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Infant Formula

Infant formula
 

Current Situation

In 2022, CDPH/WIC worked closely with the United States Department of Agriculture (USDA) and California WIC formula contractors, Abbott and Mead Johnson, to help WIC families get the formula they need. One action taken included temporarily adding more formula products to WIC's Approved Product List. This gave families more choices at the store during the shortages.

Following the period of 2022 shortages, the availability of infant formula in California has significantly improved. California WIC contract formulas, Similac Advance, Similac Sensitive, and Similac Total Comfort, are now more accessible at WIC authorized stores. On December 19, 2022, the USDA announced a three-phase plan to end the temporary expanded WIC formula options. The phase out of the temporary expanded formula options will start March 1, 2023, and will be completed on July 1, 2023.

CDPH/WIC will continue to update the webpage on WIC Approved Temporary Formula Options.

For more information on the timeline for the ending of temporary expanded WIC formula options go to the USDA website. For general guidance and information about WIC contract formulas go to the MyFamily contract formulas webpage.ā€‹

Overview

Babies need the right mix of nutrients to stay healthy, and these nutrients are found in human breast milk and in formula approved by the United States Food and Drug Administration (FDA). As parents and caregivers across the nation struggle to find formula, your baby's health depends on using products that meet federal standards and are prepared according to directions on the label. During this stressful time, the California Department of Public Health and the American Academy of Pediatrics offer tips to keep your baby safe.

How to find formula

 
  • Shop at different times of the day. Stores get shipments at different times of the day, so the shelves may be empty in the morning and stocked in the evening.
  • Have family and friends help you to find supplies to avoid making multiple trips to stores, food banks, or other community-based formula resources.
  • Check with your health care provider if your baby needs premature or therapeutic formula. They may have supplies on hand or other suggestions to help.
  • Call your local WIC office for help. If you are eligible for WIC , the local WIC office can help get you enrolled and provide any assistance they can with formula.
  • Call 2-1-1 to get connected to local resources or visit www.211.org .
  • Consider using human milk from one of the following certified human milk banks: mothersmilk.org  or uchealth.service-now.com/csp.  

Babies not on therapeutic or specialty formula usually tolerate changing from one brand to another

  • Use a different formula. Some formula is now available in stores that is made outside of the U.S., but is still FDA approved. (Resource: Tips for preparing imported infant formula (PDF)  and List of Comparable Formulas )
  • Remember to mix formula safely using the directions on the label. Always add the right amount of water. Adding too much water or too little formula is dangerous. Diluted formula can lead to imbalances in minerals like sodium which can harm nerve and brain function.
  • Wash your hands, equipment, and surfaces before preparing the formula. Harmful bacteria can make babies sick if hands and preparation areas are not clean. (Resource: How to prepare and store infant formula (PDF) )
  • Do not use formula after the "use by" expiration date. This date guarantees the safety, nutrient content, and quality of the formula.

Pasteurized whole cow's milk can be an alternative for some children

  • Cow's milk is NOT recommended for babies under 6 months old and it is not recommended for babies on specialty formulas to use cow's milk.
  • If your baby is 6 months or older you may consider using cow's milk for a few days until you can find formula or reach your health care provider. Using cow's milk longer than a week can have health risks for your baby.
  • Most infants do not transition to cow's milk before their first birthday, but some could transition sooner at 10 or 11 months. Talk to your health care provider about this option.

Your child might be ready for solid food and this could reduce your need for formula

Introduction to solid food for older babies:

  • While formula and human breast milk are the most important foods in a baby's diet until their first birthday, parents can experiment with transitioning to solids around 4-6 months.
  • A baby is on the cusp of transitioning to solid foods if they show signs of readiness, like the ability to sit up, control their head and neck, and swallow food rather than push it out of their mouth with their tongue.
  • Ask a health care provider if your baby is ready to try solid foods.

For healthy infants 10 months and older:

  • At this age, appetite may vary from day to day so there are some days more foods will be needed and other days when more formula or human milk may be needed.
  • A baby might be ready for more solid food if they eat a variety of baby foods, including mashed foods and table food, and are starting to use a cup. Formula can become a snack or supplement to solid food.
  • If you cannot find formula, talk with your pediatrician since it may be possible for your baby to start cow's milk for a short period of time while continuing to try solid foods, especially high-iron foods.
  • Ask a health care provider if your baby needs vitamins with iron.

