P2C135: Health Care Providers Reported Changes to Practice and Increase in Infant Health Risks During the Infant Formula Shortage

Background: In February 2022, an infant formula recall and closing of a major manufacturing center exacerbated a nationwide shortage of infant formula initiated by COVID-19-related supply chain disruptions. The effects were far-reaching, impacting families and health care providers across the US. To the authors’ knowledge, this is the first study that investigated the impact of the shortage on provider practices.

Methods: A 19-item web survey was developed to better understand how the infant formula shortage impacted provider practices; resources needed and those already utilized by providers; and patients’ health, including malnutrition. Subjective data on providers’ experience was also collected.

Results: 241 health care providers across 46 states in the US responded, 94% were registered dietitians and 6% were physicians, nurses, pharmacists, and medical residents. Most (99%) worked in urban or metropolitan areas and 76% worked in inpatient and academic hospitals or clinics.

Reported practice adjustments were: an increase in patient education (100%), more communication with DME providers and pharmacies (65%), or community resources (57%); longer visits (28%); supplementary formula samples distributed (23%); and more frequent malnutrition screening (5%). Providers relied most on their formal education (73%) and looked to medical societies for resources on appropriate substitutions (88%), proper use (71%) and preparation of formula (77%), nutritional needs (57%), signs of intolerance (63%) or malnutrition (32%). Table 1 provides a summary of educational tools that providers indicated would be beneficial to help support their knowledge; most requested a more robust comparison chart of formulas, which aligns with the most common suggestion made and action taken by families. Subjectively, providers expressed confusion, lack of support, and burnout.

Providers reported the following feeding practices by guardians: switching to different infant formulas (99%), toddler formulas (55%), cow’s milk (46%), alternative milks (32%), or homemade formulas (23%); early introduction of foods (14%); and formula dilution (41%).

Providers indicated they treated or diagnosed (34%) and reported a rise (15%) in severe malnutrition due to the shortage. Additionally, FTT (31%), deceleration in z-score (27%), delayed wound healing (3%) and developmental or intellectual delay (4%) increased post-shortage. Table 2 provides a summary of other diagnoses.

Conclusion: Health care providers made practice adjustments to mitigate malnutrition and illness associated with formula unavailability or misuse of formula by guardians. Despite spending more time with patients and on education, supported by guidance from medical societies, providers reported an increase in unfavorable feeding practices and a rise in malnutrition and related symptoms. Subjectively, providers reported frustration that greater workloads did not result in improved outcomes, contributing to burnout. Adding to the established need for policy changes, these data suggest the importance of reliable resources designed for health care providers to support families to feed their infants safely.