By Dr. Anthony Policastro

I watch the current concern about the formula shortage from a historical standpoint. It is interesting that there was a time when it would not have been a story at all. But now the sky seems to be falling. 

We have long known that the best milk for babies is mother’s breast milk. If all infants were to breast feed, there would be no formula issues. 

There was no such thing as infant formula until the mid-1970s. Thus formula has only been used for less than 50 years of human existence. How can there be a shortage of something that has been just a blip in our history?

When I was a pediatric resident, formula was just starting to take hold. Up until that time, most milk came from mixing evaporated milk with water and sugar. In the 1960s about 80 percent of children were fed with this combination.

At that time formula was replacing evaporated milk in non-breast fed infants. However, there always seemed to be a race. Mothers wanted to get their infants off formula and on to cow’s milk quickly. They could then brag that they beat all the other mothers at doing that.

The result was that in the early 1970s about 60 percent of children were exclusively on cow’s milk by six months of age. Another 20 percent were exclusively breast fed. The rest fell somewhere in between.

One of the big concerns was that some infants drank so much milk that they consumed almost all their calories from milk. A newborn requires about 1,000 calories per day. Forty-eight ounces of milk contains 960 calories.

They ate very little food. There was no iron in cow’s milk. Iron came from food. Thus those infants who drank large amounts of cow’s milk frequently developed iron deficiency anemia. 

I always used to recommend that total milk intake be capped at 32 ounces per day at any age. It was part of my routine at well child visits.

Since formula was iron fortified, the logic was that if an infant drank too much formula there would be iron in it. For that reason the recommendation for formula was that it should be given until infants are six months old. It was later extended to 12 months of age.

Most mothers have grown up with the 12 month recommendation. Therefore there is no longer a race to be the first one with your infant on cow’s milk.

When I finished my residency there were three main formulas. They were Similac,  Enfamil and SMA. SMA took great pains to make their formula as close to breast milk as possible. 

Most hospitals had contracts with Similac and Enfamil. So most infants started on those. Several years later both of them decided to copy SMA’s formula. They came out with “new and improved” versions. Those versions matched what SMA had been doing for years.

Because of all this in the old days a formula shortage might have been just shrugged off. Mothers would just have switched their infants from formula to cow’s milk. As long as the diet remain balanced most children would do well.

It kind of is like “Beauty is in the Eye of the Beholder.” Depending upon what historical glass you look at, the current formula shortage might be a big thing or not really.

COVID update- Sussex County remains in the high zone for hospitalizations. That is still driven by Beebe Hospital. It is currently at 99.7 percent of capacity. TidalHealth Nanticoke Hospital remains in the yellow zone. It has gone up to 83.8 percent of beds occupied. Milford Hospital remains green with 46.3 percent of capacity.

Total number of new cases in Sussex County had gone from 607 last week to 840 this week. Nationally the numbers have increased from 619,000 to 779,000. Those increases are not major ones so there is a slow rise.

At-home testing means the actual number of new cases reported is lower than the actual number of cases that are occurring.

All that being in the high zone means is that individuals should wear masks when indoors. That is to protect them from others. It is to protect others from them. In other words, mask wearing offers mutual protection.

However, as I went to indoor meetings last week, I was the only one masked. There has been no change in the number of masked people at church services. I was at a dinner dance on Friday night with 120 unmasked individuals. There is clearly a need for improvement in communicating the need for masks on an interim basis.