This is a difficult time. Here are Answers to your common questions and concerns to get you through this shortage.
There is a massive formula shortage occurring across the United States which is causing stress for new parents and parents of infants.
During the first week of May, 43% of baby formula was out of stock across the U.S. We are concerned this formula shortage will continue for the next couple weeks as supply ramps up.
This extensive blog goes over all of your common questions and concerns to get you through this shortage.
It also contains helpful formula-feeding education that parents have prior to this shortage!
Please share this with friends and family.
Why are we seeing a formula shortage in the U.S?
At the beginning of the pandemic, we saw essential items fly off the shelves because of lockdowns. This shortage is a little different as it stems from a recall that occurred earlier this year for Similac resulting in the shutdown of a large production plant in Michigan. The shutdown occurred as a way to monitor the facility to assure that it can be reopened safely and it has yet to be reopened.
There are a few reasons why this is happening and why it’s taking so long to manufacture more formula:
- There are only five approved infant formula manufacturers in the U.S (and with the plant in Michigan, it’s limited due to the recall). The regulations around the facilities that make formula are tightly monitored and have strict food safety protocols, so the limitation of one has greatly impacted the supply chain.
- Supply chain issues due to the pandemic have also affected supply of essential items. Manufacturers are experiencing continued ingredient shortages, ingredients being stalled on transport, and so much more given this global pandemic and labor issues.
- Three companies — Abbott, Gerber and Reckitt — make nearly all of the formulas that Americans use. Abbott is the largest of the three, with roughly 40% of the market. So with the Sturgis plant going down, it has caused mass disruption
- Because sales of baby formula do not fluctuate much in normal times, factories generally lack the ability to accelerate production quickly. As a result, other factories have not been able to make up for the Sturgis shutdown.
Where to find formula in a shortage?
I want to first recognize the difficult time many families are going through. Infant formula is an essential need and to have to search far and wide to find formula isn’t fair nor should it be this way.
During a shortage, there will be a lot of leg-work to get formula; but it will get better. PLEASE lean on Facebook communities, your Pediatrician’s office, friends, family, etc. to create a network to supply your needs.
Here are some ways to find formula:
- UPDATE 6/13: The HHS from the U.S. government wanted to remind the population of the following resources:
- Scheduled check-in, in stores a few times a week (try to go earlier in the morning or ask the staff when stocking occurs).
- Online inventory checks at your major retailers which include but not limited to: Costco, Sam’s Club, Target, Walmart, Pharmacies, etc.
- Amazon prime/subscription
- Online Facebook groups (If you are not in local Facebook groups, this would be the time to join one as MANY are doing formula exchanges. Confirm the formula is not expired).
- @theformulamom: Online formula exchange at https://trello.com/b/bqtxGcb2/formula-exchange-board
- Your Pediatrician’s office (ask them for samples as we do occasionally have them).
- WIC (if you qualify).
- Ask family members to check their local stores and ship it to you. I am seeing regional differences in supply (this is likely based on which plant they get shipments from and population demographics, so ask friends and family to help if they can).
- U.S. Gymnast Shawn Johnson and her husband created a free online formula exchange forum
- The U.S. Health and Human Services has also created a resource to find formula
How much formula to have on hand?
In a shortage, we want to be mindful of everybody’s needs and our own. I would have a stash of 1-2 weeks and prioritize refilling to always have at least 2 weeks-worth if possible. In an ideal world, a longer duration would be wonderful but everyone is in need so be mindful of this. Many retailers are limiting purchases for the time-being.
This chart from John’s Hopkins has a rough estimate of the amount of formula babies drink by age. Remember, that every baby is different so calculate how much your baby would need.
What formula should you buy if the one you use is not available?
If your baby is tolerating a formula and that one is not available, it’s okay to switch to something that is equivalent. We want to be mindful of the protein composition and sugar source in that formula and find something comparable.
Speak to your Pediatrician about options to swap out, but if they are unavailable; I have included some amazing resources. If your baby is on an extensively hydrolyzed formula like Alimentum or Nutramigen or a specialized formula like Elecare, speak to your Pediatrician if your baby can swap to something else.
Always search for generic equivalents as well if they are in stock. You don’t have to stick to “brand names.”
Here are a few “swap-out” guides:
- Fellow Pediatrician Dr. Natasha Burgert created a guide on her website that is very helpful.
- @theformulamom has a “All-Access Formula Index” which is an extensive guide of all formulas on the market. She had this resource PRIOR to the shortage. She is constantly updating this resource if formulas change or if new ones come on the market. She gave a code to my readers of PDT20 for 20% off the guide. It’s a WONDERFUL resource that is extensively detailed. (This is not sponsored in that I get no commission, but I just really love this resource).
Can I give my newborn powdered formula?
Ideally, we like to give ready-to-feed formulas to newborns and babies under two months HOWEVER there are many exceptions to this (even before this shortage).
If powdered formula is what is more readily available; the benefit outweighs the risk (benefit being the need to feed your baby vs small risk of infection).
If a certain formula that is best for your baby is only available in powdered form (this was the case for us when we switched to powder at 3 weeks for our son).
If your baby is full term (over 37 weeks); powdered formula is an option when prepared correctly.
If your baby is premature or immunocompromised in any way; speak to your clinician on whether powdered formula is okay. It likely will be as long as you prepare it correctly.
Here is a note on properly making powdered formula from the AAP:
“Potable (this means drinkable) water must be used. Most municipal tap water is safe, but use cold water from the faucet. Warm tap water may contain softener salt that can pull impurities from pipes. Water from a well should be tested every year to make sure it is free of harmful bacteria or chemicals like nitrate. If bacteria in water is a concern in your community, bring water to a rolling boil for 1 minute and then cool it to room temperature before using. Bottled water also can be used to make formula.”
