In addition, some parents feed the toddler versions to infants even though they do not meet federal standards for infant formula and may not provide babies with adequate nutrients to sustain their growth.

say that when most children turn 1, they can begin drinking cow milk or an unsweetened plant-based milk substitute. In a 2019 , the American Academy of Pediatrics and other health and nutrition organizations recommended against using toddler formulas, saying “they offer no unique nutritional value beyond what could be obtained with healthy foods; furthermore, they may contribute added sugars to the diet.” The toddler formulas often contain sweeteners and fats that add calories.

Some of the same companies that produce infant formula — including Enfamil, Gerber, and Similac — also make toddler formulas, as do some smaller, boutique brands that advertise that they have organic or other special qualities. Toddler formulas are available nearly everywhere infant formulas are sold and are marketed as providing extra nutrients to help children’s brain, immune system, and eye development, among other benefits. They are different from medical formulas prescribed for children with specific needs.

A found that sales of toddler formula in the U.S. rose to $92 million in 2015 from $39 million in 2006.

Parents are often confused by the marketing for the formulas, according to a study led by , a marketing and public health researcher at the University of Connecticut. She found that falsely believed toddler formulas have nutrients that toddlers can’t get from other foods.

, a pediatric gastroenterologist and pediatrics professor at Yale University, said he is concerned these products could be giving toddlers more nutrients and calories than they need. Unlike what’s designed for infants, toddler formula has no nutritional regulations: Experts say standardizing a supplement to toddlers’ diets is impossible because no two children are alike.

In , Harris said, parents report feeding their children toddler formula to fill nutritional gaps when a child isn’t eating enough, a common concern among parents.

“Infants are often voracious eaters,” said , chair of pediatrics at Children’s Hospital Colorado. But at around a year of age, children’s growth plateaus, he said, and “they’re suddenly not hungry in the way they used to be anymore.” That can worry parents, he added, but “it’s a completely normal phenomenon.”

If parents have concerns about their children’s diet, Daniels said, they should consult a pediatrician or family doctor.

Blanche Lincoln, president of the Infant Nutrition Council of America, which represents the makers of Enfamil, Gerber, Similac, and store brands, said in an email that the toddler formulas can be helpful because they can fill “nutritional gaps during this period of transition to table foods.” Lincoln, a former U.S. senator from Arkansas, said the drinks “help contribute to the specific nutritional needs of toddlers by providing energy and important nutrients, as well as essential vitamins and minerals during this important period of growth and development.”

But toddler formula isn’t being ingested by toddlers alone — it’s also being fed to infants. In a , Porto and colleagues found that 5% of infants’ parents reported giving their babies drinks marketed for the older age group. And Harris’ research indicated that of infants older than 6 months had fed their babies toddler formula in the previous month. Both studies were conducted before the recent infant formula shortage, which may have exacerbated the problem.

“Infant formulas and toddler formulas tend to be next to each other in the supermarket,” Harris said. “They look similar, but the toddler formulas are cheaper than the infant formulas. So people confuse them, and they grab the wrong one. Or they think, ‘Oh, this one is less expensive. I’ll get this one instead.’”

According to an email from FDA spokesperson Lindsay Haake, toddler drinks do not meet the definition of infant formula, so they are not subject to the same requirements. That means they do not have to undergo the clinical trials and pathogen safety testing that the infant versions do. “Unlike infant formulas, toddler formulas are not necessary to meet the nutritional needs of their intended consumers,” Haake said.

In a statement to KHN, the Infant Nutrition Council of America said, “Toddler drinks have a distinctive use and nutritional makeup from infant formula; the two are not interchangeable. The labeling of toddler nutritional drinks explicitly identifies the product as a toddler drink intended for children 12 months and older on the front of the package label.”

However, several expensive toddler formula brands made by smaller companies — often advertised as being made from goat milk, (which lacks one common milk protein), or vegan ingredients that aren’t soy — do meet nutritional requirements for infants, and some advertise that.

Harris argued that this confuses parents, too, and shouldn’t be allowed. Just because a toddler formula has the nutritional ingredients required by the FDA for infant formula doesn’t mean it has met the other tests required of infant formula, she said.

Federal regulators have not forced any of the companies to withdraw those products. In an email, FDA spokesperson Marianna Naum said, “The FDA does not comment on potential compliance actions.”

