Formula shortage affects Pacific Northwest families

A nationwide shortage of baby formula is proving stressful for families in the Pacific Northwest. Ryan Hassan is a pediatrician with Oregon Pediatrics in Happy Valley. He says he’s been talking to his patients about practical solutions and counseling them on ignoring judgmental comments on social media about feeding babies with formula.

Meanwhile, the Northwest Mothers Milk Bank has been fielding more calls from people interested in donating breast milk due to the shortage, according to Executive Director Lesley Mondeaux. The milk bank serves families with a prescription for human breast milk, which means the organization prioritizes medically fragile babies. But the milk bank is also able to help others on a short-term basis, Mondeaux says, especially if there is an increase in supply. We hear from Mondeaux and Hassan about how families in the Pacific Northwest are coping with the formula shortage.

Editor’s Note: Our guest Dr. Ryan Hassan misspoke when he was talking about baby formula and the Oregon Women, Infants, and Children (WIC) program. The correct information is: The only way WIC participants receive formula is through local stores and pharmacies using a WIC-issued benefit card. Oregon WIC received approval from USDA to add over 80 different formula types and sizes to meet the needs of WIC infants affected by the formula shortage.

Note: The following transcript was created by a computer and edited by a volunteer.

Dave Miller: This is Think Out Loud on OPB, I’m Dave Miller. We start today with the nationwide shortage of baby formula. It stems from a contamination recall and the closure of a major formula manufacturer, but existing supply issues have made it worse. Stores are now limiting the number of containers people can buy. The Oregon Attorney General and other public officials around the country have warned parents to be wary of price gouging. For more on what this shortage could mean for babies and their families, I’m joined by Ryan Hassan. He is a pediatrician based in Happy Valley. Welcome back.

Ryan Hassan: Hi, thanks for having me.

Miller: Thanks for joining us once again. This became an issue that the president talked about last week. But when did you first start hearing about a formula shortage?

Hassan: I think it was the same day or maybe a couple days after the recall that Similac had announced. So it’s been quite a while now that we’ve been dealing with the fact that there’s a lot less formula available.

Miller: How bad is the shortage in Oregon right now?

Hassan: It really varies a lot. Most of my patients I’ve worked with have been very fortunate in that they’ve had the means to have formula for themselves. But I know there’s a lot of families, certainly some that have been seeing one of my colleagues, a lactation specialist, who have not been so lucky. There’s families asking questions about “should I just water down the formula I have, should I just give them less?” And there’s certainly families who are unable to find ways to get it. And I know the WIC offices have had families where they’ve been unable to provide formula for them as well.

Miller: So even official channels don’t have special access to some supply somewhere?

Hassan: Well, in theory, they do. And my understanding is that the state does have supplies of reserve formula, and they have released some of that to the WIC offices. But of course, some babies can do well on almost any formula, but there’s other babies who really struggle except on specific ones. And especially if those are Similac formulas they need, it’s a lot more challenging.

Miller: Can you give us a sense for what some of the specialty formulas are? Because my understanding is that the factory that is still closed down, and has been for more than a month now, they are some of the prime makers of some formulas that are the only options for some specific populations of infants and babies. What are specialty formulas?

Hassan: There’s a lot of different kinds of formulas available, and I’m by no means an expert on it, and there’s certainly a lot of disagreement, especially among the formula manufacturers, about what really works best for everyone.

There’s differences in the composition, what they use for the sugar, for the fat, for the protein. People will tell you different things about how much that’s important to certain kids. But I have families who will tell me “I need this specific brand because my kiddo just does much better on it.”

Beyond that, there’s more significant types of specialization in terms of how much the proteins in the formula are broken down to be what’s called partially hydrolyzed versus fully hydrolyzed. Some kiddos don’t do well with a kind of a more standard formula, and need the proteins to be broken down into smaller pieces essentially, so they can digest it properly. And those are the partially hydrolyzed formulas.

In some kiddos, they need even more specialized formulas where it’s just the amino acids individually that they need, because otherwise they have immune responses and intolerances that took them from being able to to handle those bigger proteins. And those formulas can be very expensive and hard to come by, and they also taste horrible, which is why it’s really challenging for some of those families already.

