A few months back my niece (a toddler) was a bit sick and I accompanied my sister to the local CVS for some Pedialyte.
They were out, but basically had the adult version (Adultlyte for purposes of this story). I suggested the two couldn’t possibly be THAT different, and that it would be fine to supplement one for the other...especially since it was all OTC.
However, she felt compelled to ease her concern by asking the CVS employee in the Pharmacy if it would be “okay” and was told in no uncertain terms “no”
He didn’t have any logic, other than it said “Adult” on the box.
To me, it just seemed like a silly issue of overly strict and legalistic guidelines causing more harm in a moment of minor panic than otherwise necessary.
Ultimately, my sister decided against getting it and erred with the Pharmacy Intern....not me.
This reminds me of a few months ago when i accompanied my sister to the local CVS for some Pedialyte for her toddler, but all they had was “Adult Electrolyte Replacement Drink”.
I suggested that she just get that, because certainly the electrolyt
There seem to be a huge variety of types when it comes to baby formula. Is is medically necessary to have so many choices and does this have an impact on the current scrambling in the supply chain?
Sorry to go back to basic principles when you are (and good for you) talking about immediate solutions, but the "What I’ve learned over the past couple of years of Covid reporting, though, is that American medical authorities have a strong preference for unambiguous rules over accurate information" is pretty basic. I'd only add that the "preference" could not exist if they saw their role as enabling people to make rational cost/benefit decisions.
This would help to some degree with babies who are on ordinary formula, but the real crisis is for those who are not. That demand is not elastic. If you can't digest ordinary milk, if you have special needs, if you are tube fed--you need formula. Period.
Yes my understanding is that the real crisis is in special diet-formula where there truly are no substitutes and supply chains are totally whacked. It’s not like you can switch from fancy organic formula to the target stuff in a pinch if your kid needs something specially prepared in a lab.
An excellent article. In addition to adopting Canadian Guidelines, the advice about loosening Trade Rules makes a great deal of sense. Three of our 13 grandchildren lived in the UK in their baby years. The infant formula has less sugar than American options. When babies begin solids, mothers add some formula to leftovers and grind it in a blender. This provides the baby with nutrition that is superior to commercial baby food with low sugar and tastes of the families normal dinner options. These kids grew up healthy, lean and strong. In addition, they were not picky about foods served when they got older.
I believe the amount of lactose is less in the European formulas. For us in the US to get formula from the UK/ Europe it will mean revising the Trade Policies.
It is not. I don't know whee this comes from--I've heard it before along with "US formulas use corn syrup" (only true for allergy versions). But I've checked. Both US and European formulas are designed to mimic the composition of breastmilk and as such should have the same amount of sugar. Enfamil claims to have 0.1g/100ml more sugars than Aptamil, which is not significant.
In fact, Mead Johnson makes many of its specialty formulas in Europe--they just don't seem to compete there on their standard baby formula (Enfamil).
Thank you for pointing this out. My opinions are just formed by experience (in this case 25 yrs ago) and articles I’ve read. They can always be improved.
Apologies for the noob question. If the main problem with cow's milk is that it doesn't contain enough iron, so babies that can tolerate solid food should also eat more iron-rich foods..... why can't parents, say, blend up iron supplements in cow's milk? And if iron isn't the only problem, then other supplements as needed?
This seems obvious enough that I must be missing something. Obviously getting an optimized balance of supplements to blend into a smoothie is a lot of work/too much to expect from parents as a general rule, but it seems like there are non-trivial numbers of parents going to great ends to try to find formula anyways. Are there other things in the vitamin supplements that would be bad for babies?
I guess the question is basically.... why haven't I seen anyone advocating "homemade formula" in the short term? This seems like the sort of advice that pops up elsewhere (ie, homemade cloth masks early in the pandemic despite official guidance against masking).
So one question is *why* it's dangerous. Is it something that's in the vitamin supplements? Is it about sterilization? If the latter, it seems much less likely that bacteria would grow in a jar of iron pills than in solid iron-rich food. And you could boil it first? Like I get that people mess things up, but in the short term adding iron pills to boiled cow milk seems much less dangerous than underfeeding a baby.