One company, Nature’s One, whose toddler formulas are named “Baby’s Only,” received a decade ago from the FDA about marketing them for infants. That case was closed in 2016. The company’s website says that Baby’s Only formula “” and that “.” Critics say that language implies the formula is fine for babies younger than 1. The company’s website and its Instagram account feature customer testimonials from parents who report feeding the formula to their infants, as well as pictures of infants drinking it.

Jay Highman, CEO and president of Nature’s One, said that Baby’s Only is clearly labeled as a toddler formula and that the back of the can states that “Baby’s Only is intended for a toddler 1-year of age or older OR when directed by a healthcare professional.” He also said that since the company launched in 1999, its formulas have met all the nutritional, manufacturing, and safety standards required of infant formula even though they don’t have to. “We behaved like we are an infant formula, but we were selling it as a toddler formula,” Highman said.

He said that the clinical trials required by the FDA are a huge barrier to bringing a new infant formula to market and that many other countries don’t require a clinical trial. Baby’s Only recently completed a clinical trial, he said, and the company expects to be able to sell it as an infant formula soon.

Yet pediatricians and nutritional experts continue to caution parents about using the toddler drinks. “There’s no question that infant formula is very important in the first year of life,” Daniels said. But he doesn’t recommend the toddler version “because it’s not that useful, because it’s confusing, because it’s expensive.”

This <a target="_blank" href="/health-industry/formula-infants-toddlers-federal-standards-nutrition/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

She worked a low-wage job and had mounting student debt, so the then-19-year-old turned to the Special Supplemental Nutrition Program for Women, Infants, and Children, known as WIC, to get infant formula and food. But after she gave birth, her baby had colic and painful reflux and her pediatrician recommended a special formula not available through the program.

It took four months, three pediatrician appointments, and two meetings at her local WIC office before the program provided her with formula that worked for her daughter. She spent hundreds of her own dollars on formula in the process. That was in 2020, years before an Abbott manufacturing plant in Michigan was shut down over concerns about bacterial contamination. The February shutdown and coinciding recall catalyzed massive infant formula shortages in the U.S.

The ongoing dearth of formula has caused tremendous stress for families nationwide, especially those who rely upon WIC. The federally funded grant program, administered by nearly 90 state, territorial, and tribal governments, accounts for as much as two-thirds of all formula purchases in the U.S., according to the U.S. Department of Agriculture, which runs WIC.

For nearly 50 years, WIC has to low-income mothers and children. About — 1.5 million — received benefits from WIC in 2021. That purchasing power drove significant cost savings on infant formula for the federal and state governments that run the program. But the program’s massive purchasing also limits choices for families and can make it hard for mothers like Abbott to get formula that is a good fit for their infants.

Those limitations began in 1989 after WIC administrators opted for a policy in which formula companies bid to become the sole provider for each state. States then offer a limited assortment of formulas from the winning manufacturer.

Under the arrangement, the companies give state WIC programs significant rebates for the formula they buy. For every $1 WIC pays to the formula companies, it gets back as much as 93 cents in rebates, explained David Betson, an associate professor of economics and public policy at the University of Notre Dame who has studied the WIC program.

Rebate savings reduced annual program costs by , according to the USDA. In a statement to KHN, it said the rebate system allows states to use their food grants more efficiently and offsets the cost of formula so that more participants can be served without increasing federal funding.

And because of WIC’s bidding policies, of all WIC-supported infants get formula from just one brand: Similac, which is made by Abbott. As a result, over half a million babies possibly had to switch formula after the February recall and plant shutdown.

Many babies do fine on just about any formula, but some parents find that their baby seems to do best on a specific brand and type.

“Parents often have to experiment a little bit and often end up trying three or more formulas to find the formula that keeps their baby comfortable,” said , an assistant professor who studies infant nutrition at the University of Rochester Medical Center.

When Jenny Murray, a mom of three in Florida, started getting WIC benefits, the formula her baby had been using was not one of her state’s WIC-approved options. The formula WIC selected for her baby made him gassy. Officials at her WIC office told her she needed a note from her doctor to get a different formula, but her doctor said it wasn’t medically necessary to switch. So she has stayed with that formula. Now, amid the shortage, she’s struggling because WIC allows participants to buy only small cans of formula, and she said those are the hardest to find. (Some states’ WIC programs are temporarily changing policies amid the shortage.)

“I didn’t even make dinner tonight because I knew we’re going to be spending the rest of the evening just going from store to store to store to store in hopes that we’ll find some [formula],” Murray said. A few times, she has had to resort to paying about $40 out-of-pocket for a large can of formula because that’s all that was available.