Miller: Can you remind us of some of the reasons that families would rely on formula to begin with?

Hassan: There’s a lot of reasons why a family would want or need formula. And it’s been very disheartening to see a lot of people I’ve seen on social media, my wife has seen, who’s a feeding mother right now for our one year old, who have been shaming people about their formula choices or their feeding choices. I think the most important thing to acknowledge is some people just prefer formula, and we don’t need to be prying into “Well, did you try breastfeeding? Are you sure you couldn’t breastfeed?” Because there’s a lot of personal reasons why people might feel formula is a better choice for them. And that’s a conversation for them and their family and their healthcare providers, and we need to support families regardless of that decision.

More specifically, sometimes it’s very much more convenient to formula feed. If you have a partner, you can more easily alternate feeding rather than having just one nursing parent having to provide all the feeds. It’s nice also not to have to necessarily wake up and pump in the middle of the night all the time. So those by themselves are really compelling reasons why some families choose to use formula.

Some mothers and parents are unable to feed because they have anatomical issues, like an inverted nipple for example, makes it very hard or even painful, or maybe impossible for families to breastfeed sometimes. It’s common to have supply issues, where parents are just not able to produce enough milk for their baby. That’s not as common as it seems, a lot of families feel like they can’t make enough, but actually can, and just need a good support system. But sometimes you can’t, even with that.

And then there’s other instances, for example, my own baby was premature, and she was really small and needed extra calories that we couldn’t get just through breast milk. So we had to fortify with a premature formula. And those formulas are very necessary for a lot of premature and small babies, and have a more ideal composition of nutrients and calorie density than you might be able to get from just breast milk.

Miller: We asked listeners to tell us how the shortage is affecting them. And one person called in with a suggestion about a substitution for a formula, one that I don’t think is medically advised. What are you telling families who ask about possible alternatives to formula?

Hassan: It’s definitely a challenging situation, because for some of these families, it seems like there might not be any other options. The bottom line is that kids really do need either breast milk or formula. And there are a lot of other non formula products and nonstandard products that are just not going to provide the same nutrients, the same level of calories, the same electrolytes that kids need. There’s a very specific balance that goes into play. Formula is actually very very tightly regulated and controlled in the United States because we know that if babies get not the appropriate amount of the different electrolytes and micronutrients and macronutrients that they need, they can have some very serious complications. So it can be dangerous to do things like trying to make your own formula or have an alternative formula. And it’s unfortunate that families feel like that’s their only option right now in some cases.

Miller: I want to go back to something you mentioned earlier, that on social media and other places parents could, especially these days, because formula has been so much in the news, they could be getting a lot of conflicting messages or negative messages and judgment about using formula to feed their babies. What do you tell your patients about that?

Hassan: I tell families the same thing I’ve always tried to tell them, which is that families need to prioritize their whole health, and that’s the health of the baby and the parent, and physical and mental wellness. All of that is intertwined. There’s a lot of families for which formula really is the best option. And I see families still who really probably would do a lot better on formula, but continue to breastfeed because they feel like they need to, like they should, “Well, I know that breast milk is better.” And so that’s the choice they have to make. “Even though it’s really hard for me as a parent, I’m going to make these sacrifices for the health of my baby.”

And I think there’s definitely benefits of breast milk. But there’s also benefits to having a parent who feels supported and is having a healthy lifestyle, able to get enough sleep and emotional support, and doesn’t feel completely drained and stressed and overwhelmed by a very challenging breastfeeding process. And I think we really need to support parents more than we are. A good parent is one who is doing the best they can to keep themselves and their baby healthy, and not shaming other families for making a different choice than them.

Miller: What advice do you have for people who are trying but struggling to find formula?

Hassan: That’s a tough one. I think a lot of families are probably already considering a lot of the right options, so my advice might not be as helpful. But if people haven’t thought of it, there are options for donor milk, which is why I’m glad you guys are talking with people from the Northwest Mothers Milk Bank, because those kinds of resources are super important. Donor milk could be a great option for a lot of families.

