A mother of two, Ellen Burnette developed a ritual during the formula shortage. Her youngest son, Hayden, is almost 9 months old and needs hypoallergenic formula. Burnette works full time.

“Basically everyday, multiple times a day, I check Target.com for formula because obviously I don’t have time to go to a million stores. And from what I’m hearing , there’s nothing on the shelves anyway. So I just check Target.com every day. And then I order; I think the maximum is four. So if there’s any stock, like there might be two, or four, so I’ll add it to my cart and order it and then half the time I get an email that says, “Oh sorry, we have to cancel your ordered.”

She has enough formula for the moment but is worried that she will run out. “It’s definitely stressful.”

The federal government is working with manufacturers to get more formula in the pipeline and help families find the formula that’s out there. But pediatricians say the shortage could last a bit longer. The issue is linked to supply chain issues and a recall by baby food maker Abbott Nutrition.

A registered dietitian and pediatric intensivist from MUSC Children’s Health explained what needs to happen from here – and what parents need to know about infant formula substitutions, homemade formulas and breast milk.

Suggestions for what should happen next

First, dietician Kristi Fogg said red tape needs to be cut during the shortage – and it’s starting to happen. “WIC serves a large percentage of our population, and they are liberalizing their formulary,” she said, referring to the special federal supplemental nutrition program for women, infants and children.

“There are certain products that they can provide because of contracts, and they have already started to open up that bandwidth and provide more of it. But they have to do everything, cover all the formulas right now for a disaster relief problem. ’emergency. You should be able to get a covered formula if you order it online, not just if you go to a certain WIC provider. During that time, we should open up availability and what we can get for attendees. WIC,” Fogg said.

Elizabeth Mack, MD, said relief was coming — but not as quickly as she would like. She is a division chief at the Medical University of South Carolina College of Medicine, specializing in pediatric critical care and patient safety.

“Abbott has just received a press release indicating that the FDA approves the reopening of the Michigan plant that was subject to the recall. So it should hopefully start producing in the next two weeks, which will help, but it won’t solve the supply chain problem just yet.

Formula flexibility

Keeping this supply chain issue in mind, Mack said babies who don’t have any health issues limiting the formula they can use can switch to different types and brands if their regular supply runs out. “Right now you should take what you can get.”

Fogg agreed. “For the most part, if you get a standard cow’s milk formula, they can be pretty interchangeable. This is where the use of a generic can intervene.

She explained what happens in most formulas. “They take cow’s milk, and they modify it. This is why it is not interchangeable with cow’s milk. Cow’s milk is much higher in fat and protein, and by itself does not contain enough iron and vitamin C for a baby. So the formula simply takes cow’s milk as the bone, but then modifies it to make it more comparable to breast milk.

There are also special formulas – like Burnette-type baby drinks. “Some babies have a cow’s milk protein allergy, and they make different changes to it to make it more hypoallergenic,” Fogg said.

Parents of these babies need to be more careful, she said. Some brought their children to the hospital after formula substitutions did not go well.

House formula

While there are plenty of homemade formula recipes circulating online, Mack and Fogg strongly advise against trying them. Commercial infant formulas are regulated by the Food and Drug Administration to ensure their safety. Homemade versions such as evaporated milk mixed with corn syrup and water are not. They won’t give the baby the nutrition he needs and can lead to serious health problems.

Donor/purchased breast milk

When it comes to getting breast milk from someone else, Fogg said he has to be checked. “Breast milk is a human fluid that can transmit infections. So if you don’t have a reliable source, if you don’t know their infection status and what medications they are taking, you should not take their milk.

She also said that some “breast milks” for sale did not match the advertisement. “Some people sell you cow’s milk to make money. And it really is cow’s milk and not breast milk. There’s been plenty of data to support this – that it’s cut with fluids that don’t contain breast milk. So you have to be very careful with your source.

It was a lot of “no”. But there are things to say yes to.

Mack said if you’re having trouble finding formula, call your pediatrician’s office for help. Nutrition specialists such as dietitians and the WIC can also be good resources.

If you have a formula near its expiration date that hasn’t expired, use it, Mack said.

And if you’re about to have a baby, get lactation support services to help you breastfeed.

Meanwhile, Fogg said it’s important to keep in mind that others are also scrambling. “People become very brand specific. But you can’t hoard all those Gerber products because that’s what you want for your child. You need to be open-minded and remember that we need to feed everyone, and that’s of the utmost importance.

Burnette, the mom who visits the Target site every day to search for formula, said the struggles of other parents are definitely on her mind. “I’m just grateful that he’s almost 9 months old and not a brand new tiny baby. Sometimes I feel like I should give my formula to someone who just had a baby because that he doesn’t need it as much as they do, you know?