Recognizing problems behind infant-formula stretching


Stretching infant formula by dilution or reduced feedings exposes babies to serious developmental risks, yet it can be a monthly temptation for families receiving supplemental nutrition assistance. Find out how families forced to resort to formula stretching can be better identified and what other options can be offered to them.

Stretching infant formula by dilution or reduced feedings, thus exposing babies to cognitive, behavioral, and psychological risks, is a monthly temptation for caregivers receiving formula as part of supplemental nutrition assistance and especially in food-insecure families.

A study of caregivers whose infants received primary care at 2 urban clinics found that 81% received Women, Infants and Children (WIC) assistance, and of those, nearly two-thirds usually run out of WIC-supplied infant formula before month’s end. Most purchase additional formula, but about 1 in 6 families reported various stretching methods to make the supply of formula last. 

Nearly a third of the 144 families in the study were food insecure, even though most of them (78%) received monthly supplemental food assistance. Formula stretching was reported in more than a quarter of the food insecure families compared to only 9% in the other families.

Despite generic formula being less expensive when replacing WIC-supplied brand name formula that runs out, more than three-quarters of the families in the study would not consider it. Half of the families incorrectly thought generic formula not to be nutritionally equivalent.

Although the 2 clinics annually serve 45,000 people in what is considered a typical urban setting, the finding that 30% of the families were food insecure was twice the national average.

A second study by the same investigators focused on better identifying food-insecure families during standard clinical care so that they can be provided options to help meet their needs. By testing various interventions, the study found the 2 most effective were implementing an evidence-based electronic screen for food insecurity and educating clinicians to ask about hunger issues in a more sensitive manner, because families are often reluctant to report food insecurity.

As a result, residents providing care in an urban clinic increased their ability to identify food-insecure households from 2% of cases before the interventions to 11% afterward.

The investigators suggested that a provider-administered screening tool can be an effective way to increase identification of food insecurity in a busy clinic, assuming that the clinician can interview the caregiver in a sensitive and family-centered manner.

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