Families and physicians alike benefit from the advances and ease of the Internet. Similarly, both can be unaware of harmful misinformation circulating the Web. In this article, we describe the presentation of 2 unrelated infants, within 1 week of each other, with vitamin D deficiency rickets and severe extraskeletal manifestations of hypocalcemia, including seizures and cardiac arrest, from homemade, vegan formula found through Pinterest (San Francisco, CA). Despite good parental intentions this formula did not meet macronutrient and micronutrient standards, particularly regarding vitamin D, phosphorus, and calcium content, and led to rare, life-threatening complications in both cases. Before presentation, both patients followed appropriately with their pediatrician and discussed feeding in detail, although neither family disclosed the use of homemade formula. Pediatricians must be aware of these dangerous homemade alternative formulas, consider the manner and depth of their feeding history questioning, and continue to counsel against homemade formula to prevent further harm to children.
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September 2021
Case Reports|
September 01 2021
Recipe for Disaster: Homemade Formula Leading to Severe Complications in 2 Infants
Meredith A. Vieira, MD;
aDepartment of Pediatrics
dDepartment of Pediatrics Endocrinology, Sidney Kimmel Medical College, Thomas Jefferson University Endocrinology, Philadelphia Endocrinology, Pennsylvania
Address correspondence to Meredith Vieira, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803. E-mail: Meredith.vieira@nemours.org
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Paige K. Kube, DO;
Paige K. Kube, DO
aDepartment of Pediatrics
dDepartment of Pediatrics Endocrinology, Sidney Kimmel Medical College, Thomas Jefferson University Endocrinology, Philadelphia Endocrinology, Pennsylvania
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Jennifer L. van Helmond, MD;
Jennifer L. van Helmond, MD
bDivisions of Critical Care Medicine
dDepartment of Pediatrics Endocrinology, Sidney Kimmel Medical College, Thomas Jefferson University Endocrinology, Philadelphia Endocrinology, Pennsylvania
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Patrick C. Hanley, MD;
Patrick C. Hanley, MD
cEndocrinology, Nemours/Alfred I. duPont Hospital for Children
dDepartment of Pediatrics Endocrinology, Sidney Kimmel Medical College, Thomas Jefferson University Endocrinology, Philadelphia Endocrinology, Pennsylvania
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Evan G. Graber, DO;
Evan G. Graber, DO
cEndocrinology, Nemours/Alfred I. duPont Hospital for Children
dDepartment of Pediatrics Endocrinology, Sidney Kimmel Medical College, Thomas Jefferson University Endocrinology, Philadelphia Endocrinology, Pennsylvania
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Shara R. Bialo, MD;
Shara R. Bialo, MD
cEndocrinology, Nemours/Alfred I. duPont Hospital for Children
dDepartment of Pediatrics Endocrinology, Sidney Kimmel Medical College, Thomas Jefferson University Endocrinology, Philadelphia Endocrinology, Pennsylvania
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Nicholas B. Slamon, MD
Nicholas B. Slamon, MD
bDivisions of Critical Care Medicine
dDepartment of Pediatrics Endocrinology, Sidney Kimmel Medical College, Thomas Jefferson University Endocrinology, Philadelphia Endocrinology, Pennsylvania
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Address correspondence to Meredith Vieira, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803. E-mail: Meredith.vieira@nemours.org
POTENTIAL CONFLICT OF INTEREST: Dr Graber is a contributing author to Merck Manuals. Drs Vieira, Kube, van Helmond, Hanley, Bialo, and Slamon have disclosed no financial relationships relevant to this article.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
Pediatrics (2021) 148 (3): e2021050947.
Article history
Accepted:
May 20 2021
Citation
Meredith A. Vieira, Paige K. Kube, Jennifer L. van Helmond, Patrick C. Hanley, Evan G. Graber, Shara R. Bialo, Nicholas B. Slamon; Recipe for Disaster: Homemade Formula Leading to Severe Complications in 2 Infants. Pediatrics September 2021; 148 (3): e2021050947. 10.1542/peds.2021-050947
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We read with interest Vieira et al’s article “Recipe for Disaster: Homemade Formula Leading to Severe Complications in 2 Infants,” describing the clinical course of two unrelated infants who were fed homemade infant formula (HMF) from recipes obtained online.1 Similarly, two unrelated infants presented to our institution two weeks apart with severe failure to thrive (FTT).
The first was a two-month-old, late preterm, unimmunized, Black male who arrived dead to the emergency department weighing 2.0 kilograms (0%ile). He had been followed by his pediatrician and gastroenterologist for FTT, being fed an online HMF consisting of one-and-a-half scoops of commercial infant formula (CIF) mixed with water, dates, hemp seeds, Irish moss, and no vitamin supplementation. There was an open Child Protective Services (CPS) case at time of presentation.
The second was a four-month-old, term, unimmunized, Black male presenting in status epilepticus. He had respiratory and metabolic acidosis (pH 6.95), influenza pneumonia, and severe dyselectrolytemia. He was found to have FTT (weight 4.0kg, 0%ile; length 58.0cm, 0.11%ile; head circumference 40.0cm, 1.77%ile), severe vitamin-D deficiency rickets, starvation ketosis, and many essential amino acid deficiencies. He had not followed-up with a physician since birth. He was breastfed for two months but then fed an online vegan HMF consisting of water, dates, hemp seeds, and sea moss without vitamin supplementation. His hospital course was protracted from profound refeeding syndrome. CPS allowed the infant to return home with his mother, but the child was lost to follow-up.
A recent study found 59 blogs promoting one or more HMF recipes.2 The bloggers’ justifications for HMF included financial savings, peer recommendations, breastfeeding difficulties, CIF intolerance, non-organic or mistrust in CIF ingredients, and CIF processing concerns. Of the bloggers, 11.9% stated they were nutritionists although none were registered dieticians, 76.3% commercially advertised their recipe ingredients, 33.9% failed to provide a disclaimer that breastfeeding was the best alternative, and 74.6% did not advise the reader to consult a healthcare professional before using the recipe.
HMF’s serious implications should encourage all medical providers caring for infants and pregnant women to discuss feeding practices, breastfeeding barriers, and infant feeding intolerance factors. Education regarding adequate infant feeding regimens and HMF risks should be provided. As our second case highlights, some children present without having ever been evaluated by a physician, stressing the importance to educate parents about online health misinformation before discharge from the birthing hospital. CPS workers and child abuse specialists should also educate families against online misinformation, encouraging them to follow their healthcare providers’ recommendations. Community health efforts are paramount to warn against HMFs, discussing the reasons behind CIF’s strict manufacture regulations, teaching the community how to appraise health-promoting websites, and mitigating spread of online health misinformation. Efforts to make lactation and nutrition consultants more readily available are indispensable, including funding and promoting programs like Special Supplemental Nutrition Program for Women, Infants and Children (WIC).3 As online platforms expand, we need to protect infants from the dire effects of HMF and online health misinformation.
References:
1. Vieira MA, Kube PK, van Helmond JL, Hanley PC, Graber EG, Bialo SR, Slamon NB. Recipe for disaster: Homemade formula leading to severe complications in 2 infants. Pediatrics. 2021 Sep;148(3):e2021050947
2. Davis SA, Knol LL, Crowe-White KM, Turner LW, McKinley E. Homemade infant formula recipes may contain harmful ingredients: a quantitative content analysis of blogs. Public Health Nutr. 2020 Jun;23(8):1334-1339
3. Special Supplemental Nutrition Program for Women, Infants and Children (WIC). U.S. Department of Agriculture: Food and Nutrition Service. https://www.fns.usda.gov/wic. Accessed February 27, 2022