In El Paso, once-empty baby-section store shelves are filling up.

The familiar blue, orange and pink Abbott Nutrition brand labels such as Similac and Enfamil, as well as Gerber brands, are beginning to reappear in stores and families are not having to search for certain brands.

The recall of several infant formula products and supply-chain issues caused a shortage for months, prompting the federal government to implement Operation Fly Formula – which is flying in tens of thousands of pounds of formula that meet U.S. health and safety standards from abroad.

The equivalent of more than 43 million 8-ounce bottles of formula are expected to reach store shelves across the United States by July 12 under Operation Fly Formula.

But that has not alleviated all concerns for parents who need specialized formulas.

Additionally, there continues to be a shortage of select baby products such as Zarbee’s Baby Cough Syrup + Immune with Agave and Ivy Leaf; A&D zinc oxide cream used to treat diaper rash; and Caldesene baby powder.

Formula remains the biggest concern.

The search became more than frustrating for new parents like Nichole Monroy, whose daughter Sophie was born prematurely in April.

Monroy had intended to breastfeed but had to be on a special diet. The stress of looking at formulas each day was not helping.

“We were living day-to-day,” Monroy said in Spanish in late May. “We were afraid to serve her an extra ounce just for fear that she wouldn’t drink it and then be short the next day or not have any. And it’s not like I can just switch her from one formula brand to another that I might be able to find at the store.”

That led her to join the El Paso Finding Baby Formula Facebook group, which has grown to more than 1,600 members.

Shelves at the Target store at 1901 George Dieter Drive restocked with Similac and Enfamil products on June 3. (Alex Hinojosa/El Paso Matters)

Monroy more recently said she is able to find Puramino through Star Medical Specialties, a nutritional and medical supply company, since the ramp-up of formula production and Operation Fly Formula.

While the formula shortage has eased, messages from parents in search of specialized formulas – hypoallergenic, lactose-free, amino-based or those made for premature babies – continue to be posted on the group’s page despite the increasing supply of formula on store shelves.

Sil Hernandez created the group in May when she was having trouble finding lactose-free formula for her son, who is now 5 months old.

“The main point here is to help moms or parents in general find formula so you’re not wasting your gas running like all over the city,” Hernandez said.

Crossing the border

Some El Paso parents found themselves crossing international lines to find specialized baby formula and other products, which appeared in full supply and at lower costs during a recent visit.

A 14-ounce can of Puramino formula can cost $60 in El Paso. The same can from Farmacias Benavides in Ciudad Juárez sells for about half the price.

Shelves at the Superette along Avenida Abraham Lincoln in Ciudad Juárez were fully stocked with Nestle NAN and Nestle Nido Kinder formulas on June 24. (Alex Hinojosa/El Paso Matters)

The shelves of the Superette grocery store on Avenida Abraham Lincoln were fully stocked with Nestle NAN and Nestle Nido Kinder formulas. Gerber products were also readily available.

U.S. Customs and Border Protection El Paso spokesperson Roger Maier said that customs officers have not seen a spike in formula being brought across the border.

“Personal imports of baby formula have been few since the U.S. supply issue came up,” Maier said in an email.

Travelers can bring liquid and powder milk infant formula to the U.S. from Mexico as long as it’s for personal use. The formula should be pre-packaged and labeled in individual servings or retail-size packages.

Supply in stock at WIC

Adriana Archer, El Paso program manager for the Texas Women, Infant and Children, or WIC, program, said she was not aware of any parents trying to find formula in Mexico at the peak of the shortage. The program in El Paso serves 26,000 residents, including 6,400 infants, though not all babies in the program are formula-fed.

On average, the WIC program provides up to 10 containers of formula per infant a month, Archer said. WIC allows for substitutions of types, brands and can sizes.

“The problem hasn’t been so much that there’s no formula available as much as that they’re having trouble finding their specific formula,” Archer said. “Across Texas, WIC has been closely working with grocers and vendors so that we can direct our clients to the stores that carry what they need.”

There are 73 authorized WIC vendors across the city of El Paso.

What doctors advise

The U.S. Department of Health and Human Services suggests that if parents can’t find their specific brand of formula, they can substitute it for another brand. Parents should first check with their baby’s pediatrician and if switching formula brands, do so gradually.

Dr. Denease Francis, a pediatric gastroenterologist, said that there are a lot of formula alternatives that doctors may recommend – although they may be hard to find.

Dr. Denease Francis

“So, there needs to be a little bit of flexibility,” said Francis, who also serves as an assistant professor of pediatrics at Texas Tech University Health Sciences Center El Paso. “It might end up being that your physician may recommend a formula that they didn’t think of (before) and that’s ok. A child should be able to tolerate the switch to a different formula.”

When switching formulas, parents are encouraged to mix the previous formula with the new one.

Signs that a child may need medical treatment as a result of switching formulas may include persistent episodes of vomiting, development of an unusual rash, diarrhea and blood in their poop.

“That would be worrisome and something that would definitely indicate a potential formula intolerance and they would need to be seen by their pediatrician,” Francis said.

When babies are unable to switch formulas, pediatricians may be able to help parents find the brand or type they need.

“In some cases, we’re actually able to reach out to the manufacturers themselves,” she said. “And they may be able to provide a special emergency form that we’re able to fill out.”

With that form, Abbott Nutrition, one of four formulas manufacturers in the United States, can send some cans of the specialized formula to the customer.

Parents should also check with their child’s pediatrician before using formula purchased in Mexico, though the bigger concern is using medications and topical ointments bought outside the United States.

Dr. Ittay O. Moreno

Dr. Ittay O. Moreno, medical director and pediatric hospitalist at El Paso Children’s Hospital’s general pediatric unit, said medications and ointments from Mexico should be avoided.

“There’s always a lot of combination, suspensions that they add. But we don’t know exactly what percentage or what the concentration is, or whether it’s the appropriate dose,” said Moreno, who has treated patients on both sides of the border and also teaches at TTUHSC El Paso.

While accessing pediatric care or medication across the border might be easier or faster, it’s not always safer, Moreno said.

He’s seen children who were brought to El Paso Children’s Hospital because they were misdiagnosed at a clinic or hospital across the border or they were given over-the-counter medication purchased in Mexico that caused adverse effects.

With regard to the current lack of A&D cream with zinc oxide on store shelves, Moreno said any barrier cream should suffice if the diaper rash is simply contact dermatitis.

“But if the infection is fungal, then all the diaper rash cream in the world won’t help,” he said. “The child would need to be treated by their pediatrician with an antifungal.”

Letting the child go without a diaper for a little while the rash persists also helps, he added.

The shortage of Zarbee’s Baby Cough Syrup + Immune with Agave and Ivy Leaf could be alleviated with other treatments, he said.

“It doesn’t really do much for the cough and could actually prolong the course,” he said.

Steam showers would serve a better purpose because they help open up the lungs, Moreno said. If further treatment is needed, a child’s pediatrician might offer nebulizer treatment with albuterol.

Cindy Ramirez contributed to this story.

Alex Hinojosa is an El Paso freelance journalist and a mass communications instructor at El Paso Community College.