Navigating formula shortages: associations of parental perspectives on transitioning to alternative infant formulas for cow's milk protein allergy during the 2022 national formula shortage

Abstract

The COVID-19 pandemic led to supply chain disruptions causing a severe shortage of infant formula. The shortage impacted parents of infants with cow's milk protein allergy (CMPA) who rely on specialized formulas. However, research on parent perspectives during formula shortages is limited. We aimed to understand the factors guiding parents' decisions when transitioning to alternative amino acid formula (AAF) or extensively hydrolyzed formula (eHF) during the national formula shortage. We conducted a survey using the ZSMoments platform and found that before the shortage, parents valued safety (83%), tolerability (78%), and reputability (78%) as primary factors in selecting eHFs and AAFs. Post-shortage, formula tolerability (86%), assurance (84%), and safety (80%) gained more importance. Among those switching eHF (n = 54), health care provider recommendations (81%), reputability (78%), taste (78%), and tolerability (78%) were rated as “extremely important.” Among those switching AAF (n = 26), top factors included tolerability (77%), assurance (73%), safety (73%), cost-effectiveness (73%), and formula trustworthiness (73%). These data suggest that parents carefully weigh various factors when managing their child's CMPA and transitioning to different AAF or eHF options.

Managing cow's milk protein allergy during the 2022 formula shortage: decision-making among pediatric healthcare providers

“…Another survey of 863 parents found that 77.4% believed milk banking to be a viable option for addressing the formula shortage ( 13 ). While these methods may be acceptable short-term solutions for healthy infants, those with CMPA must rely on breast milk or formula free of cow's milk proteins, requiring additional consideration and limiting the ability to find alternatives ( 14 , 15 ). Organizations such as the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and state Women, Infants, & Children (WIC) offices have come together to form a readily available list of recalled formulas and provide specific alternatives for families and pediatric HCPs ( 16 , 17 ).…”

Impact of the 2022 national formula shortage on clinical decision-making of healthcare providers in switching amino acid formulas for infants with cow’s milk protein allergy: a survey-based study

“…Hypoallergenic formulas, such as amino acid formulas (AAF) and extensively hydrolyzed formulas, are the mainstay of CMPA management in formula-fed infants, reducing exposure to cow's milk protein and symptom severity (6,14). AAFs composed of amino acids and extensively hydrolyzed formulas containing short peptides and amino acids, are well-tolerated in most infants (9,(15)(16)(17)(18)(19)(20)(21)(22)(23). However, in cases where infants fail to respond adequately to eHF or exhibit severe allergic reactions, AAFs may be considered as an alternative due to their hypoallergenic nature and ability to meet the nutritional needs of infants with complex medical conditions (23).…”