On February 17, Abbott Nutrition issued a voluntary recall of three baby formulas — Similac, Alimentum, and EleCare — manufactured in its Sturgis, Michigan facility, after four infants on these formulas fell sick with bacterial infections, and two died. Eleven days later, Abbott recalled additional formulas and subsequently shut down the Michigan Facility.

Even before the recall, disruptions in the supply chain had decreased the production and availability of baby formula. “We know that our recent recall caused additional stress and anxiety in an already challenging situation of a global supply shortage,” wrote Abbott, the largest baby formula manufacturer in America, on May 11.

“It’s been a slow moving trainwreck,” says Jenifer Lightdale, MD, a pediatric gastroenterologist at the University of Massachusetts Memorial Medical Center and member of the American Academy of Pediatrics Committee on Nutrition. “Any infant on the formula recalled was instantly affected. And now, the trickle-down effect is that we’re running out of supply of the alternatives manufactured by other brands.”

On May 12, the Biden Administration met with the Food and Drug Administration and major formula manufacturers and released a statement outlining steps to be taken in order to ease the shortage. Manufacturers will simplify formula offerings, presumably by producing fewer different size bottles and cans. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), administered by USDA, is urging states to allow WIC recipients (who account for about half of all formula sales) to use their benefits on a wider variety of products, “so that if certain sizes or types of formula are out of stock, they can use their benefits on those that are in stock.”

The Administration and various agencies are also working to crack down on price gouging, because some bad actors are buying up formula and reselling it online for profit. And, they’re planning to import more formula from abroad. (Typically, the US produces 98 percent of the infant formula used here.)

However, even with a plan in place, many new parents are struggling to find formula for their infants, and health experts are increasingly worried about those who are turning to dangerous alternatives. If you’re struggling to find formula for your infant, or if you know someone who is, here’s what you can do.

Look for an alternative formula with the same ingredients and calorie density.

Not all formulas are created equal, and if you need to switch to an alternative formula, it’s important to find the right one. “While there are many formulas on the market, there are three main types you can purchase: powder, concentrate, and ready-to-feed,” says Natalie Ostrowski, RD, IBCLC, a North Carolina-based dietitian and lactation consultant who works at WIC and owns Milk Thistle Health, a private practice. It’s OK to switch between these categories since they don’t necessarily impact the nutrient composition of the formula, although Ostrowski warns that it’s important to follow food safety guidelines when mixing powder and concentrate with water.

What you really need to pay attention to when switching between formulas are ingredients, calories, and molecular composition. “Some are made with cow milk proteins, some with soy or other alternative proteins,” Ostrowski says. “Some are hydrolyzed, which means the molecules are further broken down into smaller components to be easier for the infant to digest.” Different formulas also have different caloric densities, she says, because some infants need more energy in order to grow optimally.

Lightdale explains that you may be able to find an identical formula from a different brand, or sold as a generic store brand. But the shortage makes this more difficult. If you’re stuck on what to switch to, she recommends calling your pediatrician and asking for a recommendation.

“A quick shift to a different type of formula, especially if vastly different in ingredients or protein source, could cause gastrointestinal upset in infants or provoke an unknown allergy,” Ostrowski says. “If you need to switch to a different formula for any reason, look for one that is as similar in ingredients and calories if possible.” And make the switch gradually if you can, by adding one additional bottle of the new formula per day, because infants have sensitive digestive systems.

If you can’t find the right formula in stores, ask your pediatrician.

“Most pediatricians do have small stocks of formulas in their offices,” Lightdale says. If you can’t find an appropriate formula in stores, the next step is to call your pediatrician and ask if they have anything available to give you. And if they don’t, they can provide you with a list of similar alternatives, or tell you which other types of formulas may be safe to slowly transition your infant to.

This is particularly important if your infant is on a hypoallergenic formula because of allergies, or a metabolic formula because of a metabolic disorder (which means they can’t digest certain nutrients and need to avoid them). “Abbott makes certain metabolic formulas that no one else makes,” Lightdale says, which means that finding an alternative brand is impossible. Your pediatrician and/or local WIC clinic can provide personalized guidance for parents of infants on these specialized formulas.

Although some parents are buying formula from overseas, Lightdale warns against this. “We are definitely not recommending this,” she says. “We are truly accustomed to very safe formulas here in the United States,” she says, citing the Infant Formula Act of 1980 that set very high nutritional and manufacturing standards for infant formulas made in the United states. “Once you start importing from other countries, there really is no guarantee that you will get the same high quality formula that you are used to getting here.” Low-quality formula can lead to health issues, from either nutrient imbalances or contamination, in infants.

