A perspective published today in the American Society for Nutrition’s American Journal of Clinical Nutrition addresses the shortage of infant and pediatric formulas and offers recommendations to help prevent future occurrences and regain the public’s trust in the safety and supply of infant and pediatric nutrition.
Identification of long-term solutions to prevent future shortages is critical, and the authors recommend strategies around three themes.
“The shortage is a catastrophic situation for infants and children with special medical needs whose sole source of nutrition comes from the formula,” stated Christopher Duggan, MD, MPH, Editor in Chief of The American Journal of Clinical Nutrition, Samuel Meltzer, MD Professor of Pediatrics at Harvard Medical School, and Director of the Center for Nutrition at Boston Children’s Hospital. Many specialized formulas have either no alternatives available or extremely limited supplies in the U.S.
First, a thorough, public process aimed at instilling public confidence in the safe production of infant and pediatric formulas must ensue. This includes public hearings and the release of investigational data into the events that caused the recall and shortages and guidance to families and the health care community about safe formula preparation and the dangers of homemade formulas. Efforts to combat misinformation in social media and other contexts are paramount.
“There are no safe alternatives for small infants who are receiving human milk or using infant formula as instructed. Using homemade formulas or diluting formula can cause serious harm to infants and should never be done,” said Steven Abrams, MD, Professor of Pediatrics at Dell Medical School at the University of Texas, and past chair of the American Academy of Pediatrics’ Committee on Nutrition.
Second, factors in the supply system that led to the shortages must be assessed and action is taken to reduce future recurrences. The American Society for Nutrition is prepared to partner with medical and scientific organizations, government agencies, industry, and other stakeholders to consider legislative and policy actions.
Current business practices related to infant formula supply and marketing practices must be evaluated. For example, specialized formulas should be produced by more than one factory and preferably not just one company. The distribution of formulas during a crisis such as a natural disaster, supply chain disruption, or production problem must be assessed. Potential bottlenecks that could occur during a crisis should be anticipated with contingency plans in place. For example, having more than a single grocer or pharmacy in a rural area source formula could help buffer against inadequate retail supplies. With respect to marketing, the use of health claims by formula makers has led to confusion among families and health care providers, particularly if a sudden switch must be made.
Further, contracting practices of the USDA’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program and their potential role in exacerbating shortages need careful evaluation. These contracts define which formulas can be provided to WIC recipients in various states. While the process brings efficiencies and cost savings to the government, problems may result if a WIC-contracted formula provider has a supply problem and easy substitutions are not allowed.
Finally, additional lactation support is needed to encourage and sustain breastfeeding to reach a family’s goals. While breastfeeding will not solve the current shortage and formula will always be needed for many infants, particularly those with special medical needs, lactation support is integral to a comprehensive strategy to prevent the consequences of critical shortages of formula. The U.S. lags many countries in breastfeeding metrics, and for many families additional support to start or maintain breastfeeding can be beneficial in reducing formula needs and the impact of formula shortages. Insurance coverage for donor human milk should be encouraged.
Feeding tips during the shortage have been issued by the American Academy of Pediatrics. The U.S. Food and Drug Administration has issued guidance on safety considerations for the use of donor human milk. The American Society for Nutrition will host an online dialogue on the topic on Thursday, June 16 at its annual meeting, NUTRITION 2022 LIVE ONLINE. Media representatives can register for the event by contacting firstname.lastname@example.org.