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. 2024 Mar 5;16(5):748.
doi: 10.3390/nu16050748.

Cross-Sectional Analysis of Infant Diet, Outcomes, Consumer Behavior and Parental Perspectives to Optimize Infant Feeding in Response to the 2022 U.S. Infant Formula Shortage

Karla Damian-Medina  1 , Karina Cernioglo  1 , Maha Waheed  1 , Dina M DiMaggio  2 , Anthony F Porto  3 , Jennifer T Smilowitz  1
Affiliations

Cross-Sectional Analysis of Infant Diet, Outcomes, Consumer Behavior and Parental Perspectives to Optimize Infant Feeding in Response to the 2022 U.S. Infant Formula Shortage

Karla Damian-Medina et al. Nutrients. .

Abstract

In May of 2022, millions of U.S. parents encountered uncertainty in safely feeding their infants due to the infant formula shortage.

Methods: An anonymous, electronic, cross-sectional, retrospective survey was used.

Results: U.S. parents (n = 178) whose infants were ~10 weeks old during the shortage completed the survey. Of parents, 81% switched formulas during the shortage, 87% switched because they could not find the formula they typically used, 34% switched 3-5 times, 29% of parents visited ≥4 stores/24 h and 26% of parents traveled >20 miles/24 h to purchase formula. Use of infant formula increased (p < 0.01); in infants requiring specialty formula, use of intact cow's milk formula increased (p < 0.05) and use of premature infant formulas decreased (p < 0.05). Infants relying on specialty formulas experienced at least one undesirable outcome compared with non-specialty users. Parents used social media, relatives/friends and healthcare providers for support during the shortage, but their helpfulness scores were suboptimal. Parents reported the need for greater infant formula availability, free prenatal lactation education and postpartum lactation support.

Conclusions: Government, regulatory and healthcare policy oversight are needed to protect the infant feeding system, including more commercially available products, access to banked donor milk and lactation support.

Keywords: breastfeeding; consumer behavior; equity; feeding practices; food security; government and regulatory policies; health; infant formula shortage; lactation; pediatrics.

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Conflict of interest statement

J.T.S. received a gift from Bobbie to support this project. Bobbie was not involved in analyzing the data generated from this or drafting this manuscript. D.M.D. and A.F.P. are medical consultants to Bobbie Labs, the research arm of Bobbie Infant Formula (U.S.).

Figures

Figure 1
Figure 1
Infant-feeding practices before and during the infant formula shortage. (A) Human milk and infant formulas. MOM = mother’s own milk; BM = breast milk; DHM = donor human milk; IF = infant formula. * p < 0.01 (n =178). (B) Complementary foods and beverages. Data are expressed as the mean (n =178).
Figure 1
Figure 1
Infant-feeding practices before and during the infant formula shortage. (A) Human milk and infant formulas. MOM = mother’s own milk; BM = breast milk; DHM = donor human milk; IF = infant formula. * p < 0.01 (n =178). (B) Complementary foods and beverages. Data are expressed as the mean (n =178).
Figure 2
Figure 2
Type of specialty infant formula used before and during the infant formula shortage. AA = amino acids; IF = infant formula. * p < 0.05. Data are expressed as the mean (n = 33).
Figure 3
Figure 3
Methods used by parents to obtain infant formula before and during the infant formula shortage. HCP = healthcare provider; FF = friends or family. * p < 0.05; ** p < 0.01. Data are expressed as the mean (n = 178).
Figure 4
Figure 4
Health outcomes experienced by infants during the shortage. Infants that required specialty formulas (n = 32) vs. infants that did not require specialty formulas. Data are expressed as the mean (n =109).
Figure 5
Figure 5
Resources parents used to obtain guidance or support to help them feed their infants during the infant formula shortage. (A). Percent of parents that used each resource. (B). Parents’ ratings on the helpfulness of each resource. Dietitian (n = 7); social media (n = 89); relatives or friends (n = 76); WIC (n = 3); nurse or midwife (n = 9); HCP (n = 84); blogs (n = 33); doula (n = 10); birthing class (n = 12); BF support group (n = 24); LC (n = 53); IF companies’ websites (n = 37); health authorities’ websites (n = 32); other websites (n = 9); videos (n = 9); other (n = 4); news (n = 28); radio (n = 4); telephone (n = 1). HCP = healthcare provider; BF = breastfeeding; LC = lactation consultant or lactation counselor; IF = infant formula. Data are expressed as the mean ± standard deviation error bars.
Figure 6
Figure 6
Parents’ ratings on the helpfulness of activities that would help families feed their infants in the near future. More IF brands in WIC (n = 9); no restrictions on IF (n = 166); insurance pays for U.S. IF (n = 169); LC support postpartum (n = 169); info online of lists of similar IF (n = 171); more IF brands sold in U.S. (n =166); info online of lists of where to buy IF (n = 171); insurance pays for imported IF (n =167); prenatal LC education (n = 168); insurance pays for DHM (n = 152); bottle-feeding education (n = 169); free DHM (n = 148); stockpile prevention (n = 163); discounted DHM (n = 140); LC support with relactation (n = 157); online videos of relactation (n = 158); online homemade IF recipes (n = 154). IF = infant formula; LC = lactation consultant or lactation counselor; DHM = donor human milk. Data are expressed as the mean ± standard deviation error bars.
Figure 7
Figure 7
Parents’ perceptions of and relation to statements about infant formula. IF = infant formula; BF = breastfeeding. Data are expressed as the mean (n = 178).
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