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1 in 8 low-income parents waters down formula, study finds

Many low-income parents feel they must resort to “formula stretching,” to keep their infants fed, even with government food assistance programs, a new study shows.

The study found that 30 percent of parents who brought their infants to an inner city children’s clinic didn’t have enough food to make it through each month. And a full 15 percent, or about 1 in 8, made ends meet by watering down their babies’ formula or by feeding less frequently, according to the study which was published in Clinical Pediatrics.

“We knew this was a high-risk population,” said study co-author Andrew Beck, a fellow in general academic pediatrics at Cincinnati Children’s Hospital Medical Center. “But these numbers are still staggering.”

Up till now there has been little research on infants in families that don’t have enough food, Beck said. Studies of hunger and food shortages across the nation have found that 16 to 22 percent of American families come up short some months.

Beck and his colleagues surveyed 144 parents of infants who attended the hospital’s Pediatric Primary Care Center. The vast majority of families who come to the clinic are covered by Medicaid and receive food stamps as well as assistance getting infant formula through a program called WIC.

 The researchers asked about food availability and feeding behavior in a 37-question survey that also looked at sociodemographic characteristics such as patient age, race, parental age, education, ethnicity and source of insurance.

Even though the majority of parents were receiving help through foods stamps and WIC, many did not have enough food to feed their families. In fact, some 65 percent of families ran out of WIC-supplied infant formula most months. And the result, in many cases, was that parents diluted or cut back on formula for their infants.

This kind of formula stretching may have consequences for the infants, Beck said.

“There will be a subset of children who will have what is called ‘failure to thrive,’” Beck explained. “More often, though, the ramifications of this tend to be less visible -- problems with cognition and behavior. In some it may lead to obesity later in life.”

While some might point to breast feeding as a solution, not every mom is in the position to do this for her child. In some jobs it’s virtually impossible to express milk during the day when a mom is away from her baby.

“Clearly, we encourage and actively support breastfeeding,” Beck said. “The reality is that a relatively low percentage of our patients breastfeed by the time they reach us.  If they do, we continue to encourage it and have a breastfeeding clinic if they need it.  Although they likely wouldn't require formula, we need to do education and a nutritional assessment for mom.  Also, as the first year progresses, even fewer families continue to nurse.”

Many of these patients may be slipping through the cracks, Beck said. At his hospital, residents reported problems with food availability in only 2 percent of parents attending the clinic.

It was clear, Beck said, that residents didn’t know how to ferret out these kinds of issues. In a second study, published in Pediatrics, the researchers showed that the numbers shot up when doctors were given the right questions to ask of their patients.

Right now Beck and his colleagues are working on finding solutions for parents who don’t have enough to feed their kids. But those solutions will only work if doctors can figure out who needs help, Beck said.  

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