The decision for each state to have formula manufacturers compete to serve the WIC program has led to higher prices, Betson said. He found that wholesale formula prices from when WIC implemented its bidding process in 1989 to 2002. Another that formula prices increased an additional 30% from 2006 to 2015. Betson said formula companies take a hit on the formula they sell via WIC and make up for it by charging non-WIC customers higher prices.

Other economists, however, say formula companies instead benefit from an increase in sales after winning a WIC contract, and haven’t been affected. (Store-brand formulas, which are made by Perrigo Nutrition, a company that doesn’t participate in WIC contracts, are about 40% less expensive than the formula brands that do participate in WIC and have nearly identical ingredients.)

And WIC spends more on formula than on any other food, as the majority of WIC-supported infants, about 88%, get at least some formula through the program. Lower-income families are more likely to use formula because these mothers often face more barriers to breastfeeding. For example, about 25% of low-income individuals have to go back to work about two weeks after giving birth, said , an assistant professor at the University of California-San Francisco, whose research focuses on infant feeding disparities. Those same parents may also work in jobs that don’t have lactation accommodations, and they may be afraid to jeopardize their jobs to ask for them, she said.

Because of the federal program’s high rates of infants on formula, WIC administrators have tried incentivizing breastfeeding by giving more food to breastfeeding moms, and some states have tried to limit access to formula for mothers who start breastfeeding. Emeline Pratt, a mother of two who lives in Vermont, said her WIC office required her to meet with a lactation consultant to get formula, even though she explained she had already given up breastfeeding. The uncomfortable appointment left Pratt in tears.

Asiodu, who said she would like more policies that support breastfeeding and enable greater access to human milk from milk banks, also sees a need for more flexibility in WIC.

“I think it’s really important that we allow families to make the decisions that really best fit their needs, and also provide resources along the way,” regardless of what feeding option they choose, she said.

Miracle Abbott said she, too, wishes WIC had more options for formula-feeding moms. Despite having a colicky baby, going to school, and dealing with the problems of the pandemic, she said, “WIC is probably the most frustrating thing we’ve had to deal with.”

This <a target="_blank" href="/health-care-costs/low-income-families-baby-formula-strain-wic/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

In addition, some parents feed the toddler versions to infants even though they do not meet federal standards for infant formula and may not provide babies with adequate nutrients to sustain their growth.

say that when most children turn 1, they can begin drinking cow milk or an unsweetened plant-based milk substitute. In a 2019 , the American Academy of Pediatrics and other health and nutrition organizations recommended against using toddler formulas, saying “they offer no unique nutritional value beyond what could be obtained with healthy foods; furthermore, they may contribute added sugars to the diet.” The toddler formulas often contain sweeteners and fats that add calories.

Some of the same companies that produce infant formula — including Enfamil, Gerber, and Similac — also make toddler formulas, as do some smaller, boutique brands that advertise that they have organic or other special qualities. Toddler formulas are available nearly everywhere infant formulas are sold and are marketed as providing extra nutrients to help children’s brain, immune system, and eye development, among other benefits. They are different from medical formulas prescribed for children with specific needs.

A found that sales of toddler formula in the U.S. rose to $92 million in 2015 from $39 million in 2006.

Parents are often confused by the marketing for the formulas, according to a study led by , a marketing and public health researcher at the University of Connecticut. She found that falsely believed toddler formulas have nutrients that toddlers can’t get from other foods.

, a pediatric gastroenterologist and pediatrics professor at Yale University, said he is concerned these products could be giving toddlers more nutrients and calories than they need. Unlike what’s designed for infants, toddler formula has no nutritional regulations: Experts say standardizing a supplement to toddlers’ diets is impossible because no two children are alike.

In , Harris said, parents report feeding their children toddler formula to fill nutritional gaps when a child isn’t eating enough, a common concern among parents.

“Infants are often voracious eaters,” said , chair of pediatrics at Children’s Hospital Colorado. But at around a year of age, children’s growth plateaus, he said, and “they’re suddenly not hungry in the way they used to be anymore.” That can worry parents, he added, but “it’s a completely normal phenomenon.”

If parents have concerns about their children’s diet, Daniels said, they should consult a pediatrician or family doctor.