And on "you can't really replicate everything they've put in there" - do you need to, in the short term? Like, is there something about the particular balance that's important to get right and has serious short term side effects if you get it wrong/only provide part of what's needed?
I hope these come across in the intended spirit of really not getting it, rather than trying to be difficult.
Okay. So. There is way more involved than just supplements.
In order to get a formula that’s suitable for babies (not a 9 month old who is also eating) you need to alter the nutritional balance. This is why the old school formula is for evaporated milk and Karo syrup that’s diluted. Even if you adjusted the vitamins with a supplement, you’d still need to fix that. In regular formula they use lactose as the sweetener. Karo is used because it’s glucose syrup that is less sweet than table sugar. But Karo can potentially contain botulism, and it gives some babies diarrhea, which is why it’s a folk remedy for infant constipation.
Evaporated milk and corn syrup is precisely what my mother (born 1922) was fed. She grew up to be very weird but I don't actually think the evap milk/corn syrup was why.
I was born in 1952 and don't know any of my age group who were fed on infant formula, yet we all made it to adulthood and many to successful lives. I doubt it even existed. Reading this chain of freakouts over the formula shortage has been eye opening into the mentality of young Americans, and not reassuring.
On the margins a bigger market by allowing import is more cushion for a single plant closing (and is probably a good idea), but coming from Covid, it seems like some of the problem is that we have hyper-efficient supply chains that have no slack, and I wonder if long-term companies just compensate for more distributed risk in a broader market by putting even less slack in the supply chain.
It seems like some of the solution is that we really need some more thought into what things the government needs to guarantee or regulate an oversupply to deal with potential risks. What it looks like depends on the failure modes of production, but in this case, maybe the government needs to incentivize warehousing a couple weeks worth of infant formula so that there's more slack in the system (a sort of distributed strategic infant formula reserver).
I don't think the larger market necessarily means there is less slack - they probably try for as little slack as possible either way.
But for things like formula or gasoline where there aren't really substitutes (if there's a wheat shortage we (the U.S.) have plenty of corn or potatoes or what not to help tide everyone over) we might want something a strategic reserve.
Although... formula has a shelf-life (unopened) of only 1 year so it's probably trickier to manage this than petroleum. I know this was a consideration when we were donating our excess formula when the kids' stopped needing it.
I might be wrong that there's any amount of deliberate/inherent slack in the system to deal with fluctuations, but my instinct is because of law of large numbers, the larger your market, the less percentage of product you need to warehouse because you can shift fluctuations in demand from production to shipping.
The shelf-life problem is definitely tricky—that's why I think the answer would probably be something like paying manufacturers to warehouse a certain quantity of formula <1 month post manufacturing, so there's a rolling buffer.
We seem to be particularly bad at these kind of collective public health (or p.h. adjacent) issue.
I'm sure both social and bureaucrattc dysfunction is involved, but it seems like instead of basically saying something like 'There is a baby formula shortage, so if your child is over X months of age and otherwise healthy, please consider...' and trusting the enough of the public can understand and will try to comply, we get all kinds of tortured messaging in an attempt to achieve a similar result.
It closely parallels the 'masks aren't effective' guidance early in the pandemic.
They could have just come out and repeatedly said 'masks are somewhat effective, but we need to reserve them for front-line workers until supply improves.'
Instead of trying to manipulate the public, give an honest and straightforward message and let the chips fall where they may.
Seems like as good a place as any for me to yell into the void: The fact that the shutdown of *one* factory can put us in crisis mode is pants on head stupid.
I wonder if particularly onerous regulations helps cause the kind of market consolidation that leads to this?
Getting a plant qualified by the FDA to produce this is pretty costly, and that may pose a barrier to entry, and/or enhance the competitive advantage of being a big company in general.
It might not be possible to do both. I suspect that that determination will require a lot of technical expertise about food production, and I don't have that.
I do have experience dealing with the FDA from a medical device design, safety analysis, and manufacturing standpoint, and I do think that many of the FDA's requirements there are pretty onerous - and not very effective at really mitigating safety risks, and so probably unnecessary.
It is a different animal than food production, but I kind of assume (perhaps unfairly) that the bureaucracy will function similarly across the board.
