Tips for Navigating the Formula Shortage, with Christina Berlett, IBCLC
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The big topic this week among our After Baby Club members, across social media, and in the national news: the formula shortage. It’s a stressful situation for a lot of families, and it’s incredibly scary. If formula isn’t available, what will we feed our babies?
Erica and I have been fielding questions, facilitating discussions, and working hard behind the scenes to connect our families with reliable, evidence-based information. While social media can be a great tool in this information age, it is also a super-conduit for misinformation. To clear things up and get the best answers for all of these questions, we’ve called in our friend and colleague Christina Berlett, an International Board Certified Lactation Consultant (IBCLC).
Are different formulas really that different from one another? If I can’t find formula, what can I feed my baby instead? How about relactating? Is donor human milk a viable option? We explore all of these questions and a ton more in our recorded chat with Christina. If you’re looking for an abbreviated version, keep reading.
Before we dive in, keep in mind that the information we’re sharing here is reliable and evidence-informed, but it is also general in nature. We are perinatal professionals, but unless you’ve established as a client with one of us, we are not YOUR perinatal professionals. If you have questions about how this information applies to you and your specific situation and circumstances, get in touch with us (we love new clients!) or with your care provider.
Meet our guest, Christina Berlett
Erica and I were so excited to welcome Christina, our professional colleague and new friend, into our community. She’s been a pediatric nurse for 17 years, with 8 of those years being in the Pediatric ICU, and earned her credential as an IBCLC in 2018. Christina works at University of Maryland hospital in downtown Baltimore as well as through her private practice, Mama Moon Lactation, which she just started last summer. She is a mom of two, and she lives with her family in the Hereford Zone – so she’s a clinical professional but also a member of our local community. We’re linking more information about Christina, Mama Moon Lactation, and how you can work with her as an IBCLC at the bottom of this article.
My baby’s formula was recalled. What do I do?!?
Enfamil, Similac, and store brands of formula…the differences between them are negligible. Turn over that can of store brand formula and check out the ingredients and you’ll see that they contain the same ingredients as the big brand names. The main differences are in how they’re packaged and marketed – which also accounts for the big difference in price.
It’s totally fine to use a different brand than you normally use and/or to switch back and forth between brands. The different brands package their comparable products in the same color, which makes it easier to determine which product you need. Check out this post from Lactation Hub for an easy visual.
“Sensitive” formulas are different from “normal” formulas; the proteins are broken down more than in a normal formula, making them easier to digest. Sensitive formulas are often labeled with words like “gentle,” “spit up formula,” or “comfort.” The sensitive formulas are, for the most part, interchangeable with one another. So, for example, if you usually buy Similac Sensitive, you could use Enfamil Gentlease instead.
What if I can’t find any formula at all? Can I make my own?
We’ve been seeing a TON of Facebook posts suggesting homemade formula, goat’s milk, and other alternatives. The American Academy of Pediatrics (AAP) cautions against the use of these alternatives, specifically because only human milk and infant formula have the proper electrolyte balance that babies need in their diets. This very specific electrolyte combination is absolutely crucial for babies, especially young babies, and babies whose electrolyte balance is off can become very, very sick.
We’ve also been seeing a lot of arguments FOR the use of these alternatives from folks who are concerned and well-intentioned but misinformed. It’s true that homemade formulas were widely used in the past. It’s also true that today we have much, much more research-based knowledge about safe and effective feeding of infants and babies, and now we know that homemade formula is not safe. Think of it this way: when Erica and I were kids in the 90s, we rode in the front seat of our parents’ cars – without car seats. At the time, that’s what we did. Today’s parents gasp in horror at the thought of their own littles riding without a proper safety restraint. When we know better, we do better.
What about toddler formula? Cow’s milk? Solid food?
Some pediatricians are saying that if your baby is older (say, 10 months old or more) and healthy, it might be okay to use toddler formula for a short amount of time. It should only be used short-term and not as a long-term solution. Because the electrolyte composition is different from infant formula, it’s not suitable for young babies.
As for cow’s milk, new guidelines from the AAP cite that cow’s milk may be an option “if your child is older than 6 months of age and is usually on regular formula (not a speciality product for allergies or other special health needs.)” Like toddler formula, it can be appropriate for short-term use (the AAP says up to one week) but isn’t suitable as a long-term solution. Cow’s milk doesn’t contain enough iron and, if given long-term, can lead to anemia.