Don’t turn to cow’s milk, homemade formula, or diluted formula.

Cow’s milk isn’t an appropriate substitute, because it doesn’t provide the necessary macronutrients, vitamins, minerals, and calories required for infant development in the first year of life, Ostrowski says.

“There’s a big difference between cow’s milk and human breast milk,” Lightdale says. “There’s a lot of science that goes into formula making in order to provide exactly the right nutrition for infants — the proteins are very balanced, as are the electrolytes (to prevent liver and kidney damage) and other nutrients.”

Homemade formula isn’t an option, either. “We’re aware of a lot of recipes for homemade formulas, but it’s dangerous to make your own formula for two main reasons,” Lightdale says. “One is the high risk of contamination — and the whole reason we’re in this mess is the possibility of contamination that caused the recall.” The second is nutrition. “We have excellent infant formulas that provide perfect nutrition, and there’s just no way to do that in your own kitchen.”

Diluting formula to make it last longer — which Lightdale says has been an issue since long before the recall because many new parents lack access and financial means to purchase adequate formula — is dangerous for the same reasons: risk of contamination and lack of nutrition. On top of that, she says, diluting formula will lower the sodium content, which can lead to hyponatremia (low sodium levels in the body) and raise your baby’s risk of seizures and other dangerous outcomes.

Breast milk may also be an alternative, but it’s important to realize that breastfeeding is difficult or impossible for many women.

“If you have recently delivered and are open to breastfeeding, it may be possible to take advantage of your own breast milk or to induce re-lactation to feed your infant or supplement their diet,” Ostrowski says. “This can be time sensitive and will likely require some support.” You can seek out an Internationally Board Certified Lactation Consultant (IBCLC) at a local hospital, WIC clinic, or private practice.

That said, breastfeeding isn’t a viable option for everyone, and it’s so important not to shame women who can’t or don’t breastfeed. “The reality is that it’s rare to exclusively breastfeed,” Lightdale says. “It’s a difficult, deep commitment, and a lot of babies need that formula for supplementation, even if they’re being breastfed.”

In some cases, you may be able to get donated breast milk from an approved milk bank. “The Human Milk Banking Association of North America is a great resource for finding a milk bank near you,” Ostrowski says. “Donor breast milk is often reserved for hospitalized and medically fragile infants, but some may provide opportunities to purchase through your local hospital or medical provider.” Just be sure that the milk bank you choose is licensed and regulated by your state, to ensure quality standards.

Lightdale emphasizes the importance of only getting breast milk from a licensed, regulated milk bank. If you feed your infant breast milk from friends or family members, or get milk from another unregulated source, you run the risk of spreading diseases that the nursing mother may or may not know they have, and of exposing your infant to medications, alcohol, drugs, and other potential contaminants.

You can supplement with solids if your infant is old enough, but it may not solve the problem.

“Supplementing with solids in most infants should start at around four to six months of age,” Lightdale says. “So it is certainly fine to offer complementary foods if your baby is old enough and they are hungry!”

That said, solid foods likely won’t be enough to meet an infant’s nutrient needs. “How much food the infant actually takes and whether that can truly help them grow is developmentally determined,” Lightdale says. “Most infants under the age of 1 year only eat ‘recreationally’ — in other words, to explore and enjoy solid food, but not yet relying on it for nutrition.”

The second year of life is when an infant really starts to wean off of liquid nutrition (formula or breast milk) and onto solids, Lightdale says, and it isn’t until 18 to 24 months that they’re really relying on solid foods for most of their nutrition. If you’ve been feeding your infant primarily with formula and they’re 18 months or older, adding more solid food into the mix to lessen formula needs is an option.

The formula shortage is a bad situation with no easy answers.

Lightdale is hopeful that the administration’s plan to address the issue will help ease the formula shortage, so that parents can continue to safely feed their infants. For now she emphasizes the importance of speaking to your pediatrician, and seeking help from your local WIC clinic if you qualify for assistance, before turning to potentially dangerous alternatives.

Christine Byrne, MPH, RD, is a registered dietitian and owner of Christine Byrne Nutrition, a virtual private practice specializing in eating disorders, disordered eating, and orthorexia. She takes a weight-inclusive, gender-affirming, non-diet approach. As a nutrition journalist, she has contributed to dozens of national media outlets.

*This article was written and/or reviewed by an independent registered dietitian nutritionist.

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