Would you be so kind as to expand on the OSHA construction site provisions? I have not heard about this, and I would very much like to know more. Thank you!
Matt. You do not understand the intensity of parenting in this country, especially around things like diet, and a desperate desire to be the best parent ever by doing the most for your child (as determined by parenting blogs), everyone else be damned. Plus, every child health practitioner in the US will tell you that if you didn't breast feed for the first year, you've already condemned your child to getting 5 million ear infections and never graduating high school. You want our children to downgrade from formula to cows milk! No doubt there will be fifty papers in 10 years demonstrating how this cohort of children are three points behind on standardized math tests and get detention more often, and are seeking therapy in record numbers for anxious attachment.
Given that Matt is the father of a 6 year-old and works in a space dominated by college-educated upper middle-class sorts, I'm pretty sure he has some ideas about the intensity of parenting . . . .
True story: when my wife delivered in an NHS hospital in the 80s, the midwives encouraged her to drink beer "to let the milk down". Don't recall whether they specified Guinness, but "Guinness for nursing mothers" is a very well-established adage.
I hate to be “that mom” but I’m really tired of these “breast isn’t REALLY best so we should just feed formula and that’s valid and OK” and then this formula shortage happens and parents are left holding the butts. There are a lot of great things about formula except for the fact that it can’t be produced at point of use by an individual. Mothers are heavily encouraged by social pressure to completely switch babies onto formula if they even think they might not be able to breastfeed. It’s never really looked upon as a viable alternative to use alongside breastfeeding. This is in large part due to the mommy wars and “breast is best” mothers acting like you’re giving your child poison if a drop of formula ever passed baby’s lips.
If mom is mostly breastfeeding for the first 9 months to a year and something like a massive supply issue with formula occurs (but that will never happen!) she can simply work to increase her supply again short term, get through the crisis, and by then as Matt pointed out, the baby will be older and your options are much more flexible. This would also make it easier to supply babies and other people who absolutely DO need formula during a crisis.
In other words - sometimes there are better options than a hard line on infant feeding in either direction.
Yeah, we might be in different filter bottles but all the doctors we've interacted with have been on the "breast is best, and we very very strongly discourage formula use".
I realize I'm coming from a very specific situation but I really disagree with this. My wife had supply issues basically from the start with kid one. He lost way more weight than acceptable for a newborn. Basically every lactation consultant and all the social pressure was "just work harder" to increase your supply and you'll get there. It didn't happen and it was insane amount of work for my wife and she was devastated by it. We tried again with kid two and it also just didn't work but we were in a much better position to realize the situation and quickly changed course. Mental health is much better and both kids are happy and healthy. So now basically any time anyone offers the solution just work harder to produce more milk, it makes my blood boil.
Yeah I get that ant it’s specific to your situation - your family obviously needs formula and I’m not arguing that my idea would work for everyone. I think it would work for enough people that it would potentially have made a difference in this supply chain scenario. It’s the “all or nothing” approach broadly that I think is bad. I’m not commenting on anyone’s personal experience which I know can be difficult and emotional.
I confess I am somewhat surprised that in the course of your research you did not run across or see fit to use the story of the origin of Pablum, the pioneering research in infant and child nutrition, emanating from the the animal husbandry research at a school now known as the University of Guelph. This led directly to the work done at U of T and ultimately resulted in the charitable funding, via rolyalty, of Sick Kids hospital by the inventors of Pablum.
It is a fascinating tale of how you can do both wrong and right.
A few months back my niece (a toddler) was a bit sick and I accompanied my sister to the local CVS for some Pedialyte.
They were out, but basically had the adult version (Adultlyte for purposes of this story). I suggested the two couldn’t possibly be THAT different, and that it would be fine to supplement one for the other...especially since it was all OTC.
However, she felt compelled to ease her concern by asking the CVS employee in the Pharmacy if it would be “okay” and was told in no uncertain terms “no”
He didn’t have any logic, other than it said “Adult” on the box.
To me, it just seemed like a silly issue of overly strict and legalistic guidelines causing more harm in a moment of minor panic than otherwise necessary.
Ultimately, my sister decided against getting it and erred with the Pharmacy Intern....not me.
This reminds me of a few months ago when i accompanied my sister to the local CVS for some Pedialyte for her toddler, but all they had was “Adult Electrolyte Replacement Drink”.
