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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