Baby Formula 101: Feeding During A Shortage

JOHN DANKOSKY: This is Science Friday. I’m John Dankosky. If you’re the parent of a newborn, you’ve likely experienced how difficult it’s gotten to find your little one’s favored baby formula. In February, Abbott Nutrition, a major manufacturer of baby food and formula, shut down a factory in Michigan. Now, this came after the FDA began investigating serious and even fatal bacterial infections in infants who were fed formula from the plant.

This one factory produces around a quarter of the US baby formula supply, so closing it has left store shelves empty, and parents are scrambling to feed their babies. Here to tell us more about formula and what parents can do during the shortage is my guest, Dr. Bridget Young, assistant professor of pediatrics at the University of Rochester and founder of BabyFormulaExpert.com, which is based in Rochester, New York. Bridget, welcome back to Science Friday. Thanks so much for being here.

BRIDGET YOUNG: Oh, John, it’s my pleasure. Thank you for having me.

JOHN DANKOSKY: So formula has helped to feed millions of babies over the years. What exactly is in baby formula?

BRIDGET YOUNG: So baby formula is this very unique food that we sometimes refer to as sole-source nutrition, meaning it’s one of those rare food items that you can feed to an infant exclusively that will grow a baby appropriately. And it’s really that or breast milk for infants under six months, who are unable to have other food. So it’s the perfect blend of macronutrients– your protein, fat, and carbohydrate, everybody’s heard of that– and the micronutrients, all the vitamins and minerals in the exact amount that a human infant needs to grow.

But the other component of formula that’s often overlooked and that we’re really dealing with now is this safety component. So the FDA has a lot of regulations and parameters that also ensure that formula is safe. Formula is the safest food product in the United States because the manufacturing plants are inspected, the batches are tested for bacterial contamination. That’s what resulted in this recall you just referred to.

And that’s because young infants’ immune systems aren’t developed. And so they’re much more susceptible to becoming ill from foodborne pathogens than an adult. So not only is formula nutritionally complete in that delicate balance recipe, but it also goes through all these extra safety measures to ensure that it also doesn’t include things that we don’t want to be in there, like bacteria.

JOHN DANKOSKY: So that tight regulation, in your mind, has really worked in order to keep the baby formula supply safe for children.

BRIDGET YOUNG: Yes. This is certainly an unprecedented situation we’re in with an actual shortage. But the shortage originated because we already had supply chain issues from the pandemic that aren’t exclusive to formula– every industry is experiencing it– then this massive recall on top of it. So the recall happened to protect infants, but now we’re seeing the downstream ramifications of not having a backup plan when you close down one of the five infant formula plants in the US. And obviously, it’s been pretty devastating.

JOHN DANKOSKY: Not all baby formula’s made the same. And some formulas don’t work as well for some babies. We heard from Vanessa San Miguel, who told Texas Public Radio that she couldn’t find her regular formula anywhere, so she had to go get something different through the San Antonio Food Bank.

VANESSA SAN MIGUEL: And that was hard because his digestion system– he was throwing up. He was constipated. It was just– it was really bad. Eventually, he was able to digest it and keep it in. So it took about a month for his body to get used to that formula.

JOHN DANKOSKY: What do we know about how some babies are able to digest some formulations of formula but not others?

BRIDGET YOUNG: Yes. Oh, my heart goes out to her. And honestly, I think the vast majority of formula-feeding families are in this scenario, where in this current state of availability, most families are facing a formula change, which is terrifying to families. So here’s why some infants tolerate one formula better than another. It’s a little mixture of biology and a little mixture of, we don’t know.

So when an infant is, especially exclusively, consuming a formula, that’s the only thing they’re eating. And there is variation in formula, which we’ll probably talk about. So they’re eating a specific set of ingredients, and that’s all they’re eating. So their body becomes really well at producing the enzymes needed to digest those specific ingredients.

And if you change it overnight, and now maybe you have a different oil included in the fat blend, or maybe you move from whey-predominant cow’s milk to a casein-predominant cow’s milk, those are all of a sudden really new things that the baby has to digest. And that can result in exactly what you just said, this transition period when the digestive system has to adjust and adapt. And that can happen much more slower in a baby because they’re younger and also because it’s the only thing they’re eating. So when the change happens, and it’s kind of a cold-turkey formula change, it’s a massive change for them because their entire diet has shifted.

So just, my heart goes out to those families. Normally, when I’m working with a family, we suggest to stretch a formula change out over at least several days in order to ease that transition to the baby. But of course, a lot of families are in a situation where that’s just not possible right now if they’re unable to find their normal formula and they’re forced to make a change quickly.

