Why is the Infant Formula Shortage Dangerous?

Why is the Infant Formula Shortage Dangerous?

David Epstein, MD, discusses the current infant formula shortage and the dangers with trying to make your own.

Asking why the infant formula shortage is dangerous is kind of a rhetorical question. Infants need to feed and many infants are not breastfed.


Without breastmilk, formula is the only remaining option. Without feeding, infants obviously can’t survive and grow. Survival and growth aside, there are other dangers of an infant formula shortage that may not be as obvious.

The main danger is families trying to create their own formula or formula replacement and trying to extend their formula supply by diluting the formula with more water to create a larger volume of formula.


The main danger is families trying to create their own formula or formula replacement and trying to extend their formula supply by diluting the formula with more water to create a larger volume of formula. Click To Tweet


These two techniques to combat the formula shortage can have dangerous consequences to infants.

The designing of infant formula is a sophisticated science and something that should not be tampered with by those who want to create their own without specialized expertise.

These infant formulas contain the exact nutritional needs for infants.

Because young infants are not eating food yet, they don’t have a variety of sources to obtain the vitamins, minerals, fats, sugars, and proteins that are needed to survive and grow. All of these things are packed into the formula.

Usually, it is recommended to start drinking cow’s milk at a year of age because infants have already started eating some form of food.

Cow’s milk or other animal milks are not an adequate food source for human infants and deficient in the iron needed for infants to prevent anemia. So these animal milks are not recommended for infants.

Furthermore, some infants have milk protein allergies and require different sources of protein than standard formulas.

There are a variety of different formulas to accommodate the various intolerances and digestive needs of infants.


Additionally, each formula has a calculated calorie amount per ounce. So an exact number of calories can be calculated for formula intake.

Infants require a specific number of calories per day to survive and grow.

If a formula is just created by liquifying food and mixed with juices, there is no way to determine the exact number of calories, as well as the required amount of protein, sugar, fat, vitamins, and minerals, that an infant is receiving.

Without knowing this information, an infant runs the risk of malnutrition, growth delay, and possible electrolyte abnormalities.


The designing of infant formula is a sophisticated science and something that should not be tampered with by those who want to create their own without specialized expertise.


Aside from the risk of malnutrition and growth delay, there is an acute care issue as well.

The risk lies more with diluting the formula with water to make the supply last longer.

While we are all at risk of electrolyte imbalances for a variety of reasons, infants are more sensitive because their sole intake is formula or breastmilk.

If either of these is diluted with too much water, infants can suffer from water intoxication.

This means that the balance of electrolytes and water are not correct for the intake and they consume more water and less electrolytes.

The electrolyte imbalances in infants can occur more rapidly because they have less reserves than older children or adults.


The most common, serious electrolyte disturbance with dilution of formula is hyponatremia.

Hyponatremia is defined as a lower serum sodium level than is physiologically normal.

As pediatric residents, we are trained that one of the most common causes of hyponatremia in infants is diluted infant formula.

Nevertheless, vomiting, diarrhea, kidney disease, heart failure, adrenal insufficiency, and many other diseases can also generate hyponatremia.

While common symptoms of hyponatremia can include weakness, anorexia, muscle cramps, and headache at moderately low serum sodium levels, they are not usually apparent in infants.

With more severely low serum sodium levels, seizures, confusion, lethargy, altered mental status, coma, and an abnormal respiratory pattern predominate and are usually the presenting signs of hyponatremia in infants. In fact, hyponatremia should be one of the first considerations in an infant younger than 6 months of age with seizures.

There can be more permanent neurologic sequelae from hyponatremia as well. The important takeaway from this is that formulas should be mixed with the proper amount of water and that diluting formulas with water should be avoided to prevent water intoxication and subsequent hyponatremia.

The infant formula shortage is concerning.

But don’t despair. Remember to utilize reliable resources for information to navigate the shortage or ask your primary care physician for help.

Please don’t fall victim to the ideas of creating your own formula or diluting existing formula to make the amount last longer. Your infant’s health depends on it.

Have you been impacted by the infant formula shortage? How have you navigated things for your family?

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Sherita D. Gaskins-Tillett, MD

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