Due to supply chain issues and the recent recall of several infant formula products, infant formula shortages have been reported. The U.S. government and other partners are working toward ensuring infant formula is safe and available for families across the country.

Here are some tips on how to safely feed your child if you are struggling to find infant formula.

Please keep in mind this is ONLY for urgent situations during the current infant formula shortage.

If your child uses a hypoallergenic or medical specialty infant formula and you are having difficulty getting this infant formula, talk with your child’s doctor about safe alternatives.

Children younger than 6 months:

• Children younger than 6 months should only drink breast milk or infant formula.
• If you cannot find infant formula, talk with your child’s doctor about what is the best feeding option for your child.
• Here are some tips to help families find infant formula during the shortage.

Children 6 months to 12 months:

• Children 6 months to 12 months should only drink breast milk, infant formula, or small amounts of water (up to 4 to 8 oz. per day).
• If you cannot find infant formula and you usually give your child a regular infant formula, you can give your 6 month to 12 month old child some pasteurized (not raw), unflavored, whole cow’s milk.
  • Cow’s milk should only be given for a short time (no more than a week) as instructed by your child’s doctor.
    • Talk with your child’s doctor about what is best for your baby. Cow’s milk does not have the right amount of nutrients your baby needs, has too many proteins and minerals for your baby’s kidneys to handle, and in some cases, may lead to intestinal blood loss.
  • If your child uses a hypoallergenic or medical specialty infant formula, talk with your child’s doctor about safe alternatives.

Tips for families who are feeding any infant formula:

• When using infant formula: Place only the amount your baby will eat in the bottle. This avoids wasting your supply.
• Do not mix infant formula with more water than the instructions say. Adding more water can cause nutritional imbalances and lead to serious health problems, such as seizures, for your baby.
• Do not make or feed your baby homemade infant formula. Feeding homemade infant formula to your baby can lead to serious health problems.
• When choosing an infant formula:
  • You can switch to another infant formula brand, including store brands, if needed. Most babies can tolerate switching between different brands. If no brands have the type of infant formula your baby uses, talk with your child’s doctor about which type of infant formula would be right for your baby.
  • If you buy infant formula online, only purchase from well-recognized distributors and pharmacies (not individual people or auction sites).

Information provided reflects input from physicians and other experts at the Department of Health and Human Services, American Academy of Pediatrics (AAP), and the North American Society For Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHAN).

Try a New Brand of Formula

Note: Children younger than 6 months old should only drink breast milk or infant formula. Talk with your pediatrcian or other health care provider if you are having difficulty breastfeeding or finding infant formula.

Most babies will do just fine with different brands of formula, including store brands, as long as they're the same type, like cow's milk-based, soy, hypoallergenic (extensively hydrolyzed), or elemental (amino acid-based). Keep in mind that your baby may seem to not like the taste, or may have a hard time tolerating a different formula, initially. If this happens:

• Try slowly introducing small amounts of the new formula by mixing it with your regular formula. Slowly increase the amount of the new formula over time.
• Be patient, since it may take some time for your baby to get used to it.
• If your baby is vomiting, has gas pains, is crying or can't be calmed down during feedings, is losing weight, has diarrhea, has blood or mucus in their poop, or is straining to poop, they may not be tolerating the new formula. Call your pediatrician or other health care provider if you have questions.

If you need help figuring out which formulas you may be able to substitute:

• Your pediatrician or other health care provider is always the best resource because they know your baby and their health history.
• You can also check this list of comparable formulas developed by an organization of pediatric gastroenterologists called NASPGHAN. Keep in mind that this list focuses on substitutes for formulas that were part of the February 2022 recall, so you might not see your baby's formula listed here. Any substitution should only be done under the recommendation and supervision of your pediatrician or other healthcare provider.

Try Formula That’s Made in Another Country

You can also consider buying formula that's made outside of the United States in U.S. stores. Stores will start carrying or may already have these options. The Food and Drug Administration (FDA) has allowed these formula companies to market certain products in the United States, and may allow more infant formula products that meet its criteria to be sold in the U.S. When preparing formula made in other countries:

• Read the mixing instructions carefully for preparing powdered formulas. They may require different amounts of powder or water than formulas made in the U.S.
• Use the FDA's conversion chart to convert milliliters to fluid ounces and common conversions from Celsius (°C) to Fahrenheit (°F).

Consumers should be cautious when buying formula that’s made outside of the U.S. from online marketplaces, as it has the potential to be counterfeit.

Talk to Your Pediatrician or Other Health Care Provider About Substitutes for Hypoallergenic or Specialty Formula.

