The improper reconstitution of powdered or concentrated formula can be a
serious threat to the health of the infants receiving this. The US has a
reporting system for adverse events such as what we have been discussing over
the past few days. At the FDA web site, www.fda.gov, is the MedWatch program
where the improper mixing of formula should be reported. Each time a health
professional encounters a situation where formula was mixed improperly or
there was confusion over the labeling, it needs to be reported. It is
important that we generate evidence of a problem if we are ever to make any
headway with how formula is labeled and used. If the labels are a problem it
is the responsibility of health care professionals to report this to the FDA
which is the regulatory agency for labeling.

Senate hearings in the 1980s pointed out that the labeling was confusing and
that the silly pictograms that have resulted do not seem to have corrected
the problem. Many parents do not read the instructions. Earlier studies
measured the concentration of formula mixed by parents and found the majority
of samples were not reconstituted properly. This is a reason that the formula
companies have developed single-feeding packets of powdered formula. The
instructions say to add the desired amount of water first (x number of
ounces) then add the formula. This creates the correct concentration.

Please consider reporting all adverse events associated with formula. This
gives us an advantage when we interact with state and federal policy makers
regarding the importance of breastfeeding and the hazards of formula feeding.

Marsha Walker, RN, IBCLC
Weston, MA

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