The formula shortage is putting hospitals in a bind as desperate parents seek help and young children with special needs not getting adequate nutrition show up to pediatric wards and emergency departments.
Although hospitals have formula on hand, they don't have enough to make up for the broken supply chain.
"We definitely don't want to send a message 'Come to the hospital, we have an abundant supply of formula,' because unfortunately that's not the case," said Dr. James Franciosi, associate chief of the division of gastroenterology, hepatology and nutrition at Nemours Children's Hospital in Orlando, Florida.
Nemours Children's Hospital's formula supply is sufficient to cover its patient volume, Franciosi said. But the hospital must turn away other families who need food for their children, he said.
"It's not that emergency rooms and hospitals are being overwhelmed with this issue, but it is causing a lot of distress," Franciosi said. "It's been challenging because there's not a magic fix for everyone."
Supply chain troubles and staffing shortages at the four major domestic formula makers have limited access to formula throughout the COVID-19 pandemic. But safety issues at one manufacturing facility have severely exasperated the problem.
Abbott Nutrition, which controls nearly half of the U.S. formula market, shut down a Michigan plant and issued a recall for certain powder formulas in February after several children were hospitalized with a rare bacterial infection linked to their products. The Food and Drug Administration is investigating the contamination.
The recall has especially diminished the availability of specialty and prescription-only formulas and created shortages for children with complex medical conditions and special dietary needs. Children who can't tolerate normal formulas, who were born premature or who have gastrointestinal ailments face the brunt of the problem.
Group purchasing organizations are working directly with manufacturers to ensure hospitals have enough formula, said Lisa Garman, vice president of marketing and communications for HealthTrust Purchasing Group. Supply has been tight and they have had to procure alternative brands, she said.
Nemours Children's Hospital has admitted several children suffering from vomiting, diarrhea, intestinal failure or malnutrition who require an IV after not tolerating alternative formula options, Franciosi said. These children typically have underlying health conditions, he said.
Vanderbilt Children's Hospital in Nashville, Tennessee, hasn't yet admitted any children because of the shortage but is receiving calls from concerned parents, a spokesperson said. The hospital isn't offering nutrition directly to families but is helping them identify alternative formulas if they can't get the brands they typically use, the spokesperson said.
Hospitals in states such as Georgia, Illinois, South Carolina, Tennessee and Wisconsin are seeing similar situations, according to media reports.
For example, four children were hospitalized at Shawn Jenkins Children's Hospital in Charleston, South Carolina, after issues transitioning to different formula, the Charlotte Observer reported. And two children were admitted to Le Bonheur Children's Hospital in Memphis, Tennessee, with dehydration and malnutrition after they couldn't access specialized amino acid-based formula, the Memphis Commercial Appeal reported.
Nemours Children's Hospital has gotten hundreds of calls from people seeking specialized formulas, but it doesn't have enough to distribute to the community. The hospital is having to wait to provide formula until children show up sick.
Children who are are hospitalized face high levels of readmissions, Franciosi said. "We stabilized them in the hospital and then they went outside and were not able to get the formula," he said.
The Orlando hospital is directing families seeking formula to pediatric clinics, local women's, infant's and children's agencies, or formula exchange websites for help, Franciosi said. Nemours Children's Hospital also hosted a webinar to educate parents on different varieties of formulas and how to select among them.
Relief appears to be on the way. Formula manufacturers have stepped up production and Abbott Nutrition will release supplies of a hypoallergenic formula for children with severe food allergies or gastrointestinal disorders. The Abbott Laboratories subsidiary intends to resume production at its Michigan plant on June 4. The company also plans to provide formula to needy families at no cost.
Last week, President Joe Biden invoked the Defense Production Act to boost production and ordered the Defense Department to transport formula from other countries.
The crisis should bring attention to underlying problems with the formula supply chain and encourage action to solve them, Franciosi said.
"Does it really make sense to have four main companies as the sole suppliers for the United States?" Franciosi said. "This is something that is shocking to see happen in America and something that I think we can do better."