JOHN DANKOSKY: And just so that I understand, is this about children physiologically preferring some type of formula versus another, or is this really just about a young digestive system that would be able to tolerate almost any kind of formula, but it’s the change that is causing the problem?

BRIDGET YOUNG: Oh, John, what a great question. I think the answer is yes. It’s likely both. That’s just my opinion.

The other thing is, any time you’re changing a formula, or the baby is going through a transition, they’re also getting older. So they’re aging each and every day. And each and every day, their digestive tract becomes more mature. So that’s the third factor that’s happening– with every day they age, they are also more likely to tolerate things better.

Now, I do want to be clear, especially in this situation, the vast majority of infants, with the exception of diagnosed medical conditions like allergy or severe intestinal disease, can really handle any infant formula on the market. They may have a couple rough days with maybe gas or some discomfort during the transition. But it’s safe for them to have any infant formula.

It’s not dangerous. But they may face a little bit of a turbulent transition time. But it is absolutely safe, again, for healthy– the vast majority of babies. So I don’t want parents to be concerned about that.

JOHN DANKOSKY: Among the things, though, that you say are not safe– this idea that parents, if they’re desperate, could be making their own formula from some recipe at home. What do you tell people about that?

BRIDGET YOUNG: Gosh, it certainly seems popular on social media. I myself have seen lots of recipes floating around. And you’re absolutely right that we 100% advise families, please don’t make homemade formula.

Here’s why. There’s no way to guarantee that what you’re mixing into the cow’s milk base or whatever the base of this recipe is actually nutritionally adequate. If you’re using some kind of supplement, which almost all these recipes do, supplements are not regulated by the FDA.

So for example, if it’s a vitamin supplement, and you think you’re adding a very specific amount, there is no way of knowing actually what’s in that supplement. It could be dramatically less. It could be dramatically more. And it could also contain other ingredients that aren’t on the list of ingredients, fillers that could be dangerous to a young infant.

And then, any time you’re adding other ingredients, you’re also potentially introducing sources of bacterial contamination, things that can make the baby physically sick very quickly. And so for those reasons, homemade formula can go bad fast. And so we are strongly recommending parents not to do that.

JOHN DANKOSKY: So what advice can you give parents right now who are just at their wit’s end. They can’t find any formula, or they can’t find the right type of formula that their baby has been able to tolerate. What are you telling them?

BRIDGET YOUNG: Yes. Oh, I’m so glad you asked. So I would like to emphasize, again, if your infant is not consuming a hypoallergenic or an amino acid formula– this is going to be the vast majority– any infant formula, any. It could even be soy formula. So the quote unquote, “infant formula,” the term on the can, that means it’s gone through all these safety measures. Any of those are fine and safe for your baby.

Places that you can look for formula that you may not have thought– of course, everyone checks their grocery stores and large stores like Target or Walmart. Other places you should check– number one of any rule, call your pediatrician. They will likely have connections with local resources. They may also have samples of formula on hand.

Also, I really encourage families to consider generic brand formulas. They are equally– the quality is equally as high, and they are equally as safe. Other places that sell formula but that wouldn’t be your first place to look, like health food stores, Whole Foods. Smaller, local shops can often still have some formula on hand.

And lastly, I’ve been really touched and impressed by seeing a lot of local community resources rise up around this. So there’s been a lot of social media local parent groups that are doing formula exchange. So lots of families have formula in the house that they’re not using, so connecting families with formula that other families have that’s not going to use. That’s another great place to check. But I would just remind everyone, from a safety standpoint, that you never want to take an opened can from someone else. You want to be sure the formula’s unopened, the can is undamaged, and it’s non-expired.

And lastly, you could also talk with your doctor about potentially donor milk. Donor milk banks have made pasteurized, safe donor milk available in the quantity that they have. And whether or not that’s available to you is going to depend on where you are geographically in the United States. And you will need a pediatrician prescription to access it. But talking to your doctor about that is another potentially great way to acquire a safe formula substitute.

JOHN DANKOSKY: And we’ll be talking about milk banks more in our next story coming up. I’d like to thank our guest, though. Dr. Bridget Young is assistant professor of pediatrics at the University of Rochester and founder of BabyFormulaExpert.com She’s based in Rochester, New York. Thank you so much, Bridget.

BRIDGET YOUNG: Oh, it’s my pleasure, John. Thank you.

JOHN DANKOSKY: This is Science Friday from WNYC Studios.

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