Blanche Lincoln, president of the Infant Nutrition Council of America, which represents the makers of Enfamil, Gerber, Similac, and store brands, said in an email that the toddler formulas can be helpful because they can fill “nutritional gaps during this period of transition to table foods.” Lincoln, a former U.S. senator from Arkansas, said the drinks “help contribute to the specific nutritional needs of toddlers by providing energy and important nutrients, as well as essential vitamins and minerals during this important period of growth and development.”

But toddler formula isn’t being ingested by toddlers alone — it’s also being fed to infants. In a , Porto and colleagues found that 5% of infants’ parents reported giving their babies drinks marketed for the older age group. And Harris’ research indicated that of infants older than 6 months had fed their babies toddler formula in the previous month. Both studies were conducted before the recent infant formula shortage, which may have exacerbated the problem.

“Infant formulas and toddler formulas tend to be next to each other in the supermarket,” Harris said. “They look similar, but the toddler formulas are cheaper than the infant formulas. So people confuse them, and they grab the wrong one. Or they think, ‘Oh, this one is less expensive. I’ll get this one instead.’”

According to an email from FDA spokesperson Lindsay Haake, toddler drinks do not meet the definition of infant formula, so they are not subject to the same requirements. That means they do not have to undergo the clinical trials and pathogen safety testing that the infant versions do. “Unlike infant formulas, toddler formulas are not necessary to meet the nutritional needs of their intended consumers,” Haake said.

In a statement to KHN, the Infant Nutrition Council of America said, “Toddler drinks have a distinctive use and nutritional makeup from infant formula; the two are not interchangeable. The labeling of toddler nutritional drinks explicitly identifies the product as a toddler drink intended for children 12 months and older on the front of the package label.”

However, several expensive toddler formula brands made by smaller companies — often advertised as being made from goat milk, (which lacks one common milk protein), or vegan ingredients that aren’t soy — do meet nutritional requirements for infants, and some advertise that.

Harris argued that this confuses parents, too, and shouldn’t be allowed. Just because a toddler formula has the nutritional ingredients required by the FDA for infant formula doesn’t mean it has met the other tests required of infant formula, she said.

Federal regulators have not forced any of the companies to withdraw those products. In an email, FDA spokesperson Marianna Naum said, “The FDA does not comment on potential compliance actions.”

One company, Nature’s One, whose toddler formulas are named “Baby’s Only,” received a decade ago from the FDA about marketing them for infants. That case was closed in 2016. The company’s website says that Baby’s Only formula “” and that “.” Critics say that language implies the formula is fine for babies younger than 1. The company’s website and its Instagram account feature customer testimonials from parents who report feeding the formula to their infants, as well as pictures of infants drinking it.

Jay Highman, CEO and president of Nature’s One, said that Baby’s Only is clearly labeled as a toddler formula and that the back of the can states that “Baby’s Only is intended for a toddler 1-year of age or older OR when directed by a healthcare professional.” He also said that since the company launched in 1999, its formulas have met all the nutritional, manufacturing, and safety standards required of infant formula even though they don’t have to. “We behaved like we are an infant formula, but we were selling it as a toddler formula,” Highman said.

He said that the clinical trials required by the FDA are a huge barrier to bringing a new infant formula to market and that many other countries don’t require a clinical trial. Baby’s Only recently completed a clinical trial, he said, and the company expects to be able to sell it as an infant formula soon.

Yet pediatricians and nutritional experts continue to caution parents about using the toddler drinks. “There’s no question that infant formula is very important in the first year of life,” Daniels said. But he doesn’t recommend the toddler version “because it’s not that useful, because it’s confusing, because it’s expensive.”

This <a target="_blank" href="/health-industry/formula-infants-toddlers-federal-standards-nutrition/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

She worked a low-wage job and had mounting student debt, so the then-19-year-old turned to the Special Supplemental Nutrition Program for Women, Infants, and Children, known as WIC, to get infant formula and food. But after she gave birth, her baby had colic and painful reflux and her pediatrician recommended a special formula not available through the program.

It took four months, three pediatrician appointments, and two meetings at her local WIC office before the program provided her with formula that worked for her daughter. She spent hundreds of her own dollars on formula in the process. That was in 2020, years before an Abbott manufacturing plant in Michigan was shut down over concerns about bacterial contamination. The February shutdown and coinciding recall catalyzed massive infant formula shortages in the U.S.

The ongoing dearth of formula has caused tremendous stress for families nationwide, especially those who rely upon WIC. The federally funded grant program, administered by nearly 90 state, territorial, and tribal governments, accounts for as much as two-thirds of all formula purchases in the U.S., according to the U.S. Department of Agriculture, which runs WIC.

