Ariana Bolumen MD, Viviana Juarez MD, Hannah Cummins DO, Shabih Manzar, MD

Abstract:

This article briefly discusses the food insecurity issue created by the recent recall of infant formulas. The reasons for the problem and solutions are provided with the CDC reference.

Food insecurity (FI) in infancy sounds like a problem of the developing world, but recently a relatively large community of parents encountered food insecurity after the formula recall. Abbott Nutrition recalled various brands and lot codes of powdered infant formula because of possible Cronobacter sakazakii contamination. This recall has created a “food insecurity” for certain families,as they cannot access the formula due to the disruption of the supply. Food insecurity affects an estimated 15 million Americans,with high rates among children aged 0-17 years living in a food- insecure household. (1) The problem is further aggravated by low breastfeeding rates (BF). Although BF rates in the United States have increased from 1973 to 2015, social and racial disparity stillexists. (2) In developing countries, the rate is relatively higher, but it has been shown that mothers from food-insecure homes were less likely to breastfeed exclusively than mothers from food-secure households. (3) Therefore, the reliance on infant formula is high, creating food insecurity with any break in the supply chain.

What about promoting BF? This is not simple. The global infant and young child feeding practices (IYCFP) showed a 42-49% initiation rate in BF, but only 37% of children younger than six months were exclusively breastfed. (4) The other issue is with the marketing and trade policies. Salmon (5) pointed out the conflicting policy between promoting and protecting the BF. She highlighted the role of the trade environment that facilitates the marketing and consumption of breast milk substitutes.

Alternatives/advice for the families (see Appendix- Formula Guide for Parents):

The CDC provides useful information on the infant formula use (https://www.cdc.gov/cronobacter/infection-and-infants.html and https://www.cdc.gov/cronobacter/outbreaks/infant-formula.html)

1. Use another brand. The US Food and Drug Administration (FDA) regulates all commercial infant formula brands to ensure they meet the minimum nutritional and safety requirements. You may use another brand but make sure that the ingredient requirements match with the recalled formula. Special formulas have special formula alternatives. Refer to your pediatrician.
2. Homemade Infant Formula: The FDA and the American Academy of Pediatrics (AAP) discourage and warn against using different recipes to make homemade infant formula. In a recent study, DiMaggio et al. (6) found that out of 2,315 respondents, 14% of the respondents used European infant formula, 5% used toddler formula, and 2% made homemade infant formula.
3. Imported Infant Formulas: The FDA does not review these formulas. These illegal formulas may not have been shipped and stored per regulations. AAP warns against using these illegally imported formulas. So, the risks associated with these formulas are even much higher.
4. Talk to the local community health worker, public health officer, and social worker. They could be a good resource.
5. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) office could provide help. Call your local WIC office and ask for help.
6. Consider shopping for the alternative formulas in different retail stores or even in different neighborhoods. Unfortunately, many parents have to drive many miles to get the right formula for their infants. Do not shop from an online marketplace or third-party distributors.

While families still struggle with the business side of acquiring the required infant formula, and we hope that this will resolve soon, the whole scenario provides pediatricians an opportunity to further encourage the families to follow the AAP guidelines, which state:

“ The AAP reaffirms its recommendation of exclusive breastfeeding for about six months, followed by continued breastfeeding as complementary foods are introduced, continuing breastfeeding for one year or longer as mutually desired by mother and infant.” (7)

[FORMULA GUIDELINES FOR PARENTS – Chart available in article below]

References:

1. Ullmann H, Weeks JD, Madans JH. Children Living in Households That Experienced Food Insecurity: United States, 2019-2020. NCHS Data Brief. 2022;(432):1-8.
2. Kirksey K. A social history of racial disparities in breastfeeding in the United States. Soc Sci Med. 2021;289:114365. doi:10.1016/j.socscimed.2021.114365
3. Al Mamun MA, Saha S, Li J, Binta A Ghani R, Al Hasan SM, Begum A. Child Feeding Practices of Childbearing Mothers and Their Household Food Insecurity in a Coastal Region of Bangladesh. Inquiry. 2022;59:469580221096277. doi:10.1177/0046958022109627
4. Gupta A, Dadhich JP, Suri S. How Can Global Rates of Exclusive Breastfeeding for the First 6 Months Be Enhanced? ICAN: Infant, Child, & Adolescent Nutrition. 2013;5(3):133-140. doi:10.1177/1941406413480389
5. Salmon L. Food security for infants and young children: an opportunity for breastfeeding policy?. Int Breastfeed J. 2015;10:7. Published 2015 Feb 23. doi:10.1186/s13006-015-0029-6
6. DiMaggio DM, Du N, Porto AF. Nutritional and Safety Concerns of Infant Feeding Trends [published online ahead of print, 2022 Feb 10]. J Pediatr Gastroenterol Nutr. 2022;10.1097/MPG.0000000000003401. doi:10.1097/MPG.0000000000003401
7. SECTION ON BREASTFEEDING, Arthur I. Eidelman, Richard J. Schanler, Margreete Johnston, Susan Landers, Larry Noble, Kinga Szucs, Laura Viehmann; Breastfeeding and the Use of Human Milk. Pediatrics March 2012; 129 (3): e827–e841. doi: 10.1542/peds.2011-3552