I suggested that she just get that, because certainly the electrolyt
There seem to be a huge variety of types when it comes to baby formula. Is is medically necessary to have so many choices and does this have an impact on the current scrambling in the supply chain?
Sorry to go back to basic principles when you are (and good for you) talking about immediate solutions, but the "What I’ve learned over the past couple of years of Covid reporting, though, is that American medical authorities have a strong preference for unambiguous rules over accurate information" is pretty basic. I'd only add that the "preference" could not exist if they saw their role as enabling people to make rational cost/benefit decisions.
This would help to some degree with babies who are on ordinary formula, but the real crisis is for those who are not. That demand is not elastic. If you can't digest ordinary milk, if you have special needs, if you are tube fed--you need formula. Period.
Yes my understanding is that the real crisis is in special diet-formula where there truly are no substitutes and supply chains are totally whacked. It’s not like you can switch from fancy organic formula to the target stuff in a pinch if your kid needs something specially prepared in a lab.
An excellent article. In addition to adopting Canadian Guidelines, the advice about loosening Trade Rules makes a great deal of sense. Three of our 13 grandchildren lived in the UK in their baby years. The infant formula has less sugar than American options. When babies begin solids, mothers add some formula to leftovers and grind it in a blender. This provides the baby with nutrition that is superior to commercial baby food with low sugar and tastes of the families normal dinner options. These kids grew up healthy, lean and strong. In addition, they were not picky about foods served when they got older.
I had my first in the UK. I never did that. And the sugar in formula is lactose and is pretty much the same from country to country.
I believe the amount of lactose is less in the European formulas. For us in the US to get formula from the UK/ Europe it will mean revising the Trade Policies.
It is not. I don't know whee this comes from--I've heard it before along with "US formulas use corn syrup" (only true for allergy versions). But I've checked. Both US and European formulas are designed to mimic the composition of breastmilk and as such should have the same amount of sugar. Enfamil claims to have 0.1g/100ml more sugars than Aptamil, which is not significant.
In fact, Mead Johnson makes many of its specialty formulas in Europe--they just don't seem to compete there on their standard baby formula (Enfamil).
Thank you for pointing this out. My opinions are just formed by experience (in this case 25 yrs ago) and articles I’ve read. They can always be improved.
Apologies for the noob question. If the main problem with cow's milk is that it doesn't contain enough iron, so babies that can tolerate solid food should also eat more iron-rich foods..... why can't parents, say, blend up iron supplements in cow's milk? And if iron isn't the only problem, then other supplements as needed?
This seems obvious enough that I must be missing something. Obviously getting an optimized balance of supplements to blend into a smoothie is a lot of work/too much to expect from parents as a general rule, but it seems like there are non-trivial numbers of parents going to great ends to try to find formula anyways. Are there other things in the vitamin supplements that would be bad for babies?
I guess the question is basically.... why haven't I seen anyone advocating "homemade formula" in the short term? This seems like the sort of advice that pops up elsewhere (ie, homemade cloth masks early in the pandemic despite official guidance against masking).
Because homemade formula is dangerous. You can't really replicate everything they've put in there, and people can and will screw it up.
So one question is *why* it's dangerous. Is it something that's in the vitamin supplements? Is it about sterilization? If the latter, it seems much less likely that bacteria would grow in a jar of iron pills than in solid iron-rich food. And you could boil it first? Like I get that people mess things up, but in the short term adding iron pills to boiled cow milk seems much less dangerous than underfeeding a baby.
And on "you can't really replicate everything they've put in there" - do you need to, in the short term? Like, is there something about the particular balance that's important to get right and has serious short term side effects if you get it wrong/only provide part of what's needed?
I hope these come across in the intended spirit of really not getting it, rather than trying to be difficult.
Okay. So. There is way more involved than just supplements.
In order to get a formula that’s suitable for babies (not a 9 month old who is also eating) you need to alter the nutritional balance. This is why the old school formula is for evaporated milk and Karo syrup that’s diluted. Even if you adjusted the vitamins with a supplement, you’d still need to fix that. In regular formula they use lactose as the sweetener. Karo is used because it’s glucose syrup that is less sweet than table sugar. But Karo can potentially contain botulism, and it gives some babies diarrhea, which is why it’s a folk remedy for infant constipation.