I’ll also say that WIC is a good resource that hopefully everyone eligible is using. But there’s always people eligible for WIC who aren’t aware, or just don’t know that they have access to it. So getting in touch with and applying for WIC is a great way to at least try and get some support.

I think it helps to try and take action on a more broader level as well. None of us should have to, but really we need to be involved in communicating with our legislators, and the governor and the administration, saying “hey, this is a problem for me. Please get us more formula.” There are reserves, as I mentioned, of formula that the state has, and I think we need to take better steps to make those available. I did hear that the Oregon government is already taking steps to try and mitigate price hiking that’s already occurred on the limited support of the formula that’s already there. But we certainly could do more to make sure that families have that option available. And something every family can do is to take part in the democratic process, and let their elected officials know like this is something that matters to me and my baby needs this. Take action on this issue.

Miller: Ryan Hassan, thanks very much.

Hassan: Thank you for having me.

Miller: We have called up, as Ryan noted, Lesley Mondeaux. She is the executive director of the Northwest Mothers Milk Bank. Welcome back to Think Out Loud.

Lesley Mondeaux: Thank you so much.

Miller: Can you remind us what the Northwest Mothers Milk Bank does?

Mondeaux: Sure. We’re a nonprofit milk bank, and our mission is to serve the most medically fragile premature infants. We serve the Pacific Northwest with a safe source of donor milk. We prioritize hospitalized infants, but when we have an abundant supply of donated milk, we are able to extend that reach to outpatient families.

Miller: How is the formula shortage, which really is, it would seem, like a different thing from an outsider’s perspective. How is it affecting you?

Mondeaux: Sure. I would say the most wonderful way it is affecting us is that we are having potential milk donors calling us, just flooding our phone lines, asking how can I help? I have extra milk, breast milk in my freezer kit. Will this potentially help another baby? And so we have seen a huge uptick in the number of people willing to donate breast milk, which is a wonderful thing.

And then we have talked to families who are struggling. And because we talk to families that tend to have babies with medical need, we are hearing from families that they can’t find their specialized formula, or they’re worried about running out of that formula. And so we work with them and their health care provider, perhaps a dietician, to see if we can help in those situations.

Miller: Am I right that the way your model works is that families need to have a prescription in order to get the donated milk that you provide?

Mondeaux: That is correct. We do require a prescription, and that just keeps us in the conversation with the health care provider and the family. We work together to try to find the best solution for the family.

Miller: So far, has the increase in milk donations that people have been calling you about made up for the increase in need that you also seem to be getting questions about?

Mondeaux: You know, I think it will. It takes a little bit of time to become a milk donor. There are some steps involved in that. Right now, we’re prioritizing people we hear from that are healthy, nonsmoking, have more milk than their own baby needs. That’s very important. And that they have excess milk that is pumped and possibly ready to be donated. Although we’re still hearing from people who are saying, “I’m breastfeeding, but I’ll start pumping if that’s what you guys need,” which is wonderful, and they just need to be patient with us as we work through the process and get people through the screening process.

Miller: Are you able to help families whose babies are not medically fragile?

Mondeaux: Sometimes. Donor milk is not an unlimited resource. We wish that it was. But it is based on availability. And we always make sure that our hospital orders are met first, because those are the most fragile babies.

We just have so much gratitude for the Pacific Northwest and the families where breastfeeding is a priority here, and is well accepted. We have been able to have a pretty active outpatient supply of donor milk for families. But it does have peaks and then wanes, depending on how many really truly sick babies that need it.

Miller: I’m curious, I’ve seen people on social media pretty blithely say things like, “just breastfeed, it’s free.” What goes through your mind when you see things like that?

Mondeaux: Well, I think the most important thing is that we’re always advocating for breastfeeding, but we want families to be able to access the assistance and the guidance that they need to be successful, if that’s their feeding goal. And so finding a certified lactation consultant that can help and work with you is so important. For some families, breastfeeding comes very easily, and other people have struggles. And so we want to make sure that everybody can get that support and guidance from the experts, if you will, so they can be successful in whatever they’re feeding journey looks like.

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