Shortage of infant formula: tips for parents

If you can no longer find the special product that your child is used to and you have to replace it, read the practical advice of our article.

Who would have thought that the market for hypoallergenic infant formula was so fragile? The February 2022 closure of a very large Abbott plant in the United States created such a shortage that Health Canada was forced to revise the import rules for these products to allow for resupply from Europe. Despite everything, thousands of parents search in vain for the “formulas” their babies are used to.

Understanding Product Categories

There are three types of hypoallergenic formulas that incorporate cow’s milk protein using a process called hydrolysis. Proteins are long molecules made up of chains of amino acids. The more they are cut into small pieces by hydrolysis, the easier they are to digest and the lower the risk of allergic reactions.

In the first category of hypoallergenic formulas, proteins are partially hydrolyzed (as in Enfamil A+ Gentlease, Similac Total Comfort and Nestlé Good Start products). In the second, they are very wide (we also read “extensive” or strong), as in Similac Alimentum, Nutramigen A+, Pregestimil A+. And in the latter we find only the amino acids that are all separated from each other (as in Puramino A+ or Neocate).

The deficiency first affected very largely hydrolyzed preparations, then it spread to those based on amino acids recommended to parents to replace the former. However, in the vast majority of cases, infants do not absolutely need these special products. Buying them — especially in bulk, to stock up — when you don’t have to make them even rarer for kids who really can’t live without them.

The deficiency, which causes great anxiety in many parents, is therefore a good opportunity to check whether the baby could return to normal products. Here’s why and how to determine if a rebrand is right for you.

Not so common allergies

Taking hypoallergenic preparations often starts after a few sleepless nights, when the parents call the emergency room because their baby is experiencing cramps. This painful and common problem in the first months of life (20% of babies get it) is not a sign that the child is developing poorly, has digestive disorders or allergies. In fact, the discomfort often goes away on its own, around four months of age.

If the doctor finds that his little patient is receiving normal infant formula, he will probably suggest, in order to reassure the parents and as a precautionary measure, switch to a hypoallergenic version, in case the baby suffers from a protein allergy to milk.

This allergy, generally undetectable with a test, affects 2% to 4% of babies, with varying degrees of intensity. It can lead to diarrhea, vomiting and gas, refusal to eat, crying and irritability and, much more rarely, anaphylactic shock. In at least half of the cases, it disappears before the age of one year. Less than 1% of infants with a milk allergy will continue to do so throughout their lives.

When the symptoms are quite mild – so there’s a good chance that the baby isn’t really allergic or it is just slightly – a formula based on partially hydrolyzed proteins may be enough to solve the problem. You can also try a soy protein formula (such as Enfamil A+ Soya, Similac Isomil, or Nestlé Alsoy). When symptoms are more severe, products based on highly hydrolyzed proteins or amino acids are more likely to be well tolerated.

However, as the milk protein allergy often resolves over time, it is recommended that after a few months and if the child’s problems seem to have resolved, it is recommended that they try to return to a normal diet, which is likely to be appropriate for them.

Over-prescribed preparations

Very often, however, the doctor immediately prescribes a preparation based on very largely hydrolysed proteins for a period of one year, noted nutritionist Valérie Vaillancourt, associated with the CHU Sainte-Justine and specialized for 17 years in the nutrition of babies with digestive problems .

This strategy avoids a second visit, causes less discomfort to the baby and has no negative effect on its development. It is also a favorite with parents because: products based on highly hydrolysed proteins or amino acids are largely reimbursed by the Régie de l’assurance disease and private insurance if they are prescribed, which removes significant pressure on the family budget.

These special “formulas” can save several thousand dollars a year compared to purchasing regular, soy milk, or partially hydrolyzed formulas, which are not reimbursed. Recipes cost the RAMQ nearly two million dollars a year. “I often see parents who refuse to change because they want to take advantage of this economic advantage, and professionals who renew prescriptions, even if it is not really justified medically,” explains Valérie Vaillancourt.

