Why can't some infants breastfeed during the formula shortage? What health experts want you to know

The sight of empty grocery shelves worries parents with infants as the Biden administration scrambles to ramp up production of baby formula amid a national shortage. 

Behind the formula shortage are several issues, including supply disruptions caused by the coronavirus pandemic and the shutdown of the largest U.S. formula factory, Abbott Nutrition.

The crisis may have many wondering why millions of babies in the USA depend on formula when exclusive breastfeeding is recommended for at least the first six months of life by major medical entities such as the American Academy of Pediatrics and the World Health Organization.

Breastfeeding doesn’t work for everyone. Health experts said a range of medical issues, from metabolic disorders to infectious diseases, may limit the ability to breastfeed.

“The contraindications for breastfeeding are rare,” said Dr. Lori Feldman-Winter, chair of the American Academy of Pediatrics’ section on breastfeeding. “Sometimes they encounter medical problems, and we need to do better to help mothers overcome those problems.”

Text with the USA TODAY newsroom about the day’s biggest stories. Sign up for our subscriber-only texting experience.

Why some babies need formula

Some babies may require formula temporarily or in addition to breast milk while others depend on it exclusively until they transition to other foods, health experts said.

Those born premature sometimes require formula in addition to breast milk to increase their weight, said Robert Hart, pediatrician and chief medical officer at Ochsner Health in Louisiana.

Although rare, babies who exclusively depend on formula in their first year of life commonly fall into three categories: metabolic disorders, gastrointestinal conditions and allergies, said Dr. Amy Hair, program director of neonatal nutrition at Texas Children’s Hospital.

Babies with metabolic conditions aren't able to digest nutrients, she said. Some babies can’t handle protein found in breast milk and require a specialized formula that contains amino acids.

“The formula is not really protein, but it’s the building blocks of protein, so it is up to the baby to build the protein,” Hair said.

Another metabolic condition involves carbs, Feldman-Winter said. Infants with an uncommon condition called classic galactosemia are unable to metabolize sugar in breast milk and need to be fed formula.

Babies with gastrointestinal diseases or a bowel anomaly may require a specialized formula, Hair said.

“The most severe forms are when babies aren’t born with enough bowels,” she said. “If they’ve lost two-thirds of their bowel, it’s difficult for them to tolerate breast milk.”

Some health experts said babies can be born with a severe cow milk allergy and may have to start on formula instead of breast milk. Other experts said some doctors may be too quick to use this diagnosis when babies present with loose stools.

“There’s been a lot of attention on babies that have a milk protein allergy, but that diagnosis is made erroneously and is not a true protein milk allergy,” Hart said. “That diagnosis is really uncommon and requires an expert.”

Why some parents can't breastfeed

Health experts recommend that parents don't breastfeed if they have certain medical conditions, are undergoing certain treatments or taking certain medications.

This includes infectious diseases such as HIV, Ebola and sometimes herpes if there are lesions present on the breast, according to the Centers for Disease Control and Prevention.

Breastfeeding is not only recommended but encouraged if parents have recovered from an infectious disease as breast milk contains antibodies that protect the newborn.

How European baby formulas differ: Everything you need to know about European baby formula

Fact Check: Image of boxes in warehouse unrelated to baby formula shortage

The CDC does not recommend breastfeeding if parents are undergoing chemotherapy or diagnostic imaging with radiopharmaceuticals or taking medications in certain drug classes as listed by the AAP. Some parents may have other physical or medical barriers.

Though medical conditions that prevent breastfeeding by parents are rare, health experts said, other issues with latching, expressing breast milk and milk transfer are very common. These issues are normally temporary and can be overcome with the proper support and resources, Feldman-Winter said, but not everyone has that access.

“There’s a desire to breastfeed in the U.S., but for many reasons, we’re not there for mothers,” she said. The formula crisis “should be a wake-up call. We need do better in terms of providing those supports.”

Breastfeeding ‘is absolutely not free’

Although exclusive breastfeeding for the first six months is recommended and safe for most babies, Feldman-Winter said, meeting the recommendations can be “very challenging.”

“Breastfeeding takes time and energy, support and a health care system … it is absolutely not free,” she said. “To say it’s free undermines the value of a mother’s work.”

In the first few months, babies breastfeed eight to 12 times a day for up to 30 minutes, according to the CDC, which health experts said is equivalent to a full-time job.

Breastfeeding also has a financial cost. The U.S. surgeon general said parents can save up to $1,500 per year breastfeeding rather than formula feeding, but the Plutus Foundation estimated breastfeeding can cost about $950 per year or more.

This calculation includes higher grocery bills as a parent is expected to eat an extra 500 calories a day to breastfeed, Feldman-Winter said. It includes prenatal vitamins, breast pumps and bottles, nursing supplies and lactation support.

“There are costs associated with professionals like consultants, obstetricians, primary care physicians and other people in the health care system to help mothers overcome inevitable problems that arise in breastfeeding,” she said.

About 80% of parents start out breastfeeding, the CDC said; that number drops to about 56% after six months and 35% after a year.

Exclusive breastfeeding is difficult for working women, who have to pump repeatedly throughout the day, Feldman-Winter said. Stress releases a hormone that makes it difficult to produce milk.

“There’s even greater barriers in underserved areas, women working for hourly wages in low-paying jobs,” she said. “Those women tend to have even fewer supports to be able to continue to breastfeed.”

Contributing: The Associated Press

Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT. 

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

This article originally appeared on USA TODAY: Baby formula shortage: Why some infants, parents can't breastfeed