Consider additional breastfeeding options

 
  • Maybe you can breastfeed a little longer. If you have thought about weaning, you may want to consider waiting.
  • Maybe you can give less formula and more breast milk. If you provide both human milk and formula, it may be possible to increase your milk supply. Talk to your health care provider or lactation consultant.

Do not try remedies on your own as young infants are fragile

Do not use homemade formula 

  • Formulas must be reviewed and approved by the FDA, because safely mixing all the ingredients in formula is difficult and must be done correctly.
  • Even small mistakes can lead to a baby becoming sick from harmful bacteria. Too much of some ingredients can stress an infant's kidneys. Too little of some nutrients and your baby may not get the nutrition they need to grow and develop.
  • Although homemade formula was used in the past, it comes with many risks to infants. Online recipes for homemade baby formula have significant safety concerns due to the potential for contamination and improper nutrient concentration. Babies have been hospitalized from reported use of homemade formulas.

Milk alternatives that are fine for adults can be dangerous for babies

  • Goat's milk is very high in protein and minerals, which can cause dehydration and be harmful to your baby's kidneys.
  • Toddler milks are not "formulas." They are nutritional drinks made from powdered milk and sugar and do not provide the nutritional content that babies need. If you absolutely have no other choice, these products or cow's milk can be safe for a few days for babies who are close to a year old.
  • Plant milks like soy, rice, oat, and hemp milk are not a safe alternative to formula. They are missing many ingredients and do not have the right kind of fat for a baby's growing brain.

If you cannot find formula and none of the above suggestions will work for your baby, call your health care provider as they can assess the situation, suggest further alternatives to help and some may have samples of formula they can provide. If you are worried about your baby and cannot reach your health care provider, you can also get help at the local hospital emergency department.

How to keep up your milk supply or make more milk

The more often you breastfeed, the more milk you will make.

  • Breastfeed every time your baby is hungry. In the early weeks, your baby will eat at least 8-12 times every 24 hours. Do not put your baby on a strict feeding schedule. Follow your baby's cues, and let your baby tell you when it's time to eat.
    • Make sure your baby is latching well. You can follow the tips here (PDF)  to help you get a good latch ā€” and know if you have one.
    • Offer both breasts at each feeding. Let your baby finish the first side, then offer the other side.
  • Empty both breasts at each feeding. To make more milk, hand express or pump after a feeding to draw out all the milk and signal your body to make more.
  • Avoid bottles and pacifiers in the early weeks. Feed your baby from your breast whenever you can.
  • Pump or express your milk. 
    • To make more milk: Pumping or expressing milk frequently between nursing sessions, and consistently when you are away from your baby, can help build your milk supply. Be sure to pump your milk if you are at work or school or away from your baby as often as you would breastfeed your baby at home.
    • To keep your milk supply: Be sure to pump your milk if you are at work or school or away from your baby as often as you would breastfeed your baby at home.
  • Take good care of your breast pump. Read the pump instructions or watch a video so you know when to replace the valve or if you need to use a larger breast flange. Both things can affect your milk supply.
    • Store your breastmilk safely. Follow recommended guidelines to safely store your expressed milk. CDC: Recommended storage and preparation techniques .
    • Relax and massage. Relax, hold your baby skin-to-skin, and massage your breasts before feeding to encourage your milk to let down.
  • Take care of yourself. Get plenty of rest, eat well, drink enough fluids, and let others help you  .

Source: USDA WIC Breastfeeding Support Products 

Questions and Answers

Question
 Answer
Why is there an infant formula shortage?
 The recent Abbott Nutrition recall of certain powdered formulas has led to national shortages of major brands of formula. Infant formula has also been impacted by supply chain problems caused by the COVID-19 pandemic, affecting consumers in California and across the U.S.
What's being done to get more formula on the shelves? / When will the shortage be over? The federal government and formula makers are working on getting more formula quickly and safely onto store shelves.

On May 16, 2022, Abbott and the federal government reached agreement to reopen the Sturgis, Michigan plant.  Abbott projects it could take six to eight weeks before formula from that plant is available on grocery shelves.
What should I do if I'm getting ready to deliver my baby?

Healthcare providers often offer help with lactation for new mothers. After you've had your baby, ask for lactation support and meet with lactation consultants to help with your milk supply, and create a plan to get everything you might need after delivery.

Ask your provider:

  • What kind of lactation support do you provide new parents?
  • Where can I get the support and how often?
  • Does my insurance pay for lactation support?
In the hospital:
  • After delivery, ask for a lactation consultant to meet with you.
  • Ask nurses to help you with breastfeeding and chestfeeding ā€“ they are there to help.

