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Hope Karnopp, Wisconsin Watch
A nationwide baby formula shortage that stressed families for much of 2022 is easing in Wisconsin, but questions about formula access still loom for some caregivers.
Grocery store shelves still aren’t as full as they were before the shortage began in February, said Camen Hofer, the chair of the Wisconsin WIC (Women, Infants, and Children) Association and director of the Wood County Health Department’s WIC program.
“But Similac is on the shelves, and families have been able to find more of the formula that they’re looking for,” Hofer said.
The formula shortage resulted from pandemic-related supply chain issues and two shutdowns of an Abbott Nutrition plant in Sturgis, Michigan — first amid an investigation into reports of bacterial infections that prompted a recall and later due to flooding.
Abbott restarted production of Similac at the Sturgis facility in late August, bringing the popular brand back onto the market. Another recall on Oct. 14 impacted some 2-ounce, ready-to-feed products due to a sealing issue on less than 1% of recalled bottles. But it was not expected to crimp overall supply in the U.S.
Recent photos posted to the Milwaukee Formula Parents Facebook group, which formed to help local parents navigate the shortage, show fuller shelves. But some parents are still struggling to find specialty formulas.
In late August, officials within the U.S Department of Agriculture’s Food and Nutrition Service anticipated supply problems to linger for the rest of 2022 “due to a shift in the varieties and sizes traditionally available in the market.”
As stock improves, here’s what parents and caregivers — especially those enrolled in the WIC program — should know about formula access.
How long will alternative formulas be available?
Before the shortage, WIC allowed families to spend their benefits on only five of Abbott’s Similac formulas, unless they requested a medical formula.
State-run, federally funded WIC programs contract with only one company in each state to lower costs. Formula companies offer states significant rebates for the privilege to exclusively provide formulas to WIC programs. Abbott contracts with about two-thirds of states, including Wisconsin.
But the Wisconsin Department of Health Services opened up more options early during the shortage, including different brands and container sizes, with Abbott covering the cost of substitutes.
Alternative brands will remain available through at least Dec. 31, 2022, the third time that date has been pushed back.
Alternate sizes and forms of Abbott’s Similac products, including Total Comfort, will continue to be available through Feb. 28, 2023, the state health department said.
Similac products are back. But are they safe to use?
The state health department notes on its substitutions list that WIC participants should return to Similac products if they are available because they are “safe and supply is increasing.”
“We are letting families know that if Abbott products are on the shelf, they are safe to purchase,” DHS spokesperson Elizabeth Goodsitt said.
But some parents remain nervous about returning to Abbott after the recall.
Camila Martin, a pediatric clinical nutritionist at UW Health Kids, said parents should know that Abbott’s recall was voluntary, not mandatory. Abbott didn’t reopen its Sturgis plant until it met strict cleaning procedures and requirements, she noted.
“There’s a lot of eyes on them right now, which helps from a safety perspective — that we know that they’re going to be extra cautious, even more so than before,” Martin said.
Although each caregiver knows their baby best, Martin said, “for most infants, it is okay just to switch from one (formula) to the other as soon as they’ve exhausted that old supply.”
Caregivers can ease the transition by preparing separate half bottles of each formula according to the directions and mixing them together, Martin added.
Will international formulas stay on the market?
Although Wisconsin’s WIC program will stop offering international brands like Kendamil and Bubs after 2022, those products may remain available in stores even after the shortage ends.
The FDA in September announced a long-term pathway for international manufacturers to remain on the market.
Families should weigh multiple variables when considering whether to stick with an international formula, Martin said, especially if there are questions about shipping the formula, language used or mixing directions.
Families should pay close attention to the mixing instructions, which are often in milliliters, not ounces. International scoops may be of different sizes, too, Hofer noted. The FDA has a conversion chart to help prepare international formulas.
“If I’m working with a family, I would always recommend that they switch to a U.S.-based equivalent that they can get from a store around here,” Martin said.
Caregivers should speak with a pediatrician if they have other questions about international formulas — including their iron content, Martin and Hofer said.
What water should I use to prepare formulas?
Some Wisconsin parents have reported a shortage of nursery or “baby” water products, some of which contain added fluoride.
“If a family has an infant that’s immunocompromised, distilled water can be an equivalent to nursery water,” Martin said. “There’s actually no regulations on what nursery water is.”
Municipal water is generally considered safe for infants, but parents can check with their physician for specifics on water safety in their area.
The World Health Organization recommends boiling water to kill bacteria — and not letting it sit for more than half an hour — before mixing it with formula while it’s still hot. Many families may not be aware of this best practice, Hofer said.
But boiling does not get rid of lead, if that’s a water supply concern.
Those with concerns about bacteria or lead in their water could buy distilled water or find another safe source, Martin said. She and Hofer recommend that families who rely on well water test it regularly and check with their local health department.
Can I use WIC to purchase formulas online?
Not yet in Wisconsin, although the USDA is working toward online shopping by testing it in seven states. The lack of online ordering limited the options of Wisconsin WIC families who struggled to find certain formulas at brick-and-mortar stores.
“It’s going to be a little bit until people can actually use their cards online, which is unfortunate, because it’s something that feels like should be happening as soon as possible,” Hofer said.
Congress may reshape WIC as it examines proposals to reauthorize child nutrition programs, but its timeline for enacting such legislation is unclear.
One proposal would require states to authorize at least three companies to accept WIC benefits online by 2025. Other proposals would allow remote enrollment appointments and expand eligibility by 2026 to cover children until they reach 6 years old or kindergarten.
Where else can I get information about infant formula?
Families should talk with their pediatrician or local WIC office. Find contact information for each WIC office here.
The state health department has information for WIC families here, including the current substitutions list.
The American Academy of Pediatrics also has tips, including this information about imported formulas and this page about the newest recall.
See our previous infant formula Q&A here. It includes a list of breastfeeding support services.
The nonprofit Wisconsin Center for Investigative Journalism (wisconsinwatch.org) collaborates with Milwaukee Neighborhood News Service, Wisconsin Public Radio, PBS Wisconsin, other news media and the UW-Madison School of Journalism and Mass Communication. All works created, published, posted or disseminated by the Center do not necessarily reflect the views or opinions of UW-Madison or any of its affiliates.
