Baby Formula: What Happened and What Does the Future Hold?

Those who are parents, want to be parents, or know parents of young children are probably more than aware of the recent baby formula recalls. In September of 2021, the first complaint of Cronobacter was reported to the Minnesota Health Department.¹ Since then, things have spiraled. As of now, there is still a baby formula shortage, concerns for Cronobacter, and a need for healthy, safe formula options for babies. 

What are the recalls about? 

The latest recalls have been focused on a specific bacterium, Cronobacter sakazakii. This is a commonly found bacteria naturally occurring in the environment. While infections are reported to be rare, the CDC reports about 2-4 cases per year, yet the actual number is unknown as it is not an illness that is required to be reported.² Cronobacter dwells in dry powders, particularly the common form of baby formula. This bacterium survives in the dry powder and flourishes once water is added. 

When a contaminated formula is consumed, especially within the first few days to weeks of their lives, it can be life-threatening. Those younger than two months of age can develop meningitis or sepsis due to the bacteria targeting the central nervous system.³ Those with weakened or compromised immune systems can need hospitalization and extreme medical treatment such as chemotherapy. The first symptoms to appear typically are fever, inappetence, excessive crying, and lethargy. However, it can quickly progress to seizures.² 

Cronobacter is naturally occurring in the environment and can be found on surfaces in the home such as kitchen counters, sinks, and bottles, but it can also wreak havoc in manufacturing facilities.³ Interestingly, as of late, the Council of State and Territorial Epidemiologists has voted that Cronobacter sakazakii infections must be reported to the CDC. The CDC has supported this position and it is expected to be required come 2024.⁴ 

Which formulas/brands have been recalled? 

In October 2021, an informant came forward about Abbott employees falsifying records and failing to test formulas prior to releasing.¹ This started an investigation in January of 2022, and in February 2022, Abbott had a voluntary recall on Similac, Alimentum, and EleCare powdered formulas.^1,5,6,7 More information regarding lot codes of recalled formulas can be found here. As of February 2023, more than 145,000 cans of Enfamile ProSobee Simply Plant-Based Infant Formula have been recalled.¹ This recall in addition to the supply chain issues post-pandemic,8 quickly led to a formula shortage, which left many parents struggling to find enough formula for their babies. As of August 2023, baby formula shortage is still an issue and there are still signs on the shelves limiting customers how many they can purchase, where there once was a variety of multiple types of formulas. 

What are alternatives? 

Finding the “right” formula for a baby can be quite difficult, but finding another can be downright impossible. According to the US Department of Health and Human Services,⁹ finding another brand, if it is the same type (cow’s milk, soy, hypoallergenic, elemental) can be an alternative during the formula shortage. However, it is also noted that a slow transition can be beneficial, and it is possible that a baby may not like the taste of the new formula or may have difficulty tolerating it at first. Another alternative, according to the US Department of Health and Human Services, is to find a formula made from another country.⁹ Some stores in the US offer formulas that are manufactured outside of the US (^*only if reviewed by the FDA)¹⁰ and some brands are only available online. Noteworthy, the risk of counterfeit infant formula is increased when buying online. Lastly, an alternative can be substituted for hypoallergenic or specialty formulas. Before making this change, it is important to discuss with the child’s pediatrician or healthcare provider what is an acceptable substitute for a specific individual. However, not all alternatives are appropriate or healthy. Some risky alternatives have been trending lately, such as replacing formula with rice drinks, goat’s milk, cow’s milk, almond milk, protein shakes, and watering down the child’s current formula. These options can lead to nutrient deficiencies and negatively affect the child’s growth and development.¹¹ 

Where to go from here? 

With the infant formula shortage still present, it is important to talk to the child’s pediatrician if a child’s formula is on the recall list or becomes difficult to find. It is important to remember to buy only what is needed; the American Academy of Pediatrics (AAP)¹² recommends no more than a 10-day to 2-week supply of formula to help ease the shortage for other parents and guardians. Parents and guardians can also reach out to local organizations, such as WIC if the formula is out of stock. Most importantly, staying aware of any additional recalls and working with the child’s pediatrician for appropriate feeding recommendations is advised. 

 References 

1. https://www.drugwatch.com/baby-formula/recall/ 
2. https://www.cdc.gov/cronobacter/infection-and-infants.html 
3. https://www.fda.gov/food/foodborne-pathogens/cronobacter-sakazakii 
4. Goodman, B. Cronobacter, bacteria linked to baby formula shortage, to become nationally reportable. June 29, 2023. https://www.cnn.com/2023/06/29/health/cronobacter-notifiable-diseases/index.html 
5. https://wicworks.fns.usda.gov/resources/infant-formula-recall#:~:text=On%20Feb.,or%20Salmonella%20Newport%20in%20infants. 
6. https://www.similacrecall.com/us/en/home.html 
7. https://www.fda.gov/food/outbreaks-foodborne-illness/fda-investigation-cronobacter-infections-powdered-infant-formula-february-2022 
8. McGovern, C., Cochrane, S., Yasmin, N. Understanding the 2022 infant formula recall. August. 22, 2022. https://foodsafety.osu.edu/blog/august-22-2022-752pm/understanding-2022-infant-formula-recall%C2%A0%C2%A0 

 

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About the Author

Dr. Stephanie Clark is a board-certified companion animal nutritionist, veterinary nurse and nutrition specialist, a pet owner, and a mother who had a baby during the formula shortage. She has spent the past almost two decades dedicating her career to the welfare of pets, livestock, and wildlife. She currently provides nutritional consultations for veterinary clinics and works in the pet food industry.