Evaporated milk and corn syrup is precisely what my mother (born 1922) was fed. She grew up to be very weird but I don't actually think the evap milk/corn syrup was why.
Respectfully, the infant mortality rate in 1922 was 76.2 per 1,000 live births. In 2022 it was 5.547. That's the difference.
I was born in 1952 and don't know any of my age group who were fed on infant formula, yet we all made it to adulthood and many to successful lives. I doubt it even existed. Reading this chain of freakouts over the formula shortage has been eye opening into the mentality of young Americans, and not reassuring.
I don't have babies and have barely paid attention to this, but I did take two minutes to peruse amazon.com and walmart.com. From the former I see I can get formula delivered to my house in two days (https://www.amazon.com/Similac-Alimentum-Hypoallergenic-Formula-1-Quart/dp/B000ARWL46/ref=sr_1_2?crid=18A8CV94EVOQ4&keywords=infant+formula&qid=1652800199&sprefix=infant+%2Caps%2C149&sr=8-2) and from the latter I see bunches of different types of formula deliverable with 3-day shipping (https://www.walmart.com/search?q=infant+formula)
Maybe I'm missing something, however.
To think the Federal Deprivation Agency has fallen so low
On the margins a bigger market by allowing import is more cushion for a single plant closing (and is probably a good idea), but coming from Covid, it seems like some of the problem is that we have hyper-efficient supply chains that have no slack, and I wonder if long-term companies just compensate for more distributed risk in a broader market by putting even less slack in the supply chain.
It seems like some of the solution is that we really need some more thought into what things the government needs to guarantee or regulate an oversupply to deal with potential risks. What it looks like depends on the failure modes of production, but in this case, maybe the government needs to incentivize warehousing a couple weeks worth of infant formula so that there's more slack in the system (a sort of distributed strategic infant formula reserver).
I don't think the larger market necessarily means there is less slack - they probably try for as little slack as possible either way.
But for things like formula or gasoline where there aren't really substitutes (if there's a wheat shortage we (the U.S.) have plenty of corn or potatoes or what not to help tide everyone over) we might want something a strategic reserve.
Although... formula has a shelf-life (unopened) of only 1 year so it's probably trickier to manage this than petroleum. I know this was a consideration when we were donating our excess formula when the kids' stopped needing it.
I might be wrong that there's any amount of deliberate/inherent slack in the system to deal with fluctuations, but my instinct is because of law of large numbers, the larger your market, the less percentage of product you need to warehouse because you can shift fluctuations in demand from production to shipping.
The shelf-life problem is definitely tricky—that's why I think the answer would probably be something like paying manufacturers to warehouse a certain quantity of formula <1 month post manufacturing, so there's a rolling buffer.
We seem to be particularly bad at these kind of collective public health (or p.h. adjacent) issue.
I'm sure both social and bureaucrattc dysfunction is involved, but it seems like instead of basically saying something like 'There is a baby formula shortage, so if your child is over X months of age and otherwise healthy, please consider...' and trusting the enough of the public can understand and will try to comply, we get all kinds of tortured messaging in an attempt to achieve a similar result.
It closely parallels the 'masks aren't effective' guidance early in the pandemic.
They could have just come out and repeatedly said 'masks are somewhat effective, but we need to reserve them for front-line workers until supply improves.'
Instead of trying to manipulate the public, give an honest and straightforward message and let the chips fall where they may.
Seems like as good a place as any for me to yell into the void: The fact that the shutdown of *one* factory can put us in crisis mode is pants on head stupid.
I wonder if particularly onerous regulations helps cause the kind of market consolidation that leads to this?
Getting a plant qualified by the FDA to produce this is pretty costly, and that may pose a barrier to entry, and/or enhance the competitive advantage of being a big company in general.
It might not be possible to do both. I suspect that that determination will require a lot of technical expertise about food production, and I don't have that.
I do have experience dealing with the FDA from a medical device design, safety analysis, and manufacturing standpoint, and I do think that many of the FDA's requirements there are pretty onerous - and not very effective at really mitigating safety risks, and so probably unnecessary.
