Electronic income

Shortage of infant formula is worse for low-income families and high-risk infants

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The shortage of infant formula has put the medical community on alert, from pediatricians screening infants for anemia to specialists struggling to replace the carefully calibrated recipes that keep high-risk youngsters alive.

“It’s a crisis,” said Mark Corkins, a pediatric gastroenterologist at Le Bonheur Children’s Hospital in Memphis, who chairs the American Academy of Pediatrics Committee on Nutrition.

What to do if you can’t find formula

The most vulnerable children have been hardest hit, including those whose parents are unable to spend hours searching for formula online or in person, as well as premature babies and medically complex babies who need a specialized nutritional support. Doctors say deficiencies caused by watering down or using alternatives to formula can in some cases be catastrophic, causing imbalances that can lead to seizures, coma and even death.

“These are not small risks. These are big risks,” said Kimberly Giuliano, a primary care pediatrician affiliated with Cleveland Clinic Children’s Hospital. She recalled a single mother who didn’t have a car describing walking to five supermarkets on an unsuccessful search before social workers could find her a formula.

Tiffani Hays, director of pediatric clinical nutrition education and practice at Johns Hopkins, has spent months at the center of a logistical jugglery involving daily calls and regular meetings to assess formula inventories in different locations, consolidate them and redistribute them where they are most needed.

One of the biggest challenges, she said, has been helping babies in need of complex care, some of whom have trouble swallowing or malformed bowels, and receive tube feedings at home. They often can’t tolerate a different brand, said Hays, who described pulling dietitians out of clinics to coordinate with prescribers and try new products and recipes.

Despite efforts, two babies had to be hospitalized. The release of a newborn has been delayed.

The shortage, which began in February after contamination at an Abbott Nutrition production facility in Michigan, has been exacerbated by pandemic-related supply chain issues. While many healthy, full-term babies can easily switch between brands, for others a switch could be a life-and-death decision. Babies with a condition known as galactosemia, for example, are unable to digest lactose, the main sugar found in formulas and breast milk.

Le Bonheur recently admitted a toddler and preschooler with a medical condition known as short bowel syndrome that requires an amino acid-based formula. When that wasn’t available, doctors tried a peptide product. The children became dehydrated and ended up needing intravenous fluids and hospital care. One was released after about a week; the other remains in the hospital.

“That’s not what we committed to do,” Corkins said. “We’re not providing the best care we can give.”

The shortage of infant formula in the United States worries parents. Here’s what you need to know.

Katie Lockwood, a primary care pediatrician at Children’s Hospital of Philadelphia, is always on the lookout for signs of iron deficiency in infants at the South Philadelphia clinic where she works: Pale skin. Fatigue. And a heart that beats too fast.

But what was once a clue that families saved money by making their own formula may now signal another plague: Parents are diluting insufficient supplies or replacing cow’s milk, which doctors advise against for children under 18. ‘a year.

“All they’re trying to do is feed their babies,” Lockwood said.

The AAP said this month that in a pinch, parents can feed babies 6 months and older cow’s milk “for a brief period until the shortage improves”.

Paediatricians say parental anxiety has increased in recent weeks as the shortage has worsened, prompted by a mix of panic buying, price gouging allegations and fears about the future.

These concerns seem well founded. In the first week of May, product analytics firm Datasembly estimated the out-of-stock rate at 43% among US retailers. Abbott and the Food and Drug Administration reached an agreement Monday to resolve safety issues and resume production, but it will take weeks to get additional formula on the shelves. The government has also launched a website with advice for parents, while encouraging states to take advantage of waivers that allow easier distribution of the formula to low-income parents.

While government data shows that most families use infant formula at some point in an infant’s development, the shortage is hitting economically disadvantaged communities and communities of color hard, in part because they rely heavily on infant formula, according to data from the Centers for Disease Control and Prevention. Half of the country’s formula – much of it from Abbott – is purchased by recipients of a mother and baby food assistance program known as WIC. More than 1.7 million infants participate in the WIC program.

“It’s a systemic problem,” said Gabrina Dixon, a hospitalist at Children’s National Hospital in Washington, who said African-American mothers often face a lack of structural support at home and at work to feed their babies. with breast milk.