For nearly 50 years, WIC has to low-income mothers and children. About — 1.5 million — received benefits from WIC in 2021. That purchasing power drove significant cost savings on infant formula for the federal and state governments that run the program. But the program’s massive purchasing also limits choices for families and can make it hard for mothers like Abbott to get formula that is a good fit for their infants.

Those limitations began in 1989 after WIC administrators opted for a policy in which formula companies bid to become the sole provider for each state. States then offer a limited assortment of formulas from the winning manufacturer.

Under the arrangement, the companies give state WIC programs significant rebates for the formula they buy. For every $1 WIC pays to the formula companies, it gets back as much as 93 cents in rebates, explained David Betson, an associate professor of economics and public policy at the University of Notre Dame who has studied the WIC program.

Rebate savings reduced annual program costs by , according to the USDA. In a statement to KHN, it said the rebate system allows states to use their food grants more efficiently and offsets the cost of formula so that more participants can be served without increasing federal funding.

And because of WIC’s bidding policies, of all WIC-supported infants get formula from just one brand: Similac, which is made by Abbott. As a result, over half a million babies possibly had to switch formula after the February recall and plant shutdown.

Many babies do fine on just about any formula, but some parents find that their baby seems to do best on a specific brand and type.

“Parents often have to experiment a little bit and often end up trying three or more formulas to find the formula that keeps their baby comfortable,” said , an assistant professor who studies infant nutrition at the University of Rochester Medical Center.

When Jenny Murray, a mom of three in Florida, started getting WIC benefits, the formula her baby had been using was not one of her state’s WIC-approved options. The formula WIC selected for her baby made him gassy. Officials at her WIC office told her she needed a note from her doctor to get a different formula, but her doctor said it wasn’t medically necessary to switch. So she has stayed with that formula. Now, amid the shortage, she’s struggling because WIC allows participants to buy only small cans of formula, and she said those are the hardest to find. (Some states’ WIC programs are temporarily changing policies amid the shortage.)

“I didn’t even make dinner tonight because I knew we’re going to be spending the rest of the evening just going from store to store to store to store in hopes that we’ll find some [formula],” Murray said. A few times, she has had to resort to paying about $40 out-of-pocket for a large can of formula because that’s all that was available.

The decision for each state to have formula manufacturers compete to serve the WIC program has led to higher prices, Betson said. He found that wholesale formula prices from when WIC implemented its bidding process in 1989 to 2002. Another that formula prices increased an additional 30% from 2006 to 2015. Betson said formula companies take a hit on the formula they sell via WIC and make up for it by charging non-WIC customers higher prices.

Other economists, however, say formula companies instead benefit from an increase in sales after winning a WIC contract, and haven’t been affected. (Store-brand formulas, which are made by Perrigo Nutrition, a company that doesn’t participate in WIC contracts, are about 40% less expensive than the formula brands that do participate in WIC and have nearly identical ingredients.)

And WIC spends more on formula than on any other food, as the majority of WIC-supported infants, about 88%, get at least some formula through the program. Lower-income families are more likely to use formula because these mothers often face more barriers to breastfeeding. For example, about 25% of low-income individuals have to go back to work about two weeks after giving birth, said , an assistant professor at the University of California-San Francisco, whose research focuses on infant feeding disparities. Those same parents may also work in jobs that don’t have lactation accommodations, and they may be afraid to jeopardize their jobs to ask for them, she said.

Because of the federal program’s high rates of infants on formula, WIC administrators have tried incentivizing breastfeeding by giving more food to breastfeeding moms, and some states have tried to limit access to formula for mothers who start breastfeeding. Emeline Pratt, a mother of two who lives in Vermont, said her WIC office required her to meet with a lactation consultant to get formula, even though she explained she had already given up breastfeeding. The uncomfortable appointment left Pratt in tears.

Asiodu, who said she would like more policies that support breastfeeding and enable greater access to human milk from milk banks, also sees a need for more flexibility in WIC.

“I think it’s really important that we allow families to make the decisions that really best fit their needs, and also provide resources along the way,” regardless of what feeding option they choose, she said.

Miracle Abbott said she, too, wishes WIC had more options for formula-feeding moms. Despite having a colicky baby, going to school, and dealing with the problems of the pandemic, she said, “WIC is probably the most frustrating thing we’ve had to deal with.”

This <a target="_blank" href="/health-care-costs/low-income-families-baby-formula-strain-wic/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">