Parents and caregivers who are eligible for WIC can go to the California WIC program or lactation consultants affiliated with other organizations for assistance in increasing breastmilk supply if they are partially breastfeeding.
Is it safe to feed my baby with milk from a milk bank?

Banked human milk may be a safe and nutritious option for some families to feed their infants. Families who wish to use banked human milk must have a prescription from their pediatrician or health care provider with a medical diagnosis, amount needed, and duration of the prescription. Families are advised to only use human milk provided from a Human Milk Banking Association of North America (HMBANA) certified milk bank. Families are advised not to buy human milk online or participate in informal human milk sharing as it may not be safe and may be harmful to their infant. 

Most health insurance plans have guidelines for when banked human milk is a covered benefit. Check with your health plan to see if it will be covered or available at a lower cost.  When it is not covered, the cost is $4.00 - $5.00 per ounce, plus the cost of shipping.

For California Women, Infants and Children (WIC) Program Participants:

  • Banked human milk is not a WIC-approved benefit and is not available for purchase with the California WIC Card.

More information on how to purchase banked human milk can be found at Mothers' Milk Bank  in San Jose or the University of California Health Milk Bank  in San Diego, the two certified human milk banks in California. 

Maybe you'd like to donate breast milk and this is a wonderful gift to share. Reach out to the two milk banks to learn how you can donate.
ā€‹Is it possible to restart breastfeeding (relactation)?
 ā€‹Relactation is possible but not always easy. Set realistic expectations based on your individual circumstances.

What is Relactation?  
  • Relactation is a way a person may be able to build a milk supply and start breastfeeding again after having stopped breastfeeding or pumping.  
  • A lactation support professional can provide specific guidance on relactation practices by assessing each family's individual situation. 
  • Parents and caregivers who are eligible for WIC can go to their local WIC program for help with relactation or for a lactation referral.
  • Parents and caregivers should contact their health care provider about ways to get lactation support. 

Here are some things to keep in mind if you are considering relactation:  

Relactation basics

  • Babies under 3 months of age have the most success. 
  • Babies who have breastfed before are usually more willing. 
  • If your baby will not latch or breastfeed, try exclusively pumping to increase milk supply. Once you start making milk again, your baby may be willing to breastfeed.

Getting started 

  • Breastfeed as often as baby is willing. 
  • Offer both breasts at least every 2-3 hours. 
  • Use an electric pump after offering the breast to empty the breast. This will help increase your milk supply. 
  • As your baby gets more of your milk, you can begin to decrease the amount of formula offered. 

It takes time 

  • Commit to trying to relactate for 4 weeks. It can take a few days to a month or more before you start making milk again. 
  • The less time that has passed since weaning, the faster your milk supply will return.
  • Offer breast when baby is not too hungry or sleepy. 
  • Increase skin-to-skin contact to help build your milk supply. 
  • Limit distractions as baby may be more willing to breastfeed in a calm and quiet place. 
  • Massage your breast while baby is at the breast. This helps baby empty the breast so your breasts will make more milk. 

If you are thinking about relactation, talk to a lactation support professional or your health care provider. To find a lactation support specialist visit the IBCLC Directory  or your health care provider for more information. If you are a WIC participant, contact your WIC Local Agency to determine if a lactation specialist is available. 

Adapted from: Idaho WIC Program, Idaho Department of Health and Welfare, Public Health Division   

Resources:  
Is the infant formula shortage a health equity issue?

Yes. The infant formula shortages significantly impact some communities more than others. Many low to medium income parents who recently gave birth depend entirely or partially on infant formula because they are unable to exclusively breastfeed long term. In California and beyond, breastfeeding initiation and duration rates are lower in communities of color and working and low-income families. Some of the reasons for this disparity may be due to inequities in how lactation support is offered or provided in and out of the hospital setting, and challenges with unsupportive work environments.

For Black birthing people in the U.S., racial disparities in breastfeeding practices span back centuries to slavery, when enslaved women were made to serve as wet nurses . Inequities persisted as formula was marketed to communities of color as the superior infant feeding source. Today, studies  show that Black mothers are more likely to be offered formula in the hospital than their counterparts.

As a result, Black birthing people and low to medium income parents who must return to work disproportionately miss out on vital breastfeeding benefits.

Additional reading:

CDPH recognizes that not all people who lactate prefer the term breastfeeding. Chestfeeding is a term that is often used by some parents to describe how they feed and nurture their infants from their bodies (La Leche League Canada (PDF) ). 
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