As a nationwide baby formula shortage leads to bare shelves in stores, some desperate families have turned to milk sharing, online formula exchanges, and driving hours away from home to find formula for their infants.
The Oaklandside spoke with Serena Meyer, a registered nurse who has also worked as a certified lactation consultant in Oakland and the Bay Area for the past decade, about how families can get through the shortage, where to look for formula or other supplements, and how to be prepared for future disruptions.
Why is there a baby formula shortage happening right now?
The opinion of many lactation care providers is that the reason for this shortage is that baby formula milk companies have been putting profits ahead of safety for years. Similac (a formula brand produced by Abbott Nutrition) had a plant back east and there was a contamination problem and several babies lost their lives, and a few more got really sick. The plant was closed and that precipitated a national shortage.
The primary source of the issue is there’s several formula makers that have a pretty tight grip on the market and when one of the plants is closed, it really impacts people’s ability to access formula.
What does the formula shortage look like in the East Bay?
I have a support group I run that has about 10,000 members in it. We still have access to formula, it just may not be the specific brand that somebody’s using. There are people I’ve heard from towards Modesto or Stockton where they’ve gone in to buy formula and the aisles are bare.
Who is suffering the most from this shortage?
The families that are suffering the most are families that have to use elemental formulas or have children with specific health needs, where they just can’t change formulas and have it be safe. High needs infants, in particular, are at greatest risk. They’re also at greatest risk from people watering down formula, which absolutely shouldn’t happen, and would be at much greater risk for any type of homemade formula, which multiple organizations have stated is very unsafe.
Why is it unsafe to dilute formula? And is it safe to make your own?
There have been instances where parents have diluted formula and it’s caused a great deal of harm to the infants because it causes malnutrition. The baby’s not getting the amount of food they need, they stop gaining weight and lose weight, and it can actually put them in the hospital. There’s so many issues with homemade formula: number one, you would have to have impeccable lab-quality clean kitchens, there can be absolutely no cross-contamination.
There’s an argument that we can use the recipes from the 1950s, when homemade formulas were used and a lot of parents or elders in the community will say, “I was fine and that’s what I fed my kid,” but the mortality rate for infants in the 50s and 60s was [much higher]. That’s not just because of the method by which they were fed, but also because they didn’t have the health care to meet the needs of preterm infants and so forth.
There’s just so many risks to homemade formula that no organization I have encountered has thought that it was a good supplement to a formula. It’s very tempting because people are desperate, but there’s no guarantee of safety. No health-care provider is going to want to put their license on the line by giving somebody directions to do something when there’s no way to do it absolutely safely.
Some people have suggested that if you can’t find formula, then just breastfeed. Why isn’t breastfeeding a solution for everyone?
It’s a really tone-deaf statement to say, “Just breastfeed.” It can take several weeks to induce lactation. Even then, you might not get a full supply. The idea that you’re going to induce lactation to fix a problem that’s happening right now … I don’t think that’s a good answer. What about bodily autonomy? There’s a population of people that don’t want to breastfeed and I really don’t feel like the answer is that they should have to.
That said, I’m happy to talk about how to induce lactation, but it’s not a one-size-fits-all [method]. We don’t all get the same results from the same actions. For inducing lactation, get a breast pump and start pumping once every three hours for about 15 minutes, both sides combined, around the clock. If you can, get a hospital-grade breast pump—most hospitals will have an outpatient lactation center where you can rent a hospital-grade lactation pump.
There are a lot of lactation consultants in the Bay Area that are willing to do free and sliding-scale appointments and even phone calls to induce lactation. It’s not something that happens fast and it’s a lot harder once your baby’s older than 8 weeks. I think a better conversation would be to make sure we’re getting people that help in the hospital, which doesn’t always happen.
We’ve seen milk sharing and giveaways popping up on Facebook and other online platforms. Is it safe to do this?
The Academy of Breastfeeding Medicine said even informal milk sharing is still a good idea. They would suggest that people follow the four pillars of milk sharing, which is usually what I access for patients I have who are interested in it. The four pillars are informed choice, donor screening, safe handling, and home pasteurization.
Is it ok to use a formula your baby isn’t used to? How should you introduce a new formula?
If you have enough of your regular formula left, most people go 50/50 for a few days and then move over to the new formula. Another thing to be careful about right now is, prior to the recall, Similac had shipped out a lot of sample kits to brand new families or expecting families and those recalled formulas may be in people’s shelves or cupboards and they don’t know it’s from the recall. The Food and Drug Administration has a recall list that people can double check.
Additionally, the CDC has suggested that hot water be used to make formula. Mix it hot, shake it, and then let it all cool down. Part of the reason you want to use hot water is to kill off some of the bacteria that rides in the dry formula from the factories. People should still stick to mixing hot when they’re able. If you’re using well water, make sure you’re boiling water. We don’t get a lot of well water users here, but maybe out towards Martinez or other areas that are more rural, that would be something really important.
