Children's Hospital Colorado

Baby Formula Shortage: Advice from the Experts

Note: The advice below relates to the formula shortage occurring in spring 2022

With the baby formula shortage in the news, parents of infants and babies have many questions about how to safely feed their little ones. We spoke to Liliane Diab, MD, pediatric nutrition doctor, and dietitians in our Neonatal Intensive Care Unit to find out what caregivers can do if they’re worried about not having enough formula and what to be aware of as they consider alternatives.

Parents are concerned about the national shortage of baby formula. What advice do you have for them?

This baby formula shortage is very concerning to a lot of parents, and justifiably so. The good news is that, in most cases, parents do have options for finding formula.

As a first step, it’s important that parents know exactly which type of formula their baby is taking and why. Are they on specialty formula or regular formula? Is it milk-based or soy-based? Are they on a specialty formula due to allergies or because of possible colic or reflux? Answering these questions will help parents decide how flexible they can be in choosing the right off-the-shelf formula.

If a baby drinks regular formula, that simplifies the search for parents or caregivers. They can use any FDA-approved formula for their baby — either generic or store brand. They can also substitute infant formula with an FDA-approved toddler formula as a short-term solution.

For babies who drink specialty formula due to allergies and for premature babies, it’s important that caregivers speak with their pediatrician right away to determine their best next steps.

Ideas for parents looking for formula:

  • If larger stores are out of stock on infant formula, check smaller grocery stores and pharmacies.
  • If you can afford it, buy FDA-approved formula online until shortages in stores ease up. Only purchase from well-recognized distributors and pharmacies.
  • Although more expensive, ready-to-feed liquid infant formulas are a safe alternative and are more readily available than powdered infant formulas right now. Parents can go online to manufacturer websites to look for coupons to potentially offset the price difference.
  • Contact your local WIC office (Women, Infants and Children Program) to see if your infant qualifies for the program.
  • Contact local food banks to see if they have infant formula.
  • Contact your pediatrician if you are still unable to find any infant formula.

Is there a safe way to make your own baby formula?

Short answer: No. There really is no way for parents to safely make formula for their infants. Even before the formula shortage, we saw serious vitamin deficiencies and dangerous electrolyte imbalances in babies who consumed homemade formula.

For many infants, formula is their sole source of nutrition. Therefore, their formula must be nutritionally complete. The ratios of vitamins and minerals to each other are also extremely important to ensure the baby absorbs them. For example, too much calcium can reduce iron absorption.

Parents also can’t solve for these deficiencies with a multivitamin. Almost all the commonly used infant liquid multivitamins fail to provide complete nutrition.

Why is it important not to dilute baby formula?

Diluting baby formula is like giving them water instead of food. While it may satisfy your baby for a short time due to the volume, it lacks the appropriate amount of nutrient-rich calories they need to support their nutrition. Feeding a baby diluted formula can ultimately lead to serious malnutrition and electrolyte imbalances, and near- and long-term growth and development issues. Caregivers should be diligent about mixing formula in the proper proportion specified on the formula packaging.

When can an infant safely transition to cow’s milk?

The answer depends on a baby’s age and stage of development. For infants 10 months and older, cow’s milk can be a temporary option, but only if the infant is eating a broad diet of other foods that are rich in iron and zinc (like fortified cereals and red meat). Some infants may require an additional iron supplement as whole milk has little to no iron.

We still recommend drinking toddler formula as the first transitional step away from infant formula before consuming whole cow’s milk. Using toddler formula helps ensure the baby is getting enough iron and zinc, which can be difficult for them to get from other foods. Toddler formula also seems to be more widely available in stores and online.

Here are some ways to get your infant enough iron:

  • Consume iron-containing foods like pureed meats and iron-fortified infant cereal (oatmeal and whole grain cereal).
  • Infants born prematurely or babies who don’t consume enough iron-rich foods may need iron supplements. Talk with your pediatrician to see if your baby needs supplementation.

What about other milk substitutes, such as almond milk, oat milk, coconut milk and others?

These milks are not recommended for children in general and they can be dangerous for infants under 1 year old. Not only are they nutritionally incomplete, but they are very low in protein and we have seen cases of kwashiorkor (a severe form of malnutrition) associated with using almond milk even prior to the formula shortage.

Can I use my friend’s extra breastmilk?

This is a sensitive question and the answer depends on the friend’s willingness to share breastmilk and information about their health, lifestyle and diet. If there is no alternative, ask any potential breastmilk provider about usage of drugs (marijuana, etc.) and medications, as well as whether they have viruses like Hepatitis and HIV that can be transmitted via breast milk. If the person’s answers to those questions give you assurance the person’s breastmilk would not pose a risk to the child, this could be a reasonable option. Ask your pediatrician if you still have questions about this option.

A similar but less imposing option is to reach out to the Rocky Mountain Mother’s Milk Bank (MMB), which has collected, processed and distributed donor human milk to babies throughout the country for nearly 40 years. Women and families can donate or purchase milk from anywhere in the state. Individuals can also give financial assistance to offset the cost to families. Our hospitals in Colorado Springs and Aurora are donation and outreach sites for MMB.

Please note that swapping or acquiring breast milk over the internet from other moms is not a safe option.

What advice do you have for parents who are having trouble finding specialized baby formula?

First, call your pediatrician. They should be able to provide some options. If your baby needs specialized toddler formula, at least in the short term, your pediatrician or a pediatric dietitian can help recommend supplements to help compensate for any lack of nutrients in toddler formula.

What else should worried parents know about the formula shortage?

Caregivers should know that they are not in this alone. A lot of people in their communities are facing the same predicament. Because of that, they should also be a good community partner. If you find 10 containers of formula available at the store, rather than buying them all, only buy three or four and leave the rest for other families in need.

Finally, be flexible. If your baby doesn’t need specialty formula, leave that for kids with medical or dietary issues.

In addition, consider introducing complementary foods to infants when they are 4 to 6 months old to help reduce formula intake. Foods such as pureed meats and iron fortified infant cereal can provide protein, iron and other essential nutrients.

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