If you need hypoallergenic or medical specialty formula, it may be harder to find a substitute. Talk to your pediatrician or other health care provider about acceptable substitutes. Depending on which formula your baby needs, your doctor may be able to submit an urgent request for specialized formula to Abbott Nutrition, which is releasing some specialty and low-iron formulas on a case-by-case basis.

No brand of infant formula is best for all babies. You should pick an infant formula that is made especially for babies. The US Food and Drug Administration (FDA) regulates commercial infant formulas to make sure they meet minimum nutritional and safety requirements. Iron-fortified infant formulas are recommended, and most commercial infant formulas sold in the United States contain iron. Commercial infant formulas come in liquid and powdered forms.

When choosing an infant formula:

• Make sure it is not expired.
• Make sure the container is sealed and in good condition. If there are any leaks, puffy ends, or rust spots, do not feed it to your baby.
• Make sure it is not labeled for toddlers.

Talk with your child’s doctor or nurse if you have questions about choosing an infant formula for your baby or if you are thinking of switching infant formula brand or type.

Homemade Infant Formula

FDA and the American Academy of Pediatrics warn against using recipes to make homemade infant formula. Using homemade infant formula can lead to serious health problems for your baby. Your baby’s nutritional needs are very specific, especially in the first year of life. Homemade infant formulas may contain too little or too much of certain components, such as vitamins and minerals (like iron).

Homemade infant formula may also have an increased risk of contamination, which could lead to your baby getting sick or developing an infection. Commercial powdered formulas are also not guaranteed to be sterile. However, FDA regularly inspects these products and the manufacturing facilities where they are made to help make sure these products are safe.

Imported Infant Formulas

There are some public claims that infant formulas sold in other countries and promoted as “natural” or “organic” are better for babies. However, there is no scientific evidence that these infant formulas are better for babies than commercial infant formulas sold in the United States. All infant formulas legally sold in the United States—whether made in the United States or imported from other countries—must be reviewed by FDA. The American Academy of Pediatrics warns against using illegally imported formulas, such as products ordered online from third-party distributors. FDA may not have not reviewed these products. Illegally imported formulas also may not have been shipped and stored properly.

FDA reviews all infant formulas sold legally in the United States to make sure they meet minimum nutritional and safety requirements. FDA also makes sure that the water used to make formulas meets safety standards set by the US Environmental Protection Agency.

Toddler Milks, Drinks, or Formulas

Toddler milks, drinks, or formulas are not needed to meet the nutritional needs of young children. They typically have added sugars. At age 12 months, your child can be introduced to plain whole cow’s milk or fortified unsweetened soy beverage.

Babies younger than age 12 months should be fed infant formulas specifically designed to meet their nutritional needs. They should not be fed toddler milks, drinks, or formulas labeled for toddlers.

Carefully read and follow the instructions on the infant formula container. These steps will help you know how to prepare and store your infant’s formula correctly. Preparing your infant’s formula according to the instructions is important.

Here are additional pointers to keep in mind when preparing and storing your infant’s formula.

Preparation

• Wash your hands well before preparing bottles or feeding your baby. Clean and sanitize the workspace where you will be preparing the infant formula.
• Bottles need to be clean and sanitized. To learn more about how to properly clean your baby’s bottles and other feeding supplies, visit the CDC webpage How to Clean, Sanitize, and Store Infant Feeding Items.
• Baby’s milk or infant formula does not need to be warmed before feeding, but some people like to warm their baby’s bottle.
  • If you do decide to warm the bottle, never use a microwave. Microwaves heat milk and food unevenly, resulting in “hot spots” that can burn your baby’s mouth and throat.
  • To warm a bottle: Place the bottle under running warm water, taking care to keep the water from getting into the bottle or on the nipple. Put a couple drops of infant formula on the back of your hand to see if it is too hot.
• If you use powdered infant formula:
  • Use water from a safe source to mix your infant formula. If you are not sure if your tap water is safe to use for preparing infant formula, contact your local health department.
  • Use the amount of water listed on the instructions of the infant formula container. Always measure the water first and then add the powder.
    • Too much water may not meet the nutritional needs of your baby.
    • Too little water may cause your baby’s kidneys and digestive system to work too hard and may cause your baby to become dehydrated.
  • If your baby is very young (younger than 2 months old), was born prematurely, or has a weakened immune system, you may want to take extra precautions in preparing your infant’s formula to protect against Cronobacter (see box).

Did You Know?

Cronobacter can be caused by germs in infant formula.

Cronobacter is a rare but serious infection that can be caused by germs in powdered infant formula. In most cases, it is safe to mix powdered infant formula following manufacturer’s instructions. But if your baby is very young (younger than 2 months old), was born prematurely, or has a weakened immune system, you may want to take extra precautions to protect against Cronobacter.

