Dangers of Formula Dilution
Published December 2019
By Tiffany Fischman, MD, FAAP — Adequate nutrition is essential to an infant’s growth and development. While experts like the American Academy of Pediatrics (AAP) and the World Health Organization (WHO) believe that breastfeeding is the best form of nutrition during the first year of life, pediatricians know that most families use infant formula during the first 12 months for a variety of reasons.
Unfortunately, research shows that many families are not as well informed about the proper preparation of infant formula as we may think. This lack of information can often lead to unsafe feeding practices.
According to the USDA, it is estimated that approximately 16 percent of children under four years of age live in households struggling with food insecurity. A study published in Clinical Pediatrics found that 27 percent of food-insecure families report stretching, diluting, or limiting formula at some point in time. In addition, nearly one in six families in this study reported modifying or limiting formula in order to make it last longer.1 They also found that rather than buying a more affordable formula, like store brand infant formula, families were stretching or diluting a national-brand infant formula. This could imply that these families are either not aware of store brand infant formula—or that they perceive it to be less beneficial than a heavily marketed, national-brand formula.
While many food-insecure families receive infant formula from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), the program is intended to be supplemental and the formula that WIC provides does not last a full month. This leaves families in a difficult situation.
Stretching formula to save money can be very dangerous. Infants rely entirely on the nutrients and calories from formula for growth and development. No cost saving is worth the risk of poor growth and development or infant mortality.
While a sensitive topic, it’s important for healthcare professionals to be proactive and talk with their families about food insecurity. The AAP’s Bright Future Guidelines toolkit can be used to help screen families for food insecurity.
It’s important to note that all infant formulas sold in the United States meet the same Food and Drug Administration (FDA) standards for quality, safety, and nutrition. Store brand infant formulas match the nutrition of the more popular, nationally advertised formula brands and cost up to 50 percent less with the potential to save families up to $900 a year.2
Discussing less expensive feeding options with families and warning parents about the dangers of diluting formula is critical to prevent misuse and the subsequent negative impacts it can have on infant nutrition, growth, and development.