Formula mixing itself comes with some risk, and one of the ways to mitigate that risk is when you open a can of formula, you have 30 days. Never ever use expired formula. You have 30 days once you open it to use it, and you’ll want to wipe the outside edge to make sure debris isn’t building up. Wash your hands before mixing formula.
If you notice that your child is acting kind of lethargic or they get really cold or hot, you’ll want to go straight to urgent care if you’re suspicious about your baby not feeling well.
Can I introduce cow or goat milk or solid foods if I’m low on formula?
Cow’s milk, in an emergency, can be used for maybe one or two days. The younger your baby is, the more likely they are to get diarrhea from it, and it can also cause anemia. You don’t want to persist with feeding straight cow’s milk. Infants under the age of 12 months shouldn’t be having straight cow’s milk. The problem with goat milk is it lacks a folate (a certain type of vitamin), which can cause anemia. No raw milk from another animal is going to be fit for infant consumption.
If you’re feeding your baby solid foods, which happens after 6 months, you can technically increase the amount of solid food your baby is getting, but at some point you need to have either formula or breast milk to supplement. In the first 12 months of life, formula and breas tmilk are considered the primary food sources, and solid food is a supplement. If you have a 7-month-old and you’re feeding them one solid meal a day, you can gently increase that to three meals a day and take some of the pressure off your family to locate formula if you’re in a formula desert.
With solid food, you give them water. You don’t need additional water for a liquid meal. When you do solid food, you still need to be offering up to 3 ounces of water and let the baby decide how much they want to eat. Your job is to offer, their job is to refuse.
Where are some places parents can get formula that they might not think to look?
Families with medically fragile infants can write or email the formula company directly and supposedly they’ll do a small release of formula to them. Accessing formula through WIC can be tried. People can change formulas and that’s considered acceptable; if you’re using Similac you can move to Enfamil or some other formula of your choice that you can access.
It’s expensive to use donor milk from the human milk bank in San Jose, but that’s an option for some people.
Freeformula.exchange is a website where people are shipping out their unused formula all over the nation. There’s Eats On Feets, which is mother-to-mother informal milk sharing, and there’s Human Milk for Human Babies, which is informal milk sharing. I know a lot of breastfeeding women that are trying to ramp up their supply to donate, and it’s a pretty amazing thing to watch.
Obviously, this is a problem happening across the county, and national and global supply chains and events are partly what’s behind it. But is there anything local elected officials could do to help?
They could consider offering families a little additional paid time off to induce lactation, since that’s an around-the-clock thing and it’s emergency care for their baby.
At a national level, we really need to hold the formula companies responsible for this and not just one of them. Think about how many billions of dollars formula companies take from their profits and put them right back into special interest groups that lobby our elected officials directly. It’s a travesty. It should not be allowed to happen. I just think about those poor families, it makes me so heartbroken for them.
This isn’t about breastfeeding versus formula. Parent to parent, it’s an awful thing for our community to have to go through, period. Feeding your baby shouldn’t be dangerous.
Hopefully this shortage won’t last long. But it could happen again in the future. We don’t want people hoarding formula, but how can parents and caregivers who rely on formula responsibly be prepared for the unexpected?
Biden invoked the Defense Production Act for formula (on Wednesday) and they’re going to have to fly formula from overseas to fix the immediacy of the issue. Here, we still have some, but I would strongly urge people not to hoard it. Just get what you need for right now. There may be somebody who’s totally out and if you have a closet full of it, that’s not fair. If you remember “toilet paper-gate” early in the pandemic, we’re really trying not to do that with formula. This is much much more serious.
Once we’re back in stock, it would be good to have about three months ahead if you can. But for low-income families, it’s not easy to be ahead at all. A lot of people are just barely holding on. I don’t want to be the person that says stock up once everything’s back in order. It’s definitely not a “stock up right now” kind of moment. This is a “take your two cans, take what you need for right now” moment.
For the future, we also need to be addressing the landscape of not just formula feeding but also breastfeeding support. Shouldn’t it be that hospitals should have to appropriately staff lactation consultants? Shouldn’t parents be informed in making the best choices for their families instead of feeling like they have no recourse but to formula-feed if they have to go back to work after six weeks?
There are so many reforms that could occur to positively affect breastfeeding rates. We need to really look at those things and fix them and not wait until there’s another catastrophe to start thinking about them. Parental leave is huge.
People who are pregnant right now should reach out and make sure they take a breastfeeding education class. Lots of hospitals offer them, or you can hire a private person, and they’re in person and online. If you haven’t made up your mind, now is the time to try to get more info about how to breastfeed.
Correction: In an earlier version of the story, we quoted Serena Meyer saying the infant mortality rate in the 1950s and 1960s was 30%. The infant mortality rate then was nearly 30 infants per 1,000 live births, and we have included a link to an accurate source.