Use Quickly or Store Safely

• Prepared infant formula can spoil if it is left out at room temperature.
  • Use prepared infant formula within 2 hours of preparation and within one hour from when feeding begins.
  • If you do not start to use the prepared infant formula within 2 hours, immediately store the bottle in the fridge and use it within 24 hours.
• Throw out any infant formula that is left in the bottle after feeding your baby. The combination of infant formula and your baby’s saliva can cause bacteria to grow. Be sure to clean and sanitize the bottle before its next use.
• Store unopened infant formula containers in a cool, dry, indoor place—not in vehicles, garages, or outdoors.
• Once a container of infant formula is opened, store in a cool, dry place with the lid tightly closed. Do not store it in the refrigerator.
• Most infant formulas need to be used within 1 month of opening the container (check the label). When you first open the container, write the date on the lid to help you remember.
• Never use formula after the “Use By” date on the container.

If you can't find enough formula, there may be some short-term options that can help in an urgent situation. You should also know about serious safety concerns related to certain alternative preparations for feeding your baby. Always talk to your pediatrician or other health care provider first if you don't have enough formula to feed your baby.

Talk to Your Pediatrician or Other Health Care Provider About Short-Term Options

If you can’t find any formula and your baby is older than 6 months, talk to your pediatrician or other health care provider about using whole cow’s milk as a short-term option.

• Whole cow's milk is not recommended for babies under one year old. Cow's milk doesn't have the right amount of nutrients your baby needs and has too many proteins and minerals for your baby's kidneys to handle.
• However, you may be able to give your baby some pasteurized (not raw), unflavored, whole cow's milk if:
  • Your baby is older than 6 months
  • Your baby drinks regular formula, not a specialty product for allergies or other special health needs
  • You can't find formula.
  • Your baby is able to take some solid foods such as iron fortified infant cereals
• Don't give your baby cow's milk for more than one week, or as instructed by your pediatrician or other health care provider. Since cow's milk does not contain as much iron as formula does, it's important to start introducing plenty of iron-rich complimentary foods at six months of age, like iron-fortified cereals.
• Talk to your pediatrician or other health care provider if you're thinking about giving your baby cow's milk.

If you can’t find any formula and your baby is close to one year old, talk to your pediatrician or other health care provider about using soy milk as a short-term solution. Avoid other plant-based milks, like oat or almond milk.

• Plant-based milks are generally not recommended for babies under one year old. However, if you can't find formula and your baby is close to one year old and can't tolerate cow's milk, soy milk may be an option. Talk to your pediatrician or other health care provider if you're thinking about giving your baby soy milk.
• Don't give your baby soy milk for more than one week, or as instructed by your pediatrician or other healthcare provider. If you have to use soy milk, buy the kind that's fortified with calcium and vitamin D. Switch back to formula as soon as you can.
• Avoid almond milk or other plant milks. These are often low in protein and minerals.

If you can’t find any formula and your baby is close to one year old, talk to your pediatrician or other health care provider about using a toddler drink for a few days.

• Toddler drinks, often found in the formula aisles, are not recommended for babies under a year of age.
• However, if you have no other choice, these products can be safe for a few days for babies who are close to one year old.
• Talk to your pediatrician or other health care provider if you're considering using toddler drinks.

Explore Resources for Breast Milk or Breastfeeding

Talk with your pediatrician or other health care provider about using human milk from a human milk bank.

• If possible, consider a local milk bank that is accredited through the Human Milk Banking Association of North America (HMBANA). Keep in mind that most of the milk from milk banks is given to hospitalized babies, and they may not have enough to serve healthy babies at all times.
• Never purchase human milk on the internet. Human milk bought through the internet could be diluted with other substances or contaminated with germs and might not be collected, stored, or transported safely. You also cannot be sure if the donor was medically screened for infectious diseases or drug use.
• Informal human milk sharing in the community also has risks. If you are considering feeding your baby with human milk from a source other than the baby’s mother, talk to your pediatrician or other healthcare provider about the potential risks.

For families who are using both breast milk and formula, consider shifting more of your baby’s diet to breast milk.

• This could mean you need to increase your breast milk supply. You can do this by breastfeeding your baby more frequently or by adding pumping sessions between breastfeedings. Pumped milk can be kept in a refrigerator and stored frozen for later use.

Avoid Unsafe Formula Practices and Buying More Than You Need

Don't try to make formula at home. There are serious health and safety concerns with homemade formula. Your baby's nutritional needs are very specific, especially in the first year of life. Homemade formula may contain too little or too much of certain vitamins and minerals, like iron. Homemade formula also increases the risk of contamination, which could make your baby sick or lead to infection.

