Total Recall I Have 7 Kids to Feed

This article was originally published April 7, 2022 and is no longer being updated.

Being unable to find formula to feed a child is an especially stressful reality for many parents and caregivers right now. Earlier this year, pandemic-related supply-chain issues and ingredient shortages led to some formulas being out of stock around the country. The problem compounded in February, when Abbott, one of the four major formula manufacturers in the US, voluntarily recalled a number of its products, including the popular Similac formulas, that had been manufactured at its Sturgis, Michigan, facility due to possible contamination with Cronobacter sakazakii.

Now parents are faced with bare shelves or purchase limits, as well as weeks-long delivery estimates on some online purchases. Bobbie and ByHeart, two new formula companies, had to close off their subscription sign-up lists and sell their products only to existing subscribers. Data suggests that formula inventory was down about 40% nationwide.

The situation may improve in the coming weeks. Abbott entered an agreement with the FDA and in early July reopened its Michigan plant (though from the time of resumed production, eight weeks or more may pass before new inventory reaches shelves). President Biden also invoked the Defense Production Act to increase formula production and created a plan to use Department of Defense aircraft to bring in formula from abroad. The FDA has laid out criteria for formula companies outside the US to bring their products to the American market. (As of June 2022, some of these are now available on store shelves.) How much all of these measures might help, and how quickly, remains to be seen.

If you're looking for formula right now, know that many infant formulas sold in the US are extremely similar, and experts say most babies can tolerate switching formulas well. In this article, we'll tell you what to keep in mind about the current recall and formula safety, as well as some dos and don'ts for switching formula brands and types.

For a full list of baby formulas, and information about formula types, check out our guide.

What to know about the 2022 formula recall

In February 2022, Abbott Nutrition recalled certain lots of Similac, Alimentum, and EleCare powdered formulas, as well as one lot of the medical formula Similac PM 60/40. All the recalled formulas had been manufactured in Abbott's Sturgis, Michigan, plant. (To find out whether a formula in your home may be affected by the recall, check the lot number of your formula on the Abbott website.) The reason for the recall is that the Food and Drug Administration is investigating links between infants who were sickened with Cronobacter sakazakii and had consumed powdered formula made at the same Abbott manufacturing plant. (The Centers for Disease Control and Prevention also reported a case of Salmonella Newport infection in an infant who had consumed formula made in the Abbott facility, but the FDA later determined that there was insufficient information to link that case to the formula.)

Cronobacter sakazakii is a bacterium that can contaminate dry foods, including powdered infant formula, and can make babies, especially newborns, seriously ill. Cronobacter infections in infants are rare (according to the CDC, there are about four cases a year, though the number may be underreported), but they can be serious or deadly. If you have any concerns about your baby after learning that you fed the child a recalled product, contact your child's pediatrician, says Tracy Milbrandt, MD, a pediatrician and associate professor of clinical pediatrics at Southern Illinois University School of Medicine.

Infant formula manufactured in the US is required to undergo testing for both Cronobacter and Salmonella. Though Cronobacter wasn't detected in any of Abbott's infant formulas, the pathogen was detected in the Abbott manufacturing plant in a "non-product contact area," Abbott said in a press release.

What to do if your baby's formula is unavailable

If you're struggling to find your go-to formula, Milbrandt says it's fine for babies on standard, cow's-milk or soy-based formulas to switch without your consulting a pediatrician. This group includes traditional formulas (those made from intact milk proteins, such as our pick, Kirkland Signature ProCare), partially hydrolyzed "gentle" formulas (those made with partially broken-down milk proteins, like our pick, Parent's Choice Tender Non-GMO Infant Formula), and "sensitive," "comfort," or "spit-up" formulas. However, if your baby is on a specialized formula, such as a hypoallergenic or medical formula, you should talk to your baby's doctor before switching.

Any formula will work for babies who were previously on a non-specialized formula, Milbrandt says. "There may be a little gastrointestinal adjustment if switching protein or carbohydrate sources, but generally babies do just fine," she adds. Porto says it's okay for babies to switch from a milk-based formula to a soy-based formula if necessary. He notes that the soy formula may taste different to a baby who is used to a milk-based formula, so they can take a couple of days to adjust. Porto also says that a baby's intake may decrease a bit while they get used to it.

If you want to have a seamless transition, Bridget Young, PhD, a professor of pediatrics at the University of Rochester School of Medicine and Dentistry, who also runs an informational website on baby formula, recommends finding a new formula with the same proteins and carbohydrates as the former formula contained. For instance, if your baby's current formula includes nonfat milk and whey, try to find a new formula with those ingredients. The carbohydrates are the second most important ingredient to keep the same, Young says, whether they're lactose, maltodextrin, or corn-syrup solids.

So if you're looking to replace Similac Advance, for example, you could purchase Enfamil Infant Formula, Kirkland Signature ProCare, Member's Mark Infant, Target's Up & Up Advantage Infant Formula (and other store-brand Advantage formulas), or Earth's Best Organic Dairy Infant Formula, among others. All of these formulas use nonfat milk and whey as their protein source and lactose as their carbohydrate source. If you're looking to replace Similac Sensitive, a formula that uses milk-protein isolate as the protein source and corn-syrup solids as the carbohydrate, you could purchase Enfamil NeuroPro Sensitive or Up & Up Sensitivity. Similac Total Comfort, which uses hydrolyzed whey protein as the protein source and maltodextrin as the carbohydrate, is similar to Gerber Good Start GentlePro or Up & Up Complete Comfort. (Our infant formula guide has detailed information about the protein compositions and carbohydrates of most infant formulas currently available.)

