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Dangers of Formula Dilution

Author:
Tiffany Fischman, MD
Children’s Hospital Los Angeles, Los Angeles, California

Citation:
Fischman T. Dangers of formula dilution [published online December 12, 2019]. Consultant360.

 

The writing of this article was funded by Perrigo Company plc. For full author disclosure, click here.

 

Adequate nutrition is essential to an infant’s growth and development. While expert organizations like the American Academy of Pediatrics (AAP) and the World Health Organization (WHO) believe that breastfeeding is the best form of nutrition during the first year of life, pediatricians know that most families use infant formula during the first year for a variety of reasons.

Unfortunately, research shows that many families are not as well informed about the proper preparation of infant formula as we may think. This lack of information can often lead to unsafe feeding practices.

According to the US Department of Agriculture,1 approximately 16 percent of children younger than 4 years of age live in households with food insecurity. A study published in Clinical Pediatrics2 found that 27 percent of food-insecure families report stretching, diluting, or limiting formula at some point in time. In addition, nearly 1 in 6 families in this study reported modifying or limiting formula in order to make it last longer.2 The study also found that rather than buying a more-affordable formula, like store-brand infant formula, families were stretching or diluting a national-brand infant formula. This could imply that these families are either not aware of store-brand infant formula or that they perceive it to be less beneficial than a heavily marketed, national-brand formula.

While many food-insecure families receive infant formula from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), the program is intended to be supplemental; the formula that WIC provides does not last a full month. This leaves families in a difficult situation.

Stretching formula to save money can be very dangerous. Infants rely entirely on the nutrients and calories from formula for growth and development. No cost saving is worth the risk of poor growth and development or infant mortality.

While it is a sensitive topic, it is important for health care professionals to be proactive and talk with the families of their patients about food insecurity. The AAP’s Bright Future Guidelines toolkit3 and the AAP’s Addressing Food Insecurities toolkit4 can be used to help screen families for food insecurity.

It is important to note that all infant formulas sold in the United States meet the same Food and Drug Administration (FDA) standards for quality, safety, and nutrition. Store-brand infant formulas match the nutrition of the more popular, nationally advertised formula brands and cost up to 50 percent less with the potential to save families up to $900 a year.4

Discussing less-expensive feeding options with families and warning parents about the dangers of diluting formula is critical for preventing misuse and the subsequent negative impacts it can have on infant nutrition, growth, and development.

For more information about infant formula safety, visit https://perrigopediatrics.com/?o=consultant360.  .

Tiffany Fischman, MD, FAAP, is a general pediatrician at Calabasas Pediatrics and Children’s Hospital Los Angeles in Los Angeles, California.

References:

  1. Coleman-Jensen A, Rabbit MP, Gregory CA, Singh A. Household food security in the United States in 2017 [published online September 2018]. United States Department of Agriculture. https://www.ers.usda.gov/publications/pub-details/?pubid=90022.
  2. Burkhardt MC, Beck AF, Kahn RS, Klein MD. Are our babies hungry? Food insecurity among infants in urban clinics. Clin Pediatr. 2012;51(3):238-243. https://doi.org/10.1177/0009922811426767.
  3. Hagan Jr. JF, Shaw JS, Duncan PM. Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents. 4th ed. Itasca, IL: American Academy of Pediatrics; 2017. https://shop.aap.org/bright-futures-guidelines-for-health-supervision-of-infants-children-and-adolescents-4th-edition-1.
  4. Addressing food insecurity: a toolkit for pediatricians. American Academy of Pediatrics and the Food Research & Action Center. https://perrigopediatrics.com/documents/Perrigo/Pages/resources/2017_FRAC_AAP-Toolkit.pdf. Published February 2017. Accessed December 2019.
  5. Retail prices from October 2019 retail price survey of assorted stores. Actual prices and savings may vary.