Don't water down formula. Adding more water means your baby does not get enough of the nutrients they need and can lead to serious health problems, like seizures.

Don't use formula past the "best by" or "use by" date. The formula may not be safe and may have lost some of its nutrients.

Don't buy more formula than you need. The shortage is affecting families who are already navigating the stress of parenting during a pandemic. It can be tempting to buy as much formula as possible right now, but the AAP suggests buying no more than a 10-14 day supply to help improve shortages.

The Food and Drug Administration (FDA) oversees manufacturers of infant formulas and helps ensure that these products are safe and support healthy growth in infants who consume them.

Don’t Make Homemade Formula

The FDA advises parents and caregivers to not make or feed homemade infant formula to infants. Homemade infant formula recipes have not been evaluated by the FDA and may lack nutrients vital to an infant’s growth. It is important for parents and caregivers to remember that infant formula can be the sole source of nutrition for infants and is strictly regulated by the FDA.

The agency has requirements for certain nutrients in infant formulas sold in interstate commerce, and if the formula does not contain these nutrients at or above the minimum level or within its specified range, the infant formula is adulterated. The agency can take action to remove adulterated formula from the marketplace.

The agency has received reports of hospitalized babies who had been fed homemade infant formula and then suffered from hypocalcemia (low calcium). Other potential problems with homemade formulas include contamination and absence of, or inadequate amounts of, critical nutrients. These problems are serious, and the consequences may range from severe nutritional imbalances to foodborne illnesses, both of which can be life-threatening. Because of these severe health concerns, the FDA strongly advises parents and caregivers not to make and feed their infants homemade formulas.

Other Safety Issues to Keep in Mind

Formula Preparation: Use water from a safe source to mix with powdered infant formula. If you are not sure if your tap water is safe to use for preparing infant formula, contact your local health department or use bottled water. If your baby is very young (younger than 3 months old), was born prematurely, or has a weakened immune system, contact your infant’s pediatrician to find out if you need to take extra precautions in preparing your infant’s formula. Use the amount of water and number of powder scoops listed on the instructions of the infant formula label. Be sure to use the scoop provided by the manufacturer. Always measure the water first and then add the powder. If the formula is not being fed immediately, refrigerate it right away, keep refrigerated until feeding, and use within 24 hours. Discard any formula left in the bottle after your infant has finished a feeding.

Bottles & Nipples: Bottles, rings, caps, and nipples need to be clean and sanitized. To learn more about how to properly clean your baby’s bottles and other feeding supplies, visit the Centers for Disease Control (CDC) webpage “How to Clean, Sanitize, and Store Infant Feeding Items.”

Formula Warming: This isn’t necessary. If you prefer to feed your infant warmed formula, place the bottle under running warm water, taking care to keep the water from getting into the bottle or on the nipple. Put a couple drops of the infant formula on the back of your hand to make sure it is lukewarm and not too hot. Never use a microwave oven for heating infant formulas. Microwaving may cause the bottle to remain cool while hot spots develop in the formula. Overheated formula can cause serious burns to your baby.

“Use By” Date: This is the date up to which the manufacturer guarantees the nutrient content and the quality of the formula. After this date, a package or container of infant formula should not be fed to infants. FDA regulations require this date to be specified on each container of infant formula.

Storage: Manufacturers must include instructions on infant formula packaging for its handling before and after the container is opened. They must also include information on the storage and disposal of prepared formula.

Freezing Formula: This is not recommended, as it may cause the product’s components to separate.

Products on the Market

The American Academy of Pediatrics recommends exclusive breastfeeding for about 6 months, followed by continued breastfeeding as other foods and drinks are introduced with continuation of breastfeeding for one year or longer as mutually desired by mother and infant. While breastfeeding is strongly recommended and many mothers hope to breastfeed their infants, many infants in the U.S. rely on infant formula for some portion of their nutrition.

Infant formula comes in three forms:

• Powder — Must be mixed with water before feeding.
• Liquid concentrate — Must be mixed with an equal amount of water before feeding.
• Ready-to-feed — Requires no mixing.

The FDA’s nutrient specifications for infant formulas are set at levels to meet the nutritional needs of infants, and formula manufacturers generally set nutrient levels that are above the FDA minimum requirements. Thus, babies fed infant formulas do not need additional nutrients unless they are fed a low-iron formula.

The infant formulas currently available in the U.S. are labeled as either “Infant Formula with Iron” or “Additional Iron May Be Necessary.” The American Academy of Pediatrics recommends that formula-fed infants receive an “Infant Formula with Iron” as a way of preventing iron-deficiency anemia.

If you have concerns about infant formula, contact your health care provider and FDA at 1-888-INFO-FDA (1-888-463-6332), or you can file a report online at MedWatch.