If your baby is older than 6 months, adding solid foods to their diet can take some of the pressure off of meeting their complete dietary requirements with formula or human milk alone. Christina recommends focusing on nutrient-dense, real foods (think fruits, vegetables, meats, healthy fats) as opposed to puffs or Cheerios. Remember, though, that a baby’s digestive system is still developing and isn’t able to digest solid foods in the same way an adult can. Formula or human milk should be the main source of nutrition until at least age one.
If you’re considering any of these options, talk to your pediatrician, who can provide tailored advice for you and your baby based on your unique circumstances. You can also check out this article from the American Academy of Pediatrics about alternatives.
I’m breast/chest feeding (or pumping) but also supplementing with formula. Can I increase my milk supply?
Yes! Each parent’s situation is unique, but in many cases it’s totally possible to increase milk supply. An IBCLC is a wonderful resource to help you troubleshoot and come up with a plan that will work for you.
When she’s helping clients with low supply, one of the first things Christina wonders is whether the parent actually has a low milk supply or just thinks they do. This is actually really common! And we get it – when you’re feeding directly from your body, you can’t see how much milk your baby is getting. Plus, those huge freezer stashes of milk you see on social media might make you feel like your pumping output is subpar (when in reality you’re doing just fine). An IBCLC will take a detailed medical history of parent and baby, look at diaper output and weight gain, observe a feeding session, and do a weighted feed to find out just how much milk baby is transferring when they feed. This comprehensive look at your feeding situation can help you determine what’s actually going on with something you can’t see or quantify.
If you’re hoping to increase output with your pump, Christina recommends checking your flange fit as a first step. The flange is the plastic piece that your nipple is pulled into when you’re pumping, and they come in a wide variety of sizes. Most pumps come standard with 24 and 27 mm flanges, but many parents need smaller sizes. A flange that is too big pulls in too much areola and doesn’t put adequate pressure on the nipple. There’s a wonderful infographic on flange sizing from IBCLC Jeanette Mesite Frem as well as a free guide available on her website. If you need help with sizing, Christina or your local IBCLC can help with that, too!
I was breast/chest feeding or pumping previously but stopped. Can I start again?
Relactation – or re-establishing a milk supply after weaning – is theoretically possible if you have lactated at some point in the past. However, are YOU a good candidate for relactation? That’s the bigger question here. There are many factors that determine how easily and how quickly a parent can re-establish a milk supply. How long were you lactating, and how long ago did you stop? Did you have a good supply before you stopped? Did you have complications during labor and delivery (which may have impacted your milk production), or did you/do you have any medical conditions that affect your supply?
Christina advises that if you had a robust milk supply and weaned recently, say within the last 6 months, you could probably relactate. If you lactated briefly a few years ago, it’s possible to relactate, but it might take longer, and you might not reach a full supply. That said, lactating doesn’t have to be all or nothing. Combination feeding – where you feed some human milk and some formula – is totally doable. Even half the amount of breastfeeding or pumping sessions may provide some human milk and reduce your need for formula.
I think I want to relactate. How do I do it? Should I?
If relactating is something you want to try, be prepared for a commitment. Re-establisbing a milk supply will require a minimum of 8 milk removals in 24 hours (either by putting baby to breast and/or using a breast pump), including at least 2 milk removals in the overnight hours. An IBCLC can be an excellent partner to help you make a plan about how to accomplish this, whether you’re trying to transition your baby back to the breast, hoping to pump your milk, or both.
Relactating can be a good option for some people, but it is definitely a lot of work. Erica and I want to stress that the decision to relactate should also include deep consideration for your mental health. Don’t get us wrong – we don’t want to convince you not to do it. We are huge proponents of breastfeeding! We also know that your plate is already full, and this is an undertaking that truly requires dedication, social support, and mental and emotional energy. If you take stock of your life and decide this would compromise your mental health, there’s absolutely no shame in deciding it’s not right for you.
What about donated human milk?
Donated human milk is an excellent alternative to formula as it is the biologically-normal food and contains the ideal combination of nutrients for human babies. Whether you’re a parent with a surplus of milk to donate or a hopeful recipient who would be grateful for donated milk, we can help connect you. Christina, Erica, and I are facilitating these kinds of connections all the time. Your local parent Facebook groups, Eats on Feets (and their respective Facebook groups for Maryland and Pennsylvania), and Human Milk for Human Babies (with specific groups for families in different areas, including the Maryland and DC Metro Area are other excellent places for these connections to be made.