As Milbrandt notes, store-brand formulas "​​are all safe, regulated by the FDA, and nutritionally equivalent" to big-brand formulas. Store-brand formulas, such as those in Amazon's MamaBear, Costco's Kirkland, Sam's Club Member's Mark, Target's Up & Up, and Walmart's Parent's Choice lines, are all manufactured by Perrigo. They're equivalent across brands: For example, Mama Bear Infant, Up & Up Infant, and Walmart Infant are all the same, and so are the Advantage formulas or Tender formulas. This makes switching between generic formulas at any store that offers them particularly straightforward.

For now, at least, Americans have some imported formulas to consider as well. Due to the shortage, the FDA is temporarily allowing certain foreign formulas to be sold in the US. Some of these traditional formulas come in "stages"—stage 1 is intended for babies 0 to 6 months old, and stage 2 is intended for babies 6 to 12 months old. (Stage 1 formulas may more closely align with US guidelines for formula, which are the same for babies 0 to 12 months old.) See our guide for more information on these formulas.

For families whose babies were on Alimentum or EleCare, which are specialized formulas for certain medical needs, finding a substitute is more difficult. One option is to purchase those formulas in ready-to-feed bottles, which were not affected by the recall; the bottles are expensive, however. According to Dr. Porto, the powdered formulas that are equivalent to Alimentum are Enfamil Nutramigen, Enfamil Pregestimil, Gerber Extensive HA, and store-brand "hypoallergenic" formula (such as Amazon's Mama Bear Hypoallergenic, CVS Health Hypoallergenic, and Target's Up & Up Hypoallergenic, which are all made by Perrigo Nutrition and modeled after Nutramigen). EleCare, an amino-acid-based formula, has even fewer equivalents: Only Enfamil's PurAmino, Nestle's Alfamino, and Nutricia's Neocate are similar. A pediatrician or a pediatric gastroenterologist will be able to help with a new prescription or recommendation.

What not to do

If you can't find your baby's usual formula, don't make your own. Milbrandt points out that homemade formula is often nutritionally inadequate and can become contaminated during preparation with the type of bacteria that federal regulations try to protect against.

If you're running low on formula, don't dilute it. Don't try to "stretch" your formula by adding extra water. Your baby can end up with electrolyte imbalances, and diluted formula is not nutritionally adequate, says Milbrandt.

If you can't find formula in local stores or from trusted online retailers, don't buy it from an online marketplace like Facebook or Craigslist. "When you buy any formula from a third-party seller, you cannot be sure the product is what you think you are buying, and you cannot be sure of storage conditions, either," Young warns. Some parents have reported being scammed or subjected to price gouging. It's best to purchase from a trusted store or pharmacy, or directly from the manufacturer.

For a baby less than 1 year old, don't use toddler formula. Toddler formula, marketed for babies over 1 year old (though medical experts say toddlers don't need it), is not regulated by the FDA in the same way infant formula is, and it doesn't have the same nutritional content or manufacturing regulations (such as pathogen testing). However, the American Academy of Pediatrics says that if you have no other choice, you can feed toddler formula to a baby over 6 months old for a few days.

If you're purchasing a new formula for the first time, don't use a scoop that didn't come with the package. Formula manufacturers can have different scoop sizes, and it's important to use the one that came with the new formula, not one that you may have kept from an old package.

Additionally, don't prepare a new formula without reading the instructions. Now that the US is bringing in formula from abroad, some preparation instructions may differ from the US standard, so always read the label and prepare the formula accordingly. Be aware that imported formulas may list the amount of liquid in milliliters instead of ounces (fortunately, baby bottles generally have lines for both).

Finally, know that buying certain imported European formulas (including from the popular brands HiPP and Holle, which aren't FDA-regulated) can carry a number of potential risks. Young points out, "Everybody heard about the FDA recall really fast, but that doesn't necessarily happen in the US if there's a recall of European formula." Plus, Young says, the labeling requirements for US and European formulas are different. For instance, in the US a formula labeled "hypoallergenic" must contain only fully broken-down milk proteins. In Europe, a hypoallergenic formula, such as HiPP-HA, may contain both intact and broken-down proteins. For a baby with a milk-protein allergy, the intact proteins in a formula like HiPP-HA may cause a reaction and shouldn't be used as a substitute for a hypoallergenic US formula like Alimentum.

This article was edited by Courtney Schley and Tracy Vence.

Sources

1. Bridget Young, PhD, professor of pediatrics at the University of Rochester School of Medicine and Dentistry and founder of BabyFormulaExpert.com, phone interview, March 1, 2022

2. Tracy Milbrandt, MD, pediatrician and associate professor of clinical pediatrics at Southern Illinois University School of Medicine, phone interview, March 2, 2022

3. Anthony Porto, MD, pediatric gastroenterologist and associate professor of pediatrics at Yale University, phone interview, February 22, 2022

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Source: https://www.nytimes.com/wirecutter/blog/baby-formula-shortage-what-to-do/

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