One of the news stories dominating the headlines in the United States is the current panic over a shortage of baby formula available for parents to purchase.
There are several explanations for an overall decrease in formula production, including an artificial drop in demand as parents worked through formula stockpiles from the pandemic and a spike in births in 2022. However, the catalyst of this shortage was a halt in production at a Michigan plant owned by Abbott products, one of only three companies that dominate the U.S. formula market.
Cases of a dangerous and often fatal bacteria known as Chronobacter sakazakii (aka. Enterobacter sakazakii) were found in four infants who were fed powdered formula made at the Abbott plant. All four babies were hospitalized and two have died. Abbott voluntarily recalled the formula from the plant and shut down production in February, though there is no evidence that the formula made in the plant contributed to the deaths. The bacteria could have come from multiple other sources.
The Food and Drug Administration (FDA), along with a whistleblower at the plant, documented past concerns with a lack of proper sanitation protocols within the Abbott facility. In February, the FDA collected samples at the plant that confirmed the presence of Cronobacter bacteria, but so far the strains that have been found do not match those that caused illness in the infants. The investigation is ongoing, and given that this particular bacteria is ubiquitous in the environment, it could take a long time to determine an exact source (or sources) of the four infections.
However, as a scientist, mother, and grandmother, I did some of my own research on the issue and was shocked by what I learned: in its powdered form, baby formula is not sterile and it never was.
This is spelled out clearly on the Centers for Disease Control and Prevention (CDC) website, but how many busy parents looked at this before deciding to use powdered formula? Who among us did a deep dive on federal baby formula guidance somewhere in the midst of all the normal distractions of a home with a new baby in it?
A quick internet search on how to choose infant formula brings up countless websites that discuss the convenience, savings, and easy storage of powdered formula. Few mention that dry formula is not sterile and extra precautions should be taken.
Cronobacter infection is considered a rare disease (the CDC counts two to four cases per year), but hospitals and labs are not required to report cases of this infection so the true number is unknown.
It is a serious infection that can cause sepsis and meningitis mostly in infants, the elderly, and cases of compromised immune systems. The bacteria can be found naturally in the environment, and has been detected in dry products such as powdered formula, powdered milk, herbal tea, and starches.
Formula powder can be contaminated in the home. Parents must be vigilant about the sanitization of equipment used in preparation, proper storage including the container lid being carefully placed back, and making sure the water used isn’t at risk of contamination. It is sometimes advised to boil and then cool the water (not to below 70 degrees) before mixing the formula.
Formula must also be stored and disposed of properly. After mixing, it can be refrigerated for 24 hours, but then must be disposed of. If the baby does not finish all of the bottle during a feeding, the remainder must be disposed of right away.
Mentions of these safety concerns are few and far between in the online parenting community. Though anecdotal, several parents I’ve spoken with did not receive any guidance on the proper preparation, storage, and use of powdered baby formula from their OB/GYN or pediatrician.
In order to make the safest decisions for their families, parents must have the best—and most complete—information available.
Right now, millions of babies rely on formula. There are safer alternatives to powdered formula, but the demand for affordable dry formula is not going away anytime soon, and testing for the bacteria in plants has been compared to searching for a “needle in a haystack.”
As the investigation continues in Michigan, it is worth asking the questions:
- What food safety solutions are being developed in the private sector and how can the FDA support these innovations? Can we develop containers that can detect and alert parents to the presence of bacteria, or perhaps an affordable method to test mixed formula bottles in the home before serving them to babies?
- How can gatekeepers of food safety better educate parents on the risks of dry baby formula? Who in our society would be the best messengers of that information?
Facts are only valuable to public health when they become knowledge.