We’ve heard concerns from some people about feeding milk from someone you don’t know. And we get it! Christina mentions that most people who are donating milk are feeding the same milk to their own babies, which may help some parents feel more at ease. It’s also totally reasonable to ask a milk donor questions about their diet, if they are taking any medications and what those are, and whether they drink alcohol and how much. If your baby has dietary restrictions, it can be harder to find compatible donor milk, but it’s not impossible!
What do I need to know about feeding donated milk if I usually feed formula?
Formula-fed babies typically stool less frequently than babies fed human milk. If you switch to human milk, you will likely notice that your baby is pooping more frequently, and the poops may look yellow and/or seedy. This isn’t the same as diarrhea – it’s just the normal way the body absorbs and excretes human milk.
Another big difference between formula and human milk is the amount given per feed. Formula is 20 calories per ounce, so as babies get older they require more ounces of formula per bottle to keep up with their increasing caloric needs. A parent’s milk, on the other hand, changes in nutrient content as their baby gets older. This means that as babies get older and their caloric needs increase, they don’t require larger volumes of human milk. A 6-month-old baby who eats a 7-8 ounce bottle of formula would likely only need 3-4 ounces in their bottle if they’re being fed human milk instead.
With this in mind, you might be wondering if the age of the donor parent’s baby matters. The short answer, according to Christina, is no. Babies in the NICU are often fed donor milk from a milk bank without knowing the age of the donating parent’s baby. The difference isn’t great enough to cause a concern.
Are there any ways I can make my formula last longer?
Stretching formula by diluting it is dangerous, so don’t do that! Formula needs to be prepared according to the directions on the package. Remember that proper electrolyte balance is super important for babies, and babies can get really sick when it’s out of balance.
Reducing waste, however, is a great way to make your formula (or pumped human milk) last longer. Christina recommends a method called paced bottle feeding. The idea here is that the baby has more control of the feed and can communicate when they’re full, which helps to prevent overfeeding and might reduce the overall amount of formula or pumped milk being fed.
Think of it this way: if you’re holding baby flat and holding the bottle in a vertical position, gravity is pouring the liquid into baby’s mouth, and they’re gulping it down. They don’t have any option but to swallow to deal with the flow, and they will likely eat everything in the bottle very quickly. With paced bottle feeding, we’re holding baby in a more upright position and holding the bottle horizontally. We’re watching for and responding to hunger and satiety cues, giving the baby breaks, and making the feed last longer. Christina recommends spending 5-7 minutes per ounce, meaning a 4 ounce bottle would take at least 20 minutes to feed. When a baby eats slowly, their belly has time to communicate with their brain that they’re full. When we’re watching for these signs, we can stop feeding when baby lets us know they’ve had enough.
My friend is struggling to find formula. How can I help?
For those of us on the sidelines, watching our friends and family struggle to feed their babies can leave us feeling desperate to help and, simultaneously, incredibly helpless. Erica and I have made our careers out of helping others, and something we have learned is this: helping others is first and foremost about serving them, not about making us feel good about helping (although this is often a pleasant side effect). This reminder helps us tap into our deep empathy, avoid saying or doing things that seem helpful on the surface but actually aren’t in the long run, and focus on truly doing the most good.
Don’t underestimate what just being there for someone can do for them. Hold space. Listen, without judgment and without trying to offer solutions (unless your friend has specifically asked for that). You may not be able to do much to help with practical matters, but you can do much to support your friend’s mental health. And this is huge! Feeling held, heard, and seen by community is one of the biggest contributors to how someone experiences a difficult situation.
I need support, but I don’t know where to start. Help?!
Start with us. That’s what we’re here for! Rooted Willow Community exists to connect you with the support you need, even when you’re not yet sure what that means.
Erica and I want you to know that this is big stuff. It’s heavy, and it’s scary, and any and all big feelings you’re having about it are totally valid. If you’re not already a part of our group, check us out at Rooted Willow After Baby Club. We’re here, and we can help.
When her son was born in 2010, she had no idea how much they would struggle with breastfeeding! She didn’t have the support and resources needed to meet her feeding goals. In 2013 when her daughter was born, she had help from amazing IBCLCs. Even though they had obstacles – tongue and lip tie, thrush, mastitis – she met her breastfeeding goals because of the support she received.
Christina thought, “if this support and guidance made such a difference for me, maybe I could do that for other parents!” Then Christina became a La Leche League leader in 2014 and began working toward certification as an IBCLC. Christina started Mama Moon Lactation in the summer of 2021 to provide evidence-based care to support your feeding goals and help you uncover your own instincts as a parent.