Although the AAP recommends that babies be breastfed until they are one year old or older, many women are unable or unwilling to breastfeed for a variety of reasons, including difficulty latching on, production of insufficient milk or a lack of breastfeeding support at home or at work.

Feature stories: The formula crisis

Black infants are less likely to be breastfed than Hispanic and white infants, while over 90% of Asian babies are breastfed. Infants who receive WIC are also less likely to be breastfed than infants who are not eligible for the program.

Lockwood, in Philadelphia, said the women she sees often face significant barriers to breastfeeding. The work schedules of many new mothers involve spending hours away from their babies, often with no privacy to express milk or no place to refrigerate their milk. Now they also face ill-informed criticism for not breastfeeding, she said.

“Unfortunately, some people don’t understand that women can’t start breastfeeding months later,” Lockwood said.

Last week, the Department of Agriculture echoed President Biden’s message of support for low-income families, urging more states to take advantage of the waivers the USDA offers under the WIC program, allowing participants to access a wider range of sizes and formula brands. The FDA said this week that it will approve new types of formulas from foreign and domestic sources on a case-by-case basis.

“We are acutely aware that the ongoing recall has left many parents and caregivers worried about access to formula and how they will feed their babies,” Agriculture Secretary Tom Vilsack said. in a press release.

Help can’t come fast enough for Houston’s Crystal Sandoval. Her Armando has been a picky and unpredictable eater, prone to spitting out the precious formula she provides.

“I would drive from WIC store to WIC store,” Sandoval said, visiting Walmarts and Targets in hopes of keeping a few extra bottles on her shelves. She refrigerates half-consumed bottles, determined never to waste a drop. And whenever it’s low, “fear starts to set in,” Sandoval said. “I never really know if he’ll end up on the last box.”

Maria L. Marquez, pediatrician and administrative medical director at Mary’s Center, a community health center that serves nearly 60,000 people in and around Washington, said she is focused on educating parents, telling them to Call ahead before spending time and gas on hopeless journeys. to pharmacies and advise on substitutions.

“It’s a lot of extra work,” Marquez said, “to guide them when it’s okay to take the available formula.”

Kate Breznak, a nutritionist in the neonatal intensive care unit at St. Christopher’s Hospital for Children, a safety-net facility in North Philadelphia, said she has maintained adequate supplies for inpatients, although she sometimes had to switch infants from one formula to another during their hospital stay to ensure they were getting the higher levels of calcium, phosphorus, protein and calories than the preemie formula provides. These days, once babies leave the NICU, her search continues on behalf of new parents who may not be so digitally savvy.

“I try to google and find places where mom might be able to get formula,” Breznak said.

Some desperate parents try everything they can to feed their children. Colette Acker, who runs the nonprofit Breastfeeding Resource Center in Abington, Pennsylvania, said she recently helped a mother try re-lactation, a strenuous effort to stimulate her breasts to produce milk again.

Another client, Michelle Galanek, developed mastitis, a breast infection, followed by an abscess shortly after the birth of her second child.

When Galanek had to supplement his reduced milk supply with formula, the baby developed a rash, indicating a cow’s milk allergy which sent him to emergency care. Her husband, along with their 2-year-old child, went in search of a hypoallergenic formula, which they eventually received from a pediatrician.

Since then, Galanek has relied on online research and a network of friends and family to browse the shelves and find the type of Enfamil her baby needs, while continuing to work with Acker. to stimulate the production of breast milk.

“It’s funny – if it wasn’t for what’s going on with the formula, I’d probably quit [breastfeeding]said Galanek, describing a painful and time-consuming process. “But not knowing how to find a formula or if it’s consistently available is the lesser of two evils.”

Parents’ individual efforts to find formula are multiplied many times over at a huge institution like Hopkins. The cost of overtime and having to pay retail prices to buy off-contract products will be enormous, Hays said. Additionally, some parents are “rolling the dice again,” she said, having to change a second time because alternatives aren’t always available.

“I really didn’t think something like this could happen in the United States,” Hays said. “It’s shocking to me.”

Laura Reiley contributed to this report.