous alternatives.
The shortfall came about for various reasons. Labor and supply shortages brought about by the COVID-19 pandemic limited production for months. The baby formula industry is also tightly regulated in the U.S. Around 98% of formula consumed in the U.S. is produced domestically and retailers and consumers are generally prohibited from buying formula produced overseas, which has constrained the supply chain.
Things got even worse when an Abbott factory in Sturgis, Michigan voluntarily shut down back in February due to safety concerns after two infants died. Abbot is one of the largest baby formula manufacturers in the country. It is largely known for producing powdered formulas under brand names like Similac and EleCare. As of early May, 43% of U.S. baby formula was out of stock.
“The scenario where you have a manufacturing problem that occurred at an Abbott facility in Michigan, those kinds of things happen all the time,” Nada Sanders, a professor of supply chain management at Northeastern University’s D’Amore-McKim School of Business, told ABC News. “Ultimately, we have very, very weak supply chains.”
The Food and Drug Administration recently made an agreement with the factory to resume production, but it may be months before this product reaches the market. In the meantime, parents have had to make do with what they have.
Dr. Owais Durrani, an East Texas emergency-room physician, has been witnessing the effects firsthand. He recently treated an infant who was fed watered-down formula to make it last as long as possible.
But Durrani says adding water to baby formula offsets the balance of electrolytes, which leads to less sodium in the infant. This can shrink the baby’s blood volume, which can lead to low blood pressure and life-threateningly low levels of circulating oxygen. It can also lead to seizures, which can be fatal.
Thankfully, his clinic hasn’t seen patients in that state, but he fears the worst has yet to come if parents lack access to formula.
“A formula is essentially regulated as closely as any prescribed medication when it comes to the ingredients in it to make sure a baby’s kidneys are developing, their liver, their electrolytes — everything else is in a very fine balance,” Durrani said.
And messing with that balance can have serious consequences.
“They’re not as resilient as an adult who might be out in the sun for 12 hours and get dehydrated — we’ll still be OK for the most part, but for a baby, that’s not the case,” Durrani added. “Each electrolyte, each component, each mineral in that formula is very important.”
Durrani and his colleagues have also received an influx of calls and texts from concerned parents asking about homemade baby formula. But he told them using homemade baby formula recipes aren’t safe and that only regulated formulas contain the right balance of nutrients for brain and body development.
“We know that homemade formula, even the ones online, run the risk of contaminated components to them, they have the wrong mixture of minerals and protein for babies, and a lot of times the things that you add to them just may not be absorbed by the baby,” said Dr. Steven Abrams, a pediatrician who is affiliated with the American Academy of Pediatrics.
“They should really not be drinking any kind of nonhuman milk,” says Dr. Victoria Regan, a pediatrician at Children’s Memorial Hermann Hospital in Texas. “If they’re not getting milk from either mom or a reputable breast-milk supplier, the essential nutrients are lacking, affecting both physical and neurodevelopment.”
Experts also warn against using a friend’s breast milk when supplies are low.
“The issue with that is it can pass on disease,” Durrani said.
But the Academy of Breastfeeding Medicine says sharing breast milk may be acceptable in an emergency. Moms should talk to their providers about the risks and benefits of informal breast milk sharing, and screen potential donors to rule out those with certain health conditions, medication use, and habits, according to a 2018 position statement. The academy also provides information on removing bacteria from breast milk. Experts urged parents not to buy breast milk from unlicensed vendors online.
Parents often need a doctor’s note when switching baby formula, but Durrani said babies should be able to tolerate other reputable brands of formula unless they have severe allergies. The worst case is that the baby will have diarrhea or spit up the formula. But parents should only consider this option if they can’t access their baby’s preferred brand.
“For a parent to make that change, it’s stressful as well because it’s another unknown,” he said.
Parents can also ask their pediatrician for samples of other formulas to see how their baby reacts.
“Pediatricians are here to help. We’re here to help. We’re not going to turn a hungry baby away from the emergency department. We’ll make sure when that baby’s discharged, there’s some type of plan in place,” Durrani said. “But please don’t use any of those other options because that can lead to life-threatening issues.”
The Biden Administration is flying in baby formula from other countries to help fill in the gaps. Manufacturers and logistics companies transporting baby formula have also been given priority status to speed up delivery times.
“Hopefully Abbott will be able to get their production out and get everything smoothly running and what’s taken by customers is replenished at the right cadence,” Sanders said. “Meaning no bumps.”