For the past few months, I’ve been fielding questions about the baby formula crisis. Make no mistake, the shortage of baby formula is indeed a crisis.

Babies are delicate. Their immature bodies rely on having just the right intake of water and salts, and just the right composition of proteins, fats and carbohydrates. Their organs can’t keep that balance independently, the way healthy older children and adults can. Formula is carefully designed for this.

Breastmilk is the ideal food for babies, providing nearly complete nutrition for the first year of life. But not every baby or mother can breastfeed. For example, infants with galactosemia are unable to metabolize milk sugar, and mothers with certain infections risk passing them to their babies through breast milk. There are a variety of social and physical factors that can make breastfeeding, or pumping breast milk, untenable.

Sometimes we can induce the production of breast milk, but this is a usually difficult and always time-consuming process. It isn’t an option for the mother staring at an empty formula shelf while her two-month-old cries in hunger. And solid foods are not a safe option for babies under four to six months of age as they aren’t physically ready to swallow or digest them.

Historically, the most common alternative to a breastfeeding mother was a wet nurse, a woman hired or enslaved to breastfeed another’s infant. The milk of domestic animals, usually cows, was also used as a substitute. But this milk was often contaminated, and animal milk does not have the same nutritional composition as human milk, so babies fed this way were vulnerable to malnutrition and infection. Many died as a result.

As science progressed, we learned more about food preservation and sanitation. We learned to pasteurize milk. We learned to produce sweetened condensed and evaporated milk. We learned about the nutritional gaps between human and animal milk, and we began to understand why the latter was not good for babies.

By the mid-20th century, most formula-fed babies drank a homemade concoction based on evaporated milk, water and sugar. These home formulas were susceptible to contamination and difficult to get balanced just right. Many babies still died in infancy because of these issues, although far fewer than in previous centuries.

Eventually, commercial formulas were refined to closely mimic the nutritional composition of breastmilk. Manufacturers developed specialty products for infants with issues like prematurity, food allergies and metabolic diseases. These formulas were easy to mix, and far less likely to be contaminated.

Modern baby formula is the result of centuries of science. With it, millions of babies grow and thrive. Not having access threatens lives.

Debra Johnston, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.

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