Preventing another infant formula crisis: What needs to happen now

a baby's hands hold the outline of a baby bottle
(Images: Adobe Stock. Illustration: Sebastian Stankiewicz/Boston Children’s Hospital)

The current national shortage of commercial infant formula might seem like it came out of nowhere, but today’s scarcity is an exacerbation of a longer-standing problem.

Triggered by supply chain issues related to the COVID-19 pandemic, the situation worsened recently. This February, a major manufacturer voluntarily recalled and then ceased production of its powder formula, which had been linked to a fatal outbreak of Cronobacter sakazakii infection. As a result, more than 40 percent of formulas are now out of stock across the U.S. The situation has been even more problematic for children who require specialized formula, such as those with intestinal failure, kidney disease, and food allergies.

As families and clinicians alike scramble to provide babies with adequate nutrition, Boston Children’s gastroenterologist Christopher Duggan, MD, MPH, is also looking to the future. Duggan, director of the Center for Nutrition at Boston Children’s and editor-in chief of The American Journal of Clinical Nutrition — along with Steven A. Abrams, MD, of Dell Medical School at the University of Texas — offers three major recommendations for preventing another formula crisis.

#1. Educate the public

The extensive publicity surrounding the current formula shortage has left some families with more questions than answers. Many parents have taken to social media, where misinformation abounds. This includes recipes for homemade, unregulated infant formulas; calls for importation of formulas not fully reviewed by the FDA or shipped under FDA supervision; and recommendations to overdilute formula, switch formula types, or introduce solid food excessively early. Such misinformation has the potential to harm infant and child health.

A thorough, public process aimed at growing public confidence in the safe production of infant and child formulas must occur. This includes public hearings and release of investigational data into the events that caused the recall and shortages, as well as guidance about safe formula preparation and the dangers of homemade formulas. Efforts to combat misinformation in social media and other contexts are paramount.

#2. Decrease the risk of future shortages

To reduce future shortages, we need to act now to assess the factors in the supply system that led to the current situation. Leading medical and scientific organizations must partner with government agencies, industry, and other stakeholders to consider legislative and policy actions. It’s also crucial to evaluate current business and marketing practices related to infant formula. For example, specialized formulas should be produced by more than one factory and company.

Likewise, contracting practices of the USDA’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program and their potential role in exacerbating shortages needs careful evaluation. These contracts define which formulas can be provided to WIC recipients in various states, which can be challenging if a WIC-contracted formula provider has a supply problem and easy substitutions are not allowed.

#3. Support breastfeeding families

Finally, clinicians should support families in breastfeeding. While breastfeeding will not solve the current shortage and formula will always be needed for many infants, particularly those with special medical needs, lactation support is integral to a comprehensive strategy to prevent the consequences of critical shortages of formula. Government and private company policies should support breastfeeding families (e.g., longer maternity leave), and insurance coverage for donor human milk should also be encouraged.

Read the full perspective in The American Journal of Clinical Nutrition.

Learn more about the Center for Nutrition.

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