Diluting baby formula and homemade recipes aren’t good ways to deal with the shortage. Consider these alternatives.

Several months into an infant formula shortage that has left store shelves bare, frazzled caregivers are becoming increasingly desperate to find the food they need to feed their children.

And when there just isn’t any formula to be found? Doctors and dietitians worry that families will unknowingly put their babies at risk with an unsafe work-around.

Infant formula was among the household essentials in short supply because of pandemic over-buying. A massive recall of formulas by Abbott Nutrition in February has significantly worsened the problem, with some specialty formulas becoming nearly impossible to find.

“It’s a horrible position for families to be in,” said Jessica Libove, a certified lactation specialist and a lactation program manager for the Philadelphia Department of Health’s Division of Maternal, Child, and Family Health.

» READ MORE: What to know about the infant formula shortage

If you are struggling to find infant formula, consider the safety of alternatives before you try them:

No. This may seem like a harmless way to stretch supply, but adding extra water to formula can lead to emergency health issues, such as seizures and heart problems, said Nicole Fragale, a registered dietitian and clinical nutrition manager at Nemours Children’s Health. Too much water throws off the balance of electrolytes in the formula, which can quickly affect a baby’s ability to function properly, she said.

Diluting formula reduces the amount of calories — and necessary nutrition — your baby gets.

Not only does diluted formula pose a deadly health risk, but “what will eventually happen is the baby is going to be hungrier and want even more formula,” Fragale said.

No. Medical providers and the FDA advise against homemade formula recipes. While it was common for parents to make their own formula before commercial powders rose in popularity in the 1960s and 1970s, doctors and dietitians say homemade formula does not have the correct balance of vitamins and nutrients.

“There’s a very specific ratio of carbs, protein, fats, vitamins, and minerals — it’s impossible to mimic that in a homemade recipe,” Fragale said.

Formulated for adults, not infants, store-bought vitamin and mineral supplements may come in a concentration that’s too high or too low, which can be toxic, Fragale said.

While homemade formula usually does not pose the immediate danger that watering down formula does, it can lead to long-term developmental problems. For instance, many of the recipes cropping up online — often shared with the seal of approval “Just like Grandma used!” — don’t have enough iron or calcium, which are critical to bone and brain growth.

It depends on the age. Babies under one year should not have cow’s milk because it has too many proteins and minerals, and not enough other nutrients, according to the U.S. Centers for Disease Control and Prevention. Your baby’s kidneys are not developed enough to handle cow’s milk, and that could pose a risk of intestinal bleeding.

So long as your pediatrician says your baby is developmentally ready, you can introduce nutritious pureed solid foods to babies 6 months or older, which may reduce your reliance on formula, Libove said. Avocado and sweet potato are two foods that are filling and have many of the same nutrients as formula or breast milk.

Check wholesale stores, local mom & pop shops, and discount retailers that may not sell out as quickly. Consider, too, stores that are not primarily food stores but may carry some food items. For instance, BuyBuyBaby, a baby gear, furniture, and gift store, sells formula on its website (though many varieties are back-ordered). Food pantries, churches, shelters, and charities may have received formula donations they can offer. Many local parent groups on Facebook have become informal trading spaces for formula, though Libove urged people to take only formula that is unopened, unexpired, and from someone they know or can meet in person.

Call your pediatrician to talk about alternatives. If your baby uses regular formula, you may be able to switch to another brand or a generic.

“If a parent opens the cabinet and realizes they don’t have any, sometimes pediatricians have formula” such as samples or emergency reserves, said Katie Breznak, a registered dietitian for the neonatal intensive care unit at St. Christopher’s Hospital for Children in Philadelphia.

Probably. Most babies who are not medically fragile and use regular formula can switch to another brand, Libove said. She suggests that parents look for a generic or store-brand formula, which may not sell out as quickly as popular-brand names.

Caregivers commonly become loyal to a particular brand they like best, but “if it’s regular formula, there really isn’t much difference,” she said. Pediatricians can recommend other brands or generics that are safe for your baby.

“If you are faced with the choice of watering down your brand or using a generic brand in proper quantities, the generic brand is going to be safer for your child,” Libove said.

Call your pediatrician to see whether they have samples or know where some may be in stock. Discuss with the pediatrician whether there is a safe alternative to your currently prescribed formula.

The FDA and Abbott on Tuesday reached a deal to reopen the shuttered plant. It will take weeks for formula to reach store shelves after the reopening, Abbott said. Previously, the FDA authorized Abbott to release on a “case-by-case basis” some specialty formulas, which are critical for babies with allergies, dairy intolerance, or other medical complications and that have been especially hard to find. They are being provided free of charge, in coordination with physicians and hospitals, the Associated Press has reported. Parents should talk to a pediatrician before using these formulas because they were made during the time of the bacterial infection.

Milk banks, where people can donate breast milk that is then pasteurized and sterilized, may be an option for some infants who rely on specialty formula for a medical need other than intolerance to breast milk.

Maybe. Restarting lactation is possible but takes time and is challenging — especially if you never breast-fed or if it has been several months since you did — so this isn’t a good option for parents in urgent need of food for their baby. Increasing milk supply may be a particularly good option for people who already breast-feed, but supplement with formula, Libove said. The amount of milk our bodies produce depends on demand, which means you can begin increasing supply by nursing more often — even if for a short time.

Consult a certified lactation specialist to talk about whether restarting lactation is a good option for you or for help developing a plan to increase supply. Most private insurance plans cover lactation consultations. Many specialists offer a sliding payment scale to support families that are uninsured or covered by Medicaid, which typically does not pay for lactation services. Find a certified lactation consultant by searching the U.S. Lactation Consultant Association’s database. Philadelphia families can connect with a consultant through the city’s breastfeeding counseling program or by downloading the Pacify mobile app, which offers free, on-demand help.

Every state has a WIC program that provides food, including infant formula, to families who meet income and need requirements. WIC is a supplemental program, which means you may be eligible for WIC even if you you don’t qualify for other public assistance, such as SNAP or Medicaid.

After enrolling in WIC, a nutrition specialist reviews your family’s needs to develop a food plan, with a list of covered foods. If your infant needs formula, your doctor will write a note informing WIC which formula you need. The program typically does not cover all the formula a family would need, but can help significantly.

Normally, only the specific formula in your WIC food plan will be covered, but Pennsylvania WIC is allowing families to choose from a list of alternatives deemed similar to their assigned formula because of the Abbott recall and shortage issues.

Maybe. Health insurance plans may cover formula if a doctor says it is medically necessary. Rules vary by health plan, so contact your benefit manager or insurer to find out whether you may qualify.

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