It's Time To Talk About Formula Safety

There's a formula recall that is affecting families all across the U.S.

Recall involving 3 brand name infant formulas https://www.fda.gov/news-events/press-announcements/fda-warns-consumers-not-use-certain-powdered-infant-formula-produced-abbott-nutritions-facility

Linked to 4 infant illnesses; one infant death may be attributed to Cronobacter acquired from the formula

FDA may have known for 4 months prior to recall per Politico https://www.politico.com/news/2022/02/18/fda-infant-formula-illness-four-months-before-recall-00010226

*World Health Organization Guidance on Safe Preparation of Infant Formula is available here https://www.who.int/foodsafety/publications/micro/PIF_Care_en.pdf

What Parents & Facilities Need to Know:

• Check for the recalled lot numbers and expiration dates - discard if you have them; absolutely under no circumstances should they be fed to any child or animal 

• Be sure to check all formula in your home or facility - you may have samples or other unusual sizes of formula tucked away somewhere

• Powdered infant formula is never sterile and contamination can occur at any point in the manufacturing or transportation process

• Mixing powdered formula with bottled water does not make it safer because the water is not the potential source of contamination

• Infants 2 months and younger and those born ill or preterm are at more risk  if they consume contaminated formula - therefore, the World Health Organization has long recommended that these babies only consume ready-made formula 

• Infants who consume more formula or only formula are at more risk than those who are partially breastfed, but even one exposure to contaminated formula can make a baby sick

• Actual safe preparation instructions include boiling, then cooling to 158°F the water which will be mixed with formula powder. Once the formula has been mixed, it should be allowed to cool to a safe feeding temperature by holding it under cold running water before using OR refrigerated immediately for up to 24 hours. Careful measuring is required to ensure the proper nutrient content and safety of the product. The preparer should clean their hands, surfaces, and all tools which will be used to prepare formula. The heated water is what kills bacteria.

• If you received formula from a hospital, WIC office, or doctor’s office, they most likely cannot tell you if they gave you the recalled lot numbers because they are not required to track them, so you need to check them yourself

• Parents and caregivers should always check to ensure the powdered formula they are using has not expired or been recalled - retail outlets which sell infant formula are frequently found to be selling expired formula

Why This Conversation Is So Complex and Delicate

• People have been led to assume that any conversation about breastfeeding or formula is an opportunity to “shame” someone about how they are feeding their baby

• Formula is readily distributed by many people, organizations, hospitals, health care providers, food banks, and more, but instructions on safe formula feeding is rarely distributed anywhere

• Even some health care providers readily dismiss safe preparation instructions as “too hard” for parents to do or “not needed” because our public water supply is monitored —> the former being a form of gatekeeping information from parents and the latter being beside the point as the water is not the concern

• Parents do not expect information about formula to be available from lactation care providers (IBCLCs, for instance, are required by their credentialing organizations to know and teach it to parents who are using it or intend to use it), and additionally they do not seek information about formula from lactation care providers because they have been led to believe that lactation advocates will try to “persuade” them to breastfeed or “make” them feel guilty about using formula

• While the Baby Friendly Hospital Initiative requires designated hospitals to teach parents using formula about safe preparation instructions, hospitals outside of the designation (which means *most* birthing facilities in the US) are not required to do so, so most parents are not taught this information

• Parents are often advised to seek information about formula preparation and other formula-related instructions from their pediatricians or other health care providers, but those health care practitioners are not trained to do this, so their guidance is inconsistent and not reliably evidence-based

• Health care providers, hospitals, and other health care organizations are courted by formula companies to distribute samples of their products as well as literature extolling the “benefits” of using them, often giving free gifts and education to the health care providers themselves as a way of appearing generous and benevolent

• Safe preparation of powdered infant formula is, in fact, hard, and it can be challenging for parents who are out of their homes, especially when they have not been adequately prepared in advance for the multiple step process required

• Formula recalls are NOT rare, but they are not always well-publicized. That needs to change because when a contaminated formula is out there on shelves, babies’ lives are at risk. The death of even one baby from contaminated formula is unforgivable, and we have to be able to talk about this risk openly to help families minimize their babies’ exposure.

*Why I included a link to the World Health Organization guidance rather than the U.S. Centers for Disease Control (CDC): the CDC’s guidance does not improve upon the WHO’s guidance, nor are there circumstances unique to the U.S. which would make the CDC’s guidance more relevant. The WHO’s guidance is clearly written and easy for families to understand and follow. It is also available in multiple languages.