It is a different animal than food production, but I kind of assume (perhaps unfairly) that the bureaucracy will function similarly across the board.
Would you be so kind as to expand on the OSHA construction site provisions? I have not heard about this, and I would very much like to know more. Thank you!
Matt. You do not understand the intensity of parenting in this country, especially around things like diet, and a desperate desire to be the best parent ever by doing the most for your child (as determined by parenting blogs), everyone else be damned. Plus, every child health practitioner in the US will tell you that if you didn't breast feed for the first year, you've already condemned your child to getting 5 million ear infections and never graduating high school. You want our children to downgrade from formula to cows milk! No doubt there will be fifty papers in 10 years demonstrating how this cohort of children are three points behind on standardized math tests and get detention more often, and are seeking therapy in record numbers for anxious attachment.
Given that Matt is the father of a 6 year-old and works in a space dominated by college-educated upper middle-class sorts, I'm pretty sure he has some ideas about the intensity of parenting . . . .
/s
Import Irish baby formula. Has extra Baileys Irish Crème, which helps babies sleep through the night.
"...Baileys Irish Crème..."
Guinness or feck off.
True story: when my wife delivered in an NHS hospital in the 80s, the midwives encouraged her to drink beer "to let the milk down". Don't recall whether they specified Guinness, but "Guinness for nursing mothers" is a very well-established adage.
This is the content I pay for.
I hate to be “that mom” but I’m really tired of these “breast isn’t REALLY best so we should just feed formula and that’s valid and OK” and then this formula shortage happens and parents are left holding the butts. There are a lot of great things about formula except for the fact that it can’t be produced at point of use by an individual. Mothers are heavily encouraged by social pressure to completely switch babies onto formula if they even think they might not be able to breastfeed. It’s never really looked upon as a viable alternative to use alongside breastfeeding. This is in large part due to the mommy wars and “breast is best” mothers acting like you’re giving your child poison if a drop of formula ever passed baby’s lips.
If mom is mostly breastfeeding for the first 9 months to a year and something like a massive supply issue with formula occurs (but that will never happen!) she can simply work to increase her supply again short term, get through the crisis, and by then as Matt pointed out, the baby will be older and your options are much more flexible. This would also make it easier to supply babies and other people who absolutely DO need formula during a crisis.
In other words - sometimes there are better options than a hard line on infant feeding in either direction.
It's like we socially, collectively, oscillate between extremes.
Either 'breast is best and you are a failure if you don't breastfeed' or 'formula is just as good and how dare you shame mothers who don't breastfeed'
A boring but reasonable stance of:
'breast is best, but formula is good enough in almost all situations, so don't stress out about it too much one way or the other.'
...doesn't get much social visibility.
(Even though I think that's basically the american pediatrics official stance.)
Yeah, we might be in different filter bottles but all the doctors we've interacted with have been on the "breast is best, and we very very strongly discourage formula use".
I realize I'm coming from a very specific situation but I really disagree with this. My wife had supply issues basically from the start with kid one. He lost way more weight than acceptable for a newborn. Basically every lactation consultant and all the social pressure was "just work harder" to increase your supply and you'll get there. It didn't happen and it was insane amount of work for my wife and she was devastated by it. We tried again with kid two and it also just didn't work but we were in a much better position to realize the situation and quickly changed course. Mental health is much better and both kids are happy and healthy. So now basically any time anyone offers the solution just work harder to produce more milk, it makes my blood boil.
Yeah I get that ant it’s specific to your situation - your family obviously needs formula and I’m not arguing that my idea would work for everyone. I think it would work for enough people that it would potentially have made a difference in this supply chain scenario. It’s the “all or nothing” approach broadly that I think is bad. I’m not commenting on anyone’s personal experience which I know can be difficult and emotional.
I confess I am somewhat surprised that in the course of your research you did not run across or see fit to use the story of the origin of Pablum, the pioneering research in infant and child nutrition, emanating from the the animal husbandry research at a school now known as the University of Guelph. This led directly to the work done at U of T and ultimately resulted in the charitable funding, via rolyalty, of Sick Kids hospital by the inventors of Pablum.
It is a fascinating tale of how you can do both wrong and right.