This article was created in response to the ongoing war in Ukraine for parents living in a crisis zone. Any information given below is done so with these circumstances in mind.
Being a new parent in a crisis zone is an undeniably scary experience, and if you formula feed and your baby’s supply is at risk, you’ll understandably be concerned.
That’s why we’ve called on Dr. Sara Ritchie, Assistant Professor of Pediatrics at Medical University of South Carolina, USA, to highlight some of the options that might be helpful for you to know about and try out during a baby formula shortage.
“The good news is that the majority of formulas are pretty similar in their makeup,” Dr. Ritchie reassures.
“Switching between formulas can cause babies to pass stool more or less often and/or result in stool being softer or harder because of micro differences, but in theory, it should be fine.”
Making this shift somewhat gradually is a good thing to aim for. For example, you could mix the formula you’re moving on from and the one you’re moving on to — provided the mixing instructions are the same — to ease the baby into the transition, advises Dr. Ritchie.
She urges you to be cautious about mixing instructions, especially if your baby was born early.
“There are very specific mixing instructions to achieve calorie contents in formulas, and not every formula is mixed exactly the same,” Dr. Ritchie explains.
“If you had a preterm baby who’s [consuming] a higher calorie content, you’d want to be really careful that you’ve confirmed the proper mixing instructions for the new formula to achieve that same calorie content,” she adds.
Of course, no parent wants to face this decision, but if you find yourself in that situation, the age of your baby is something you definitely need to carefully consider.
“Expired generally means it’s unsafe. As a physician, I would say you really should follow those expiration dates,” Dr. Ritchie says.
“[But] if you’re having to ration your formula, I would prioritize younger babies getting the unexpired formula.
“After 6 months, babies have a more mature gut, and if there is a small contamination, they’re going to be able to handle it a little bit better in theory than a younger baby.”
Dr. Ritchie explains that babies under 6 months should ideally be given ready-to-feed formula that doesn’t need to be mixed with (potentially unclean) water before powders that need to be mixed with water as a second choice. If this is your only option, ensure the water is clean (bottled water that’s sealed and trusted is fine to use).
She adds that diluting formula with extra water to make it last longer should be avoided. As well as potentially meaning your baby isn’t getting the nutrition they need, there are other risks.
“For babies 4 months and under, you really don’t want to dilute the formula because having more water in their system creates an imbalance for the kidneys [and can impact how they] manage electrolytes and urine,” she says.
“You should feed the formula you have, and if your baby is 4 months or over, supplement with solid food.”
"With formula-fed babies, it’s safe to start solid foods at 4 months"
Dr. Ritchie emphasizes that she would prioritize formula for babies under 6 months old. After 6 months, there are more options you can go with. She advises the following are safe for this age range:
- Plain water
- Pasteurized or boiled full-fat animal milk (cow, goat, and sheep are all fine)
- Reconstituted evaporated milk (not condensed milk)
- Fermented milks like yogurt drinks
- Ultra-high temperature milk
Animal milk should be prioritized over plant-based milk because of its nutritional content, although plant-based milk isn’t unsafe to give to 6+ months babies for a short amount of time.
“With formula-fed babies, it’s safe to start solid foods at 4 months. The idea is that the gut has matured by then, so if [your baby is] getting close to that and [they’re] low on nutrition, I don’t think it’s a bad idea to just go ahead and start,” Dr. Ritchie says.
“Don’t [give babies] things that aren’t soft enough, like hard nuts or popcorn. A lot of things can be boiled or cooked to a consistency that’s nice and soft.”
Canned items are fine, but be careful with salt and added sugar content. Avoid unpasteurized foods.
Dr. Ritchie advises that babies aged 4 to 6 months are used to their nutrition coming through liquid, so they might not take to the solid foods as quickly as you might hope. In this situation, try to make sure that they’re staying hydrated at the very least.
In more desperate situations, Dr. Ritchie advises that you could feed your baby oral rehydration solutions [often used by people doing endurance sports] in the very short term. These may be available from aid organizations working in a crisis zone.
However, she notes: “With a younger baby, you wouldn’t want to go more than 24 hours using that. With a baby aged 6 months plus, you might be able to use it for 48 hours or so.”
Dr. Ritchie reassures that it’s absolutely possible, though do keep in mind it’s not a guarantee and can take some time.
“[As time goes on] from your most recent lactating time, it’s going to make it a little bit harder, and it might take weeks rather than days [to reinduce lactation]. However, even up to 12 months and over, it can be restarted,” Dr. Ritchie explains.
“The key to that is frequent stimulation of the nipple (at least every 2 hours). Usually, that’s just suckling by the infant. Although if you have access to a breast pump, that would also be really helpful.
“It’s also going to be easier in theory to reinduce lactation for younger babies because they feed more frequently. The more you stimulate, the better it’s going to be to induce that lactation again.”
While it can take longer to feed a baby without the teat of a bottle, Dr. Ritchie advises that “You’d be surprised how quickly they can lap up milk.”
A small cup like a medicine cup or shot glass, a spoon, a syringe, or even an eyedropper could be cleaned and used to feed, she suggests.
“It’s nice if it’s clear because then you can see where the milk level is,” notes Dr. Ritchie.
To use a cup or spoon, “Hold your baby upright and tilt the cup or spoon just enough so the liquid is just touching your baby’s lips and tongue so that they can lap it.”
“With a syringe — or an eyedropper — your baby can be fed while slightly reclined. See if you can get them to latch on to your finger to get that sucking motion going, and then slide the dropper or the syringe into their mouth.
“Often, they’ll suck the liquid out themselves, but if not, you can go ahead and squeeze it.”
Try to make sure the vessels you’re using are cleaned using soapy water and then sterilized. Boiling them for 10 minutes is recommended.
"Even up to 12 months and over, breastfeeding can be restarted"
Sterlization is particularly important when feeding babies aged 3 months and under. Sterilized items should be prioritized for newborns, preterm babies, and babies with a weaker immune system due to illness or medical treatment.
“The gut starts to mature a lot around 4 to 6 months. [From] that age range, regular soapy water is a good plan if you can’t boil,” Dr. Ritchie explains.
If you don’t have any access to sterilization methods, try to be vigilant about isolating the items you’re using to feed your baby.
“Separating them from areas where you prepare food before it’s cooked and from bathrooms is definitely going to be helpful,” Dr. Ritchie says.
Disposable items might also be a preferable option. “I [can’t say that] reusable cups and spoons are going to be 100% disinfected, but certainly if they’ve come in a sealed package and you’ve kept the package as isolated as possible after opening, it’s going to be better than picking up a cup [that’s been used and washed].”
You’ll likely be looking for signs that your baby is getting enough of what they need. To help with that, Dr. Ritchie says the following are positive signs a baby is hydrated:
- Your baby has wet diapers regularly (“about 5 to 6 or more in a day”).
- The soft spot on the top of the head (the fontanelle) is nice and flat.
- Your baby is making tears when they cry (from 2 weeks old).
- The inside of their mouth “is wet with drool.”
If you have access to a scale, that’s also a really good measure. In the first month of life, your baby should be putting on about 30 grams or 1 ounce a day. Beyond that, Dr. Ritchie says healthy weight gain per week is:
- 0 to 4 months - 155 to 240 grams
- 4 to 6 months - 85 to 130 grams
- 6 to 12 months - 40 to 85 grams