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Food Insecurity and the Dangers of Infant Formula Dilution

Power of Peds

Published December 2019

By Tiffany Fischman, MD, FAAP — Food insecurity is a major challenge facing many families in the United States. In fact, one in six children live in a household struggling with food insecurity. Even more alarming, 53 percent of families with infants younger than one year of age use the Special and Supplemental Nutrition Program for Women, Infants and Children (WIC).1 Many of these families feed their babies infant formula, which serves as their primary source of nutrition for the infant’s first 12 months.

While WIC is a fantastic program, it is and always was intended to be a supplemental program. Subsequently, families who qualify for WIC must pay full price for approximately 20 percent of their infant’s needs. This is cost-prohibitive, especially considering Enfamil and Similac prices continue to rise; they have risen 6 percent during the past four years. Families that earn just above the WIC threshold are particularly at risk because they must pay full price for formula. Faced with a difficult situation, parents may attempt to stretch their formula supply by diluting it with extra water to make it last longer. This practice dilutes essential nutrients and is very dangerous for babies who rely on formula for their main source of nutrition in a time of rapid growth and development.

A 2011 study published in Clinical Pediatrics found that 27 percent of food-insecure families admitted to stretching, diluting, or limiting formula at some point in time. Pediatricians realize that families often make unsafe feeding choices to save money.

Perrigo Pediatrics—a pediatrician-support program by U.S. infant formula maker Perrigo—and Wakefield Research, recently released findings from a nationwide survey of 500 U.S. pediatricians. The “ Formula for Safety ” survey found that 99 percent of pediatricians said families expressed concerns about the cost of infant formula. Further, 97 percent of these pediatricians reported families expressed concerns about running out of formula. Most pediatricians in this study heard specifically about families diluting infant formula, with 75 percent hearing about it once per week or more.2

Regardless of whether families are diluting, making homemade formula, or choosing a less nutritious substitute, the data is clear—families are jeopardizing their baby’s health in order to save money. Although there are a variety of resources available to food-insecure families, this data reflects that it may not be enough.

According to the Perrigo Pediatrics survey, only 15 percent of pediatricians would first recommend low-cost or store brand infant formula options for families, even though more than three in four pediatricians (76%) agree there is no significant difference between store brand and name-brand infant formulas. This is surprising, because nearly all pediatricians are aware that many families struggle with paying for infant formula.

All infant formulas sold in the United States must meet the same Food and Drug Administration standards for quality, safety, and nutrition. Healthcare professionals can confidently recommend store brand infant formula as a resource for all families regardless of their financial status. For food-insecure families, the cost savings of approximately $75 per month will make a huge difference and help prevent poor health outcomes associated with unsafe feeding practices.3

While a sensitive topic, it’s important for healthcare professionals to be proactive and talk with their families about food insecurity. The American Academy of Pediatrics (AAP) has a toolkit you can use to help screen families for food insecurity. Because infant formula is so widely used, pediatricians must ask families if they are having trouble affording it. Discussing less expensive feeding options, including store brand (generic) formulas, must be part of the conversation.

This article originally appeared on MDEdge

1Burkhardt, M. C., Beck, A. F., Kahn, R. S., & Klein, M. D. (2011). Are Our Babies Hungry? Food Insecurity Among Infants in Urban Clinics. Clinical Pediatrics, 51(3), 238–243. doi: 10.1177/0009922811426767
2Wakefield Research. (2019). Perrigo Formula for Safety Survey. 500 respondents.
3Retail prices from October 2019 retail price survey of assorted stores. Actual prices and savings may vary.

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