*This is intended as informational-only. Parents should work directly with their health care provider for guidance with their specific situation.

Tennessee is among the states hardest hit by the current infant formula shortage. Though efforts are underway to remedy the situation resulting from supply-chain issues and compounded by the FDA recall of infant formula in February, many families are struggling to feed their babies today. The American Academy of Pediatrics (AAP) has issued guidance for managing the situation, just for a few days. However, it is largely limited to infants older than 6 months of age. While we don’t have many solutions, we do want to emphasize some “do’s” and “don’t’s” during this time of shortage:

Don’t’s (Things we know increase risk of illness)

1. Do NOT water down infant formula to make it last longer. Though it seems like a simple solution, it will actually put a baby at risk of getting very sick or worse. Babies’ small bodies need the very specialized combination of nutrients contained in infant formula. Adding extra water (or other foods) upsets this careful balance. Aside from breast milk, correctly-prepared infant formula is the next best choice for healthy babies.
2. Do NOT use alternative milks, like soy milk, oat milk, and rice milk. These are NOT formulated for babies and can make them very ill. Avoid these products as a substitute for infant formula.
3. Do NOT use homemade formulas. These may seem like a good choice, especially in a crisis, but parents should contact their healthcare provider, local WIC agency, or food pantry, to locate sources of emergency infant formula, rather than trying to make something themselves.
4. Do NOT use other animal milks*. People might recommend using goat’s milk, cow’s milk*, or other animal milks at this time, but these are rarely good options. Though the AAP states that whole cow’s milk might be an option to use for a baby 1) older than 6 months, 2) for a short time and, 3) if they are not at risk for allergies or have conflicting dietary needs, cow’s milk is still not recommended for infants under 6 months of age. *AAP statement.

Do’s (or, at least, some actions to consider)

1. Do contact your health care provider. Though they may not have answers, they are in the best position to work with your particular situation and to help you locate resources in your community. They will likely refer you to your local WIC agency and/or area food pantries.
2. Do consider other infant formula brands. As long as your baby is not on a specialized formula, such as an elemental, a metabolic, or a hypoallergenic formula, they should tolerate other brands well. If store brands are available, and your baby consumes “regular” formula, this would be a great option, temporary or not.
3. Donor breast milk. Before considering this option, it is important to consider some important factors. There are two basic kinds of “donor” breast milk.
   • Formal donor breast milk is from a human milk bank. Donors and donated milk are screened for medications, viruses, bacteria, and more. The donated milk is pasteurized in a lab setting, labelled, and tracked from donation to delivery to a baby in need. A network of regulated donor milk banks provides this precious fluid to medically fragile babies, such as those born very premature and/or in the NICU setting. Formal donor milk is generally not available to families with healthy babies born at term, because the need is so high among sick babies.
   • Informal donor breast milk – While NOT recommended by health organizations such as the AAP, some parents are getting breast milk directly from other mothers, via informal breast milk sharing networks. This breast milk is donated by those who may have extra and do not want to see it go to waste. While this is an age-old human behavior (what did we do before infant formula, after all?), there are some risks. Parents need to at least be aware of these potential risks. There is no way to be sure donor milk is free from bad bacteria or viruses. If considering using informally shared breast milk, parents should consider home-pasteurization to reduce these risks. IMPORTANTLY, PARENTS SHOULD BE VERY SUSPICIOUS OF ANY OFFER OF INFORMAL BREAST MILK THAT IS NOT FREE (aside from possibly covering shipment costs). These informal breast milk networks are typically there to SHARE excess with those in need, and will not attempt to profit from it. Breast milk, when offered for a price from an unfamiliar source, is at increased risk of being unsafe.
4. Do consider working with a lactation professional to re-establish your own breast milk supply. While likely to be very challenging, if you initiated breastfeeding (but then weaned) AND your baby is still very young, it may be possible to re-establish your supply. However, this is not a solution for today, as it can take a significant amount of time to re-establish your supply. It can take as long as the time since weaning. In other words, if you stopped breastfeeding two weeks ago, it is likely to take about 2 weeks of frequent pumping and/or latching baby to the breast to make as much milk as you were making before. You can reach out to your local breastfeeding coalition or WIC agency to find good breastfeeding support professionals if you are interested in re-lactation (breastfeeding again). If you are in East Tennessee, you can start by downloading the Community Breastfeeding Resource Guide published by the Knox County Health Department and the Tennessee Department of Health.

Hopefully, this provides you with some good resources and possible options during this infant formula supply crisis. We cannot stress enough that you should work directly with your health care provider so that you can identify solutions specific for you and your baby.

ICAN-THRIVE Lab