The Formula Shortage: Lactation Providers Can Help
In February, Abbott Nutrition recalled several types of regular and special-needs formula due to contamination. The recall compounded supply shortages already occurring due to COVID-19, and the result is a true infant feeding emergency.
Families around the country who rely on infant formula are facing unprecedented stress. As a professional trained in infant feeding, what help can you offer?
Here, based on the Emergency Nutrition Network’s document Operational Guidance on Infant Feeding in Emergencies, are evidence-based recommendations and ways you can help during this global crisis.
Increasing Milk Supply
Many infants under six months of age affected by the formula shortage are partially breastfed. With your support, a parent who is mixed-feeding may be able to increase their milk supply and rely less on formula.
Here’s how to help:
- Start with a thorough history. Understanding how and why formula became part of the feeding picture is important to creating a plan to increase supply. If there were problems that led to supplementation, they need to be addressed.
- Evaluate baby’s current intake of breastmilk and formula to create a plan for safely reducing supplementation while increasing milk supply.
- Optimize breastfeeding.This is the first-line treatment for increasing supply. Provide support for optimal latch and position, and urge the parent to nurse as often as baby is willing. Teach breast massage and compression techniques to ensure emptying, and encourage skin-to-skin.
- Maximize pumping. Research has shown that some parents can double their pumping output with hands-on pumping. Our illustrated handout for parents explains how.
- Herbal galactogogues and medications. Provide accurate information and resources on the use of these for parents.
- Follow them closely. As a parent reduces supplements and increases supply, follow up frequently to ensure adequate intake and weight gain and provide encouragement.
These topics and more are addressed in this course.
Parents who didn’t initiate lactation or who have weaned may find themselves wondering whether it’s possible to provide their milk for their baby due to the formula shortage. Offering information, support, and encouragement for relactation is one way you can help.
- Start with a Complete History. A parent who has weaned may not have gotten adequate help with problems they encountered and may be starting from a place of already having had a difficult lactation experience. They or their baby may have had underlying issues that went undetected and unaddressed, contributing to the decision to wean and could affect their relactation attempt–their baby may have tethered oral tissues, for example.
- Protocols and Galactogogues. Multiple protocols and approaches to relactation exist, incorporating various combinations of pumping/feeding, herbal galactogogues, and prescription medications. Familiarizing yourself with the protocols, galactogogues, and medications is key.
A thorough understanding of their experience from birth to the present (including how much of a milk supply the parent established, how long the baby nursed, and what led to weaning) is absolutely key to creating a plan that can work for relactation.
For a complete discussion of how to explore these questions and plan for successful relactation, check out our free live webinar on this topic!
A relactating parent may also need help encouraging their baby to the breast and may benefit from help with how to use a supplemental nursing system.
All of these topics and more are explored in depth in our class Relactation and Induced Lactation, which explains five relactation protocols and prepares you to help a relactating parent manage and safely reduce supplements over time as their milk supply grows.
You can find concise information about relactation, including how to determine an infant’s intake needs, in our free two-page handout. This handout can also be shared with parents.
Wet Nursing and Donor Milk
Not all parents will want or be able to relactate, and building a milk supply takes time.
Wet nursing and donor milk can be used alone, or in conjunction with relactation–as the parent works to increase their own milk supply, these can be used to supplement the milk they’re making.
The topics of wet nursing and donor milk are culturally sensitive and need to be approached with awareness of the individual’s culture and comfort level. However, where there is comfort around them, they can provide great benefits. Helping families explore these alternatives and access them in their own context is one more way you can assist.
Lactating parents who have an ample milk supply may ask you how they can help other families during the formula shortage. Encourage these families to explore donating their milk and help them identify options in your community for donating.
Help Families Get a Great Start
The formula shortage constitutes a global emergency, and events that threaten food security for infants around the world are becoming more and more commonplace.
Families you are supporting prenatally or those who have just given birth are in a great position to focus on establishing an abundant milk supply that will avoid reliance on formula.
Your skill and expertise in counseling these families about how to establish and maintain all the milk they need to feed their baby helps them create a secure food source for their own infant–and lessens demand for infant formula overall, so there is more available for babies who are unable to receive human milk.
Support Families Where They Are
For some parents, relactation, donor milk, and wet nursing will not be options for a variety of reasons. As lactation support professionals, our first job is to listen to families, understand their concerns and perspectives, and help them to meet their goals.
During the formula shortage, providing effective care may mean understanding the proper use of formula and attempting to help families explore avenues for accessing it in their context.
Keep these keys in mind:
- Babies under six months who cannot receive human milk need formula. Cows’ milk or alternative milks are not appropriate.
- Adding extra water to infant formula to extend the supply is dangerous and should not be done.
- For infants over six months, if formula is not available, in an urgent situation it may be replaced with pasteurized, full-cream cow or goat milk, or ultra-high temperature (UHT) milk, reconstituted evaporated (but not condensed) milk, fermented milk or yogurt.
- Follow-on milks, growing-up milks, and toddler milks marketed to children aged six months or over are not necessary. Standard infant formula is adequate.
- Home-modified animal milk is not recommended for infants less than six months of age due to significant nutritional inadequacy and should only be used as a last-resort, stop-gap measure.
This free, in-depth discussion of relactation was recorded live and featuresTaNefer Camara, MS-HCA,IBCLC, a Maternal Health Strategist with over 15 years of experience supporting families through birth, breastfeeding, and postpartum.