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IntroductionCow's milk protein allergy (CMPA) affects 2%-7% of infants and is managed with hypoallergenic formulas. The 2022 recalls of infant formulas due to factors including contamination led to specialty formula shortages, highlighting CMPA management challenges. Understanding healthcare providers' (HCPs) decision-making in transitioning to alternative formulas during shortages is crucial. Limited attention has been given to how pediatric physicians make these choices.MethodsThis study utilized US HCPs' de-identified survey data to assess driving factors when switching extensively hydrolyzed formulas during shortages.Results104 eligible HCPs participated, including general pediatrics, pediatric allergy/immunology, and pediatric gastroenterology specialists. Safety, tolerability, and efficacy were identified as top factors for switching formulas. Formula 1 was considered well-tolerated, patient-accepted, and safe by all HCPs. Most expressed strong belief in Formula 1's safety and effectiveness.DiscussionFindings inform CMPA management during shortages, offering guidance to HCPs for suitable formula selection and enhanced infant care.

BackgroundIn 2022, the United States experienced a national shortage of infant formula due to a global supply chain crisis and a large-scale domestic formula recall. The existing literature on healthcare providers' (HCPs) clinical decision-making during formula shortages is limited. This study aims to analyze the factors influencing pediatric HCP clinical decision-making when switching between amino acid formulas (AAF) for managing cow's milk protein allergy (CMPA) in infants under 24 months of age during an unprecedented national formula shortage.MethodsThe study included pediatric HCPs with experience managing CMPA in infants and toddlers under 24 months during the formula shortage from January 2022 to November 2022. A de-identified survey comprising 26 questions examining driving factors used in clinical decision-making was administered to pediatric HCPs using a real-time mobile data collection tool.ResultsAmong the surveyed pediatric HCPs (n = 75), the factors most frequently considered as “extremely important” when switching to another AAF included safety (85%), tolerability (73%), and efficacy (83%). No statistically significant differences were found in HCP ratings among the listed examined factors of the four AAFs. The availability of specific formulas was the only factor that exhibited a statistically significant difference in perceived performance among pediatric HCPs when comparing the four AAFs (p

Background: Mothers report feeling immense pressure to breastfeed their infants, and not doing so can be associated with stigma, shame, and judgment. Many Latina mothers struggle to meet their breastfeeding goals and substitute formula earlier than planned. During 2022, an infant formula recall caused a shortage and made acquiring formula difficult or impossible in many areas of the United States. This study explores Latina mothers' experiences with infant feeding during the time of the formula shortage. Methods: In-depth interviews (N = 7) were conducted with Latina mothers who formula-fed during the shortage. Interviews were analyzed using reflexive thematic analysis. Mean maternal age was 29.7 years, and mean infant age was 10.3 months. Three mothers were born in the United States, and 4 were immigrants. Results: Thematic analysis generated 3 themes: (1) Fighting to breastfeed; (2) Breastfeeding is not the only way to be a "good" mother; and (3) No formula on the shelves. Participants described their determination to continue breastfeeding despite challenges before realizing that it limited their ability to care for their children. They discussed the emotional toll of the formula shortage and strategies for finding formula. Conclusions: The findings emphasize the need for additional structural support for infant feeding in the United States to prevent future formula shortages and for better lactation care and mental health support for mothers who want to breastfeed. [ABSTRACT FROM AUTHOR]

• The infant formula shortage of 2022 affected infant feeding choices. • Breastfeeding rates significantly increased during the formula shortage. • It is uncertain whether increased breastfeeding rates will be sustainable. • The Theory of Planned Behavior helps understand infant feeding decisions. This study aimed to determine the impact of the infant formula shortage on breastfeeding rates. The sample included infants attending newborn through 2-month visits at a rural pediatric practice. Preshortage data was compared with postshortage data from newborn (pre: n = 302; post: n = 302), 1-month (pre: n = 273, post: n = 259), and 2-month (pre: n = 255; post: n = 234) visits. Data analysis using Pearson's χ2 and Mann-Whitney tests found a significant increase in breastfeeding rates postshortage compared with preshortage. Breastfeeding initiation increased by 10.6% compared with preshortage. Many factors contributed to the significant increase in breastfeeding initiation during the formula shortage. Reports of illnesses associated with the ingestion of infant formula made breastfeeding more appealing. Furthermore, breast milk was readily available, whereas formula was not. Positive breastfeeding experiences during the formula shortage may lead to a sustained increase in breastfeeding. [ABSTRACT FROM AUTHOR]

Introduction: Cow's milk protein allergy (CMPA) affects 2%-7% of infants and is managed with hypoallergenic formulas. The 2022 recalls of infant formulas due to factors including contamination led to specialty formula shortages, highlighting CMPA management challenges. Understanding healthcare providers' (HCPs) decision-making in transitioning to alternative formulas during shortages is crucial. Limited attention has been given to how pediatric physicians make these choices., Methods: This study utilized US HCPs' de-identified survey data to assess driving factors when switching extensively hydrolyzed formulas during shortages., Results: 104 eligible HCPs participated, including general pediatrics, pediatric allergy/immunology, and pediatric gastroenterology specialists. Safety, tolerability, and efficacy were identified as top factors for switching formulas. Formula 1 was considered well-tolerated, patient-accepted, and safe by all HCPs. Most expressed strong belief in Formula 1's safety and effectiveness., Discussion: Findings inform CMPA management during shortages, offering guidance to HCPs for suitable formula selection and enhanced infant care., Competing Interests: MW has served as a consultant for Reckitt. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Oliveros, Brown, Fabbrini, Farrar, Lamos, Florio, Beacker, Baran and Wilsey.)

Background: In 2022, the United States experienced a national shortage of infant formula due to a global supply chain crisis and a large-scale domestic formula recall. The existing literature on healthcare providers' (HCPs) clinical decision-making during formula shortages is limited. This study aims to analyze the factors influencing pediatric HCP clinical decision-making when switching between amino acid formulas (AAF) for managing cow's milk protein allergy (CMPA) in infants under 24 months of age during an unprecedented national formula shortage., Methods: The study included pediatric HCPs with experience managing CMPA in infants and toddlers under 24 months during the formula shortage from January 2022 to November 2022. A de-identified survey comprising 26 questions examining driving factors used in clinical decision-making was administered to pediatric HCPs using a real-time mobile data collection tool., Results: Among the surveyed pediatric HCPs ( n  = 75), the factors most frequently considered as "extremely important" when switching to another AAF included safety (85%), tolerability (73%), and efficacy (83%). No statistically significant differences were found in HCP ratings among the listed examined factors of the four AAFs. The availability of specific formulas was the only factor that exhibited a statistically significant difference in perceived performance among pediatric HCPs when comparing the four AAFs ( p  < 0.05)., Discussion: This study elucidates the crucial aspects that influenced pediatric HCPs' selection of AAFs for CMPA management during the 2022 formula shortage. The findings highlight the significance of safety, tolerability, efficacy, and availability in the pediatric HCP decision-making processes., Competing Interests: MW has served as a consultant for Reckitt. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be constructed as a potential conflict of interest., (© 2024 Baran, Brown, Farrar, Oliveros, Beacker, Lamos, Florio, Fabbrini and Wilsey.)

Competing Interests: Disclosure of interests: No interests were disclosed.