I personally used gallons of store-bought water (not nursery water as that’s not needed) to prepare formula vs. using tap water as I personally have trust issues with the water supply. Our son didn’t need formula warmed, but if you do warm formula; you can do so in a bottle warmer. Another option is to place it in a container of warm water to warm up. Don’t microwave the milk as it contains hot-spots and warms unevenly.
If your baby is under two months, boiling water and letting it cool for 5 minutes can help reduce infection risk.
Make sure to add the water first and then the powder so the ratio is correct.
What to do about preemie babies and formula?
Preemie formulas include Neosure and Enfacare which contain different ratios of nutrients to support the premature body. Depending on the age of your child and their growth, speak to your Pediatrician ASAP to discuss another option. Your doctor may recommend transitioning to the standard formula or mixing the formula to allow for more calories. But speak to them first!
What about switching off a hydrolyzed formula to a standard formula?
We occasionally can do this depending on the age of the baby and the reason for starting the hydrolyzed formula. Speak to your Pediatrician to discuss best alternatives if it’s possible.
What about toddler formulas?
Most formulas are not recommended as they contain different nutrient profiles (and in general are not even needed for toddlers!). Here is a visual of toddler formulas that would be appropriate if you can’t find your preferred formulas. If you are in a bind, you can use a toddler formula if your child is close to one year of age (Please run this by your Pediatrician as well).
Should I buy European formulas?
@theformulamom and I discussed this in our LIVE session on Instagram. But, I would generally try to stick to U.S. Formulas. However, importing formulas from Europe is okay in a bind but make sure you are ordering it from a reputable website or BETTER yet, have a family member or friend overseas ship it. We discuss this more in our live. Also, the U.S is looking to import formulas safely from other countries during this shortage.
What NOT to do during a formula shortage (or ever)?
- Purchase formula that is more specialized if your baby doesn’t medically need it. Examples include Elecare and/or Nutramigen or Alimentum. These formulas are meant for children with certain medical conditions and we want to make sure they have enough of what they need. Consider a swap out as mentioned above in the guides.
- Don’t dilute powdered formula to make it last longer. This is dangerous as it can lead to electrolyte abnormalities in the body and/or alter the nutrient composition that is created when we mix formula per the packaging.
- DO NOT MAKE FORMULA AT HOME: Social media is running rampant with at-home formula recipes. PLEASE do not do this. Your home is not a sterile facility and the composition of these home-made formulas is not nutritionally sufficient for your baby so you can risk them being malnourished or get an infection.
What about introducing cow’s milk before one?
I have always recommended the introduction of cow’s milk as early as 10 months as long as the child does not have an allergy indicated by a clinician. In my YouTube video I go over when and how to introduce cow’s milk and discuss which one to choose if you don’t do cow’s milk. We want to make sure the fat composition and other nutrients is adequate.
The AAP has stated that if your child is older than 6 months of age and has received yogurts and cheese already, you can give whole cow’s milk if you are in a bind. The ideal situation would be to have formula, however this is a better option than diluting formula or making your own. They recommend that if you do this, to make sure you are giving them iron rich foods as whole milk doesn’t contain this like formula. If you are transitioning to cow’s milk between the ages of 6-9 months, I would speak to your child’s clinician about IF your child needs iron supplementation.
After 6 months, your baby should be getting solid foods. Continue to offer these varieties of foods. By 9 months, you will likely notice your baby isn’t taking as much volume of formula so you will be using less and less (and can even switch to cow’s milk if you’re in a bind).
PLEASE refrain from using Goat’s Milk before one year of age or unpasteurized milks. These carry nutritional deficiency risks and risk of infection. A goat’s milk based FORMULA is okay before one, but Goat’s milk can lead to a type of anemia due to it being low in Vitamin B12 and folate (as compared to Cow’s milk).
How long will this formula shortage last?
UPDATE (7/7): The FDA and White House have announced plans on allowing formula that has been imported during this shortage to stay on the market in the U.S. This is huge and is being considered in an effort to diversify the marketplace, provide more options for families, and provide the formula a family may have become familiar with during the shortage. Three main companies have had a stronghold in the U.S. for so long and diversifying can be a step in a good direction.
UPDATE (6/13): The White House has issued their formula shortage crisis timeline to be fully transparent about the process. It is a good read and does provide some hope and insight. I know how frustrating it is for this to feel like it’s “too little too late,” but I do appreciate the clarity in their plan to make this better. What I will appreciate even more is assuring this NEVER happens again. Operation Fly Formula continues to bring more formula into the U.S. I want to give another shout out to @theformulamom for breaking down all the new formulas coming in so you can find what swap-out may work for you.
UPDATE (6/4): The Michigan plant that was shut down 4 months ago is finally going to begin production of formula. “Abbott is starting production of EleCare and other specialty and metabolic formulas, with initial EleCare product release to consumers beginning on or about June 20,” Abbott said. They are also going to continue to work to get other formulas produced as well. For the full article, read here.
UPDATE (5/30): With Operation Fly Formula underway. A couple formulas may be on shelves soon. @theformulamom has created two infographics that I found to be helpful. This is for Aussie Bubs and this is for Kendamil. These are great options and @theformulamom includes comparative formula brands in the infographic.
UPDATE (5/18): President Biden has invoked the Defense Production Act (Think: When we needed PPE the same thing was done) to mobilize more resources to produce formula safely. He also announced Operation Fly Formula to get more formula overseas safely to the U.S.
For the full Fact sheet on the policies occurring, click here. To be fully transparent, I’m not sure how quickly this will change things, but hoping its sooner than later.
This is a very hard time to be a parent and I completely recognize it. Not only as a Pediatrician, but also as a mother who formula-fed her child. So my thoughts are with you as we get through this together.