A nationwide shortage of infant formula that stressed families for much of 2022 is easing in Wisconsin, but questions about access to formula still raise some health care providers.
Grocery store shelves are still not as full as they were before the shortage began in February, said Camen Hofer, president of the Wisconsin WIC (Women, Infants, and Children) Association and director of the Wood County Health Department’s WIC program.
“But Similac is on the shelves, and families have been able to find more of the formula that they’re looking for,” Hofer said.
The formula shortage was due to pandemic-related supply chain issues and two shutdowns of an Abbott Nutrition facility in Sturgis, Michigan — first after an investigation into reports of bacterial infections prompted a recall and later due to flooding.
Abbott restarted production of Similac at the Sturgis facility in late August, bringing the popular brand back to market. Another recall on October 14 affected some 2-ounce, ready-to-feed products due to a sealing problem in less than 1% of recalled bottles. But it was not expected to reduce overall supply in the US
Recently posted photos on the Milwaukee Formula Parents Facebook group, which was formed to help local parents navigate the shortage, show fuller shelves. But some parents still struggle to find specialty formulas.
In late August, officials at the U.S. Department of Agriculture’s Food and Nutrition Service predicted that supply problems would persist through the remainder of 2022 “due to a change in the varieties and sizes traditionally available in the marketplace.”
As stocks improve, here’s what parents and caregivers — especially those enrolled in the WIC program — should know about formula access.
How long will alternative formulas be available?
Before the shortage, WIC allowed families to spend their benefits on only five of Abbott’s Similac formulas, unless they requested a medical formula.
State-run, federally funded WIC programs contract with only one company in each state to keep costs down. Formula companies offer states significant rebates for the privilege of exclusively providing formula to WIC programs. Abbott has contracts with about two-thirds of the states, including Wisconsin.
But the Wisconsin Department of Health Services opened up more options early in the shortage, including different brands and container sizes, with Abbott covering the cost of substitutes.
Alternate badges will remain available at least through December 31, 2022, the third time that date has been pushed back.
Alternate sizes and forms of Abbott’s Similac products, including Total Comfort, will continue to be available through Feb. 28, 2023, the state health department said.
Similac products are back. But are they safe to use?
The state health department notes on its replacement list that WIC participants should return to Similac products if available because they are “safe and supply is increasing.”
“We are letting families know that if Abbott’s products are on the shelf, they are safe to buy,” DHS spokeswoman Elizabeth Goodsitt said.
But some parents are still nervous about returning to Abbott after the recall.
Camila Martin, a pediatric clinical nutritionist at UW Health Kids, said parents should know Abbott’s recall was voluntary, not mandatory. Abbott did not reopen its Sturgis facility until it met strict cleaning procedures and requirements, she noted.
“There’s a lot of eyes on them right now, which helps from a safety perspective — that we know they’re going to be extra careful, even more so than before,” Martin said.
Although each caregiver knows their baby best, Martin said, “for most babies, it’s okay to just switch from one (formula) to the other as soon as they run out of the old supply.”
Caregivers can ease the transition by preparing separate half-bottles of each formula as directed and mixing them together, Martin added.
Will international formulas remain on the market?
Although Wisconsin’s WIC program will stop offering international brands like Kendamil and Bubs after 2022, these products may remain available in stores even after the shortage ends.
The FDA announced in September a long-term path for international manufacturers to stay on the market.
Families should weigh several variables when considering whether to stick with international formula, Martin said, especially if there are questions about sending the formula, using the language or mixing directions.
Families should pay close attention to the mixing instructions, which are often in milliliters, not ounces. International buckets can also have different sizes, Hofer noted. The FDA has a conversion chart to help prepare international formulas.
“If I’m working with a family, I would always recommend that they switch to a US-based equivalent that they can get from a store here,” Martin said.
Caregivers should talk to a pediatrician if they have other questions about international prescriptions — including their iron content, Martin and Hofer said.
What water should I use to prepare formulas?
Some parents in Wisconsin have reported shortages of nursery or “baby” water products, some of which contain added fluoride.
“If a family has an infant who is immunocompromised, distilled water can be an equivalent to grandchild water,” Martin said. “There are actually no rules about what nursery water is.”
Municipal water is generally considered safe for babies, but parents can check with their doctor for details about water safety in their area.
The World Health Organization recommends boiling water to kill bacteria — and not letting it sit for more than half an hour — before mixing it with formula while it’s still warm. Many families may not be aware of these best practices, Hofer said.
But boiling does not get rid of lead, if it is a problem with the water supply.
Those concerned about bacteria or lead in their water can buy distilled water or find another safe source, Martin said. She and Hofer recommend that families who rely on well water test it regularly and check with their local health department.
Can I use WIC to buy formula online?
Not yet in Wisconsin, although the USDA is working against online shopping by testing it in seven states. The lack of online ordering limited options for Wisconsin WIC families who struggled to find certain formulas in brick-and-mortar stores.
“It’s going to be a little while until people can actually use their cards online, which is unfortunate, because it’s something that feels like it should happen as soon as possible,” Hofer said.
Congress could reshape WIC as it reviews proposals to authorize child nutrition programs, but its timeline for enacting such legislation is unclear.
One proposal would require states to approve at least three businesses to accept WIC benefits online by 2025. Other proposals would allow remote enrollment appointments and expand eligibility through 2026 to include children until age 6 or kindergarten.
Where else can I get information about infant formula?
Families should talk to their pediatrician or local WIC office. Find contact information for each WIC office here.
The state health department has information for WIC families here, including the current benefit list.
The American Academy of Pediatrics also has tips, including this information about imported formulas and this page about the latest recall.
See our previous formula F&A here. It includes a list of breastfeeding support services.
The nonprofit Wisconsin Center for Investigative Journalism (wisconsinwatch.org) partners with Milwaukee Neighborhood News Service, Wisconsin Public Radio, PBS Wisconsin, other news media and the UW-Madison School of Journalism and Mass Communication. Any work created, published, published or disseminated by the Center does not necessarily reflect the views or opinions of UW-Madison or any of its affiliates.
This article first appeared on WisconsinWatch.org and is republished here under a Creative Commons license.