However, in a context of scarcity, this logic becomes difficult to sustain, especially since some babies absolutely need the missing preparations. This is the case for those who are severely allergic to both milk and soy proteins (for example, who have already experienced anaphylactic shock after consumption), or who suffer from inherited metabolic diseases such as tyrosinemia or galactosemia. Babies with this disease can only tolerate milk made from amino acids, and even breast milk can hinder their development!

Myths to deconstruct

Two big myths also make doctors and parents prefer these products. First, there’s the idea that they prevent allergies in children at high risk of suffering from them, which has been disproved, as this recent paper from the Canadian Pediatric Society shows.

Second, some argue that formulas containing soy protein should be avoided as they can cause hormonal issues in babies. “It’s not true, and yet some parents really don’t want it! Recently, I saw a mom whose baby ate tofu but wanted him to drink a hypoallergenic “formula.” It does not make any sense ! says Valerie Vaillancourt.

What must we do ?

Out-of-stock products are therefore not needed for all babies currently consuming them. If your child uses them, you should consult a pharmacist, pediatrician, general practitioner, nutritionist or specialist nurse practitioner to assess whether he really needs these preparations, or what they could replace.

To help you, this professional can rely on a decision algorithm recently designed by the Ministry of Health and Social Services in collaboration with four nutritionists from university children’s hospitals, the Ordre des dietétistes-nutritionnistes du Québec and from the Association of Pediatricians of Quebec . The document states in the introduction that these products are overprescribed.

Contrary to popular belief, it is possible to change bottles without endangering the baby as long as it doesn’t happen too often. If the consulted health care provider does not suspect a really serious allergy, and the symptoms were mild enough for the introduction of the hypoallergenic “formula”, the algorithm suggests that they prescribe, for example, a preparation based on partially hydrolyzed proteins or soy protein-based for at least one to two weeks while the baby gets used to this new food. Most will do just fine.

“In all cases, we must consult as the baby’s age, health status and other factors can influence the replacement strategy. And it’s not easy to navigate between all the options! insists Valerie Vaillancourt. It should be noted, however, that in the hyper-competitive world of infant formula, manufacturers often try, through claims, to promote one product over another because it contains special ingredients such as omega-3 fatty acids, even if their benefit has not been proven. In the same category of products, all brands are equal.

What not to do

The deficiency forces parents into strategies that can be very risky, especially for a baby under one year old, who is growing very quickly. Plant-based milks bought at the grocery store, goat or sheep milk, and homemade preparations are strongly discouraged, according to Health Canada, as none contain the correct proportions of the various nutrients necessary for toddlers’ growth. It is also contraindicated to dilute commercial preparations in order to obtain proportions different from the recommended dosage.

The magazine rolling stone reports a plethora of recipes promoted in Facebook groups, on TikTok or on Instagram, which have been seen by hundreds of thousands of people since the shortage began. Mixtures based on condensed milk, hemp seeds, dates, distilled water, carrot juice, yeast, seaweed extracts or multivitamins, grandma’s recipes… most of these solutions are downright dangerous for babies because they don’t really contain the right nutrients and can contain more contaminants or germs than a baby can tolerate.

Don’t be fooled by those who claim that the manufacturers’ recipes are not good. Yes, breast milk is much better, companies exaggerate the benefits of certain additives on their labels and they rarely have to issue recalls. But their products are infinitely safer than homemade recipes prepared on the corner of the table, with ingredients from who knows where!

Also beware of the many online sellers who claim to still have preparations that are subject to shortages in stock. In the United States, the Federal Trade Commission has warned the public that multiple scammers are stealing logos, imitating labels or websites of outright manufacturers and pocketing the money without ever delivering the goods.

If you become discouraged by the difficulty of finding the product that is right for your child, the best strategy remains to consult a professional at your pharmacy or a medical clinic near you. Do not despair, there are solutions!

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