Purdue HHS researchers provide expertise, outreach during baby formula shortage

Azza Ahmed

Written by: Tim Brouk, tbrouk@purdue.edu

The ongoing baby formula shortage is adding stress for families nationwide.

According to a May 18 article from The Guardian, baby formula was out of stock at 43% of retailers in the beginning of May. Many states’ Special Supplemental Nutrition Program for Women, Infants and Children (WIC) baby formula reserves, which go to low-income families, were also depleted.

A myriad of reasons caused the shortage — already strained supply chain issues due to the COVID-19 pandemic, Abbott Laboratories’ recall of some of its baby formula products due to a federal investigation of formula linked to the death of two infants and then Abbott closing one of its formula manufacturing facilities in Sturgis, Michigan.

Purdue University College of Health and Human Sciences researchers have been lending their expertise and research to Greater Lafayette community family groups and agencies. Azza Ahmed, associate professor in the School of Nursing, has dedicated much of her career to breastfeeding research, promotion, education and support. She is an international board-certified lactation consultant, who has extensive knowledge on breastfeeding alternatives such as baby formula.

In recent days, she met with community partners from local hospitals, WIC offices, health departments, nurse-family partnerships and the Riggs Community Center during the Greater Lafayette Breastfeeding Coalition meeting. The most urgent discussions revolved around dispelling unsafe alternatives to formula and giving a consistent message to mothers on keeping their babies safe during the shortage.

“Parents are starting to think of different alternatives like homemade formula, which is very risky and dangerous,” said Ahmed, who has received honors from the American Academy of Nursing, Indiana Public Health Association, and the Sigma Theta Tau International Honor Society of Nursing. “There is a lot of risk for nutritional imbalance. There is a lot of risk for contamination and putting the child at risk for infections, hospitalizations and fatalities.”

Ahmed offered other warnings that fall in line with the American Academy of Pediatrics and the Academy of Breastfeeding Medicine:

• Animal milk is not recommended for babies under 1 year old. However, Ahmed said whole cow milk for infants older than 6 months could be used temporarily while watching for signs of anemia. Goat milk contains too much protein and minerals for the systems of babies younger than 1 and is difficult for the child to digest.
• Parents should not “water down” or dilute formula to stretch the product out. Growing babies need the full potency of the product.
• All purchases of formula should show the product has been approved by the U.S. Food and Drug Administration (FDA).
• Do not buy human breast milk from the internet.
• Families should not purchase formula from other countries. The FDA and other federal agencies are working to import formula products from other countries to help fill empty shelves. Once approved, those boxes of formula will be deemed safe for babies and will be available for purchase in the U.S.
• If a family’s favorite brand of formula is out of stock but other brands are available, whatever is available should be purchased, including store-brand formulas.
• Babies under 1 should not be fed oat, almond, coconut or other plant-based milks on the market because they don’t contain proper nutrition for infants.

Lactation consultation

Low-income families have been especially affected by the formula shortage. Ahmed wants mothers to know there is support, whether they are new or experienced moms. With the Greater Lafayette Breastfeeding Coalition partners, Ahmed has shown support to new mothers in helping them breastfeed their infants, sometimes right after the birth.

“After giving birth, we help with putting the baby on their chest and starting breastfeeding as soon as they can as long as it’s a healthy newborn and the mother is in good condition,” Ahmed explained. “If there are any breastfeeding difficulties, there are community resources to help the mother solve them and educate the mothers and increase their self-confidence and self-efficacy. After the hospital discharge, we help them connect with local lactation consultants including WIC, if they are eligible. WIC and local hospitals have their own lactation consultants that would continue to help them in case of any breastfeeding problems.”

Ahmed’s research interests explore why women have difficulty in lactogenesis, or secreting milk. A recent study looked at the lack of sleep for expectant mothers. More than 60% of the participants were African American, a population with traditionally low breastfeeding rates, according to the Centers for Disease Control and Prevention.

“We found a relationship between short sleep duration and fragmentation and delayed lactation,” Ahmed said. “When mothers have delayed lactation, they started to supplement with formula, which then affects the breastfeeding outcomes later.”

For mothers having difficulty in producing enough milk at times, Ahmed spearheaded lactation consultation services to teach mothers how to increase their milk supply through proper pumping and storing breast milk. Ahmed said pasteurized human milk could be an option if its available from a certified milk bank, which essentially operates like a blood bank.

Nutrition of baby formula

Alvin Furiya

Alvin Furiya, assistant clinical professor in the Department of Nutrition Science and director of the Didactic Program in Dietetics, said altered or homemade formula gives the baby “too little” nutrition. 

“There are so many unknowns,” said Furiya, who noted babies on special formulas or have food allergies are especially at risk for formula alternatives dangers. “Homemade formula is not wise because it’s not going to match the nutrient content of either breast milk or the formulation.” 

A homemade formula will not have enough protein, iron and fat in it, Furiya continued, and cow’s milk is too low in iron for a baby under 1. These nutrients are essential in growth and development of a baby.  

Adding more water to stretch out formula is also dangerous to a baby’s system, according to Furiya. 

“Most infants do not need any additional water. By diluting it, it could give them too much water, and that could lead to seizures,” he said. “And diluting it will not provide enough nutrients, which goes back to the growth and development issue.” 

While steps are being made near and far to get baby formula back on the shelves consistently, Furiya expects the shortage to last for a couple more months. Families can check daily at retail and grocery stores as well as reach out for help, whether from a local human milk bank or a family pediatrician.

No matter how a mother feeds her infant, Ahmed said, the formula shortage has shaken families to the core. There are alternatives to formula, but families must be wary of the many harmful alternatives being shared online. “Our goal is to support them during this critical situation,” she said. “We need to help the mothers — to reassure them, to teach them about how to get safe and appropriate information, and at the same time, provide them resources during this formula shortage.”