Medical Examiner

Even the Formula Experts Are Stumped by the Formula Crisis

But there’s one thing they say you should definitely not do.

A woman in a white shirt, her face in shadow, holding a baby
Hollie Santos on Unsplash

Mallory Whitmore’s job was always kind of high-stakes, but never like this. Before, when parents turned to her to find the right formula for their babies, she could point to a menu’s worth of options. Trained as an infant feeding technician, Whitmore runs an Instagram account, the Formula Mom, where she dispenses advice on all aspects of formula feeding, from finding the right kind to dealing with baby hiccups to overcoming the stigma of not feeding your baby via breast.

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If feeding your infant with formula can be emotionally complicated, at least the consumer part was a cinch, “as simple as going to the store and choosing between 40 different kinds of formula,” she says. “It was really a buyer’s market.”

Thanks to a formula shortage affecting much of the country, it is, to put it very lightly, no longer a buyer’s market. And where the Formula Mom once focused on categorizing brands in a purchasable index (“organic,” “clean”) and earning affiliate revenue by recommending accessories, she now finds herself covering a crisis.

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Just as other consumer guides were forced over the last two years to pivot to include recommendations on buying face masks and locating COVID tests, Whitmore has shifted in the past days to trying to help parents navigate the formula shortage: She co-hosted an Instagram Live with a pediatrician, posted a slideshow on the costs associated with breastfeeding, and recommended a formula-mixing device that could help prevent parents from wasting any of the precious stuff. That last video was hosted by Whitmore’s identical twin sister, who is currently formula feeding a 4-month-old and is, Whitmore wrote, “in the trenches with y’all during the shortage.”

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Surveying those trenches, Whitmore has seen a worrying trend on Instagram, her platform of choice: recipes for homemade formula. “I hear you, I see you, I am furious with you,” she wrote in a post on Tuesday. “But please, please do not prevent one risk (running out of formula) by introducing another risk.” The risk of DIY-ing formula has long been clear: In 2021, the Centers for Disease Control and Prevention reported a trio of infant deaths due to a homemade formula concocted from coconut water and sea moss. Now, as parents face empty shelves—or outages of the formula options covered by federal assistance—Whitmore worries along with pediatricians that more families are turning to self-made formula not out of dietary preferences but desperation.

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Obviously, plenty of infants throughout history have subsisted on food that is neither human breast milk nor store-bought formula. Formulas of yore have included walnut milk heated and mixed with cornmeal, or a concoction of animal milk, breadcrumbs, and sugar. While these Similac precursors may have worked for some babies, “this history of infant feeding is also a history of infant mortality,” says Carla Cevasco, an assistant professor of American studies at Rutgers University and the author of Violent Appetites, a history of hunger. “When parents were faced with having to feed their children with something other than breast milk, it was a scary situation.”

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Infants were fed with homemade formula recipes provided by pediatricians—such as a mix of water, evaporated milk, and corn syrup—as recently as the 1960s. It’s hard to know exactly how many babies became ill or died from these recipes, but “we do know that the infant mortality rate has dropped significantly in the last 100 years,” says Adrienne Hoyt-Austin, a pediatrician at UC Davis Children’s Hospital. Thank a number of public health improvements, diet very much among them.

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A bottle of prepared formula isn’t just a soft, liquid-y food. It’s a special concoction of fatty acids, Whitmore explains, with a specific ratio of calories from carbs versus from fats, and mineral levels calibrated for a baby’s tiny kidneys. “Formula is a medical food,” says Hoyt-Austin. Homemade formula, in contrast, can have “an unsafe balance of salts,” Hoyt-Austin explains. This can lead to “vomiting, lethargy, brain swelling”—that last of which can cause seizures—“and even death,” she says. “For babies who are 6 months or less, not having that formula is a medical emergency, just like not having your prescribed medication would be a medical emergency.” If you are out of Lexapro or blood pressure meds, it is not fixable with some futzing around in the kitchen, even if you somehow did have access to the approximate ingredients—formula is the same deal. Special balances of ingredients aside, you also do not have a medical-grade kitchen, no matter how often your counters get scrubbed. Babies are not equipped to handle wayward food-production germs; that’s how the formula shortage mess started in the first place, when a major producer had to pull its product from the market.

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This emergency is particularly acute for babies who can’t tolerate regular formula and need a hypoallergenic version, which can be even harder to find right now. Many of these infants have now been thrust into an ongoing experiment of sorts to see if they can handle regular formula instead of the specialized kind, says Jenifer Lightdale, a pediatric gastroenterologist and member of the American Academy of Pediatrics Committee on Nutrition. “You’re crossing your fingers that the baby is going to be OK,” she says, adding that “a lot of the professional chatter is about the need to hospitalize babies” who may vomit up the formula and need to be rehydrated. The general health-advice caveat to speak to your pediatrician before trying something new for your baby applies here—but don’t count on them to be able to produce more actual formula for you. “It’s been awkward. We have felt helpless,” Lightdale says. “It’s not like I have any special ability to figure out where the formulas are.”

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Neither does the Formula Mom herself. “What I’m recommending if [parents] truly can find nothing is to start looking at toddler formulas,” says Whitmore, noting that some meet the nutritional requirements for feeding babies but have not gone through the Food and Drug Administration evaluation necessary to label them as baby formula. She also notes that experts say cow’s milk is a safe alternative, for a very short period of time, for babies over 6 months. (Children typically get the go-ahead to drink animal milk at age 1.)

What’s needed, as is always the case in these situations, is a systemic solution. On Wednesday, President Joe Biden invoked the Defense Production Act to help produce more formula for Americans. Whitmore, in full news-explainer mode, covered it on her Instagram stories. “The president has taken serious executive action to cut through red tape to get a quicker resolution for this crisis,” she wrote, explaining that, among other things, this means companies that make any key ingredients for formula must provide them to formula manufacturers over other clients. (She also asked her followers not to argue with her in her DMs over the politics of the shortage: “I now understand why doctors of the world are so dang tired from the last two years.”) Just as with COVID supplies and the virus, Biden’s move could help, but won’t necessarily be enough to help parents through a future crisis of a similar nature. “I do hope that this crisis spawns really meaningful change in how we prioritize the needs of infants,” says Whitmore. “It’s very every-man-for-himself Hunger Games right now.”

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