Gareth Southgate says that he may be forced to draft young forwards Tom Craddock and Ben Hutchinson into his first-team.
Having already lost Jeremie Aliadiere for around six weeks to a hamstring injury, Mido and Tuncay Sanli joined him on the sidelines after suffering knocks in the derby draw with Sunderland.
Tuncay has a feared fracture to his leg, whilst Mido is reported to have a hamstring injury too - which would mean the duo are unlikely to play again until November at the earliest.
That leaves just Lee Dong-gook available to Southgate, so he is now being forced to look at Boro's youngsters once again.
Boro's academy is the most productive in the Premier League and now Craddock and Hutchinson - who have both scored three times for the reserves already this term - could be given their chance in the coming weeks, although Southgate is also looking at his options on the transfer front.
"It's easy to say now that we should have got more in, but it gives an opportunity to other people," said Southgate.
"Maybe we'll have to look at people out of contract, maybe we'll give some youngsters a chance.
"We know that they would embrace the way we're playing. It's tough to deal with.
"There is Craddock and Hutchinson who have been scoring goals for the reserves, but it's a very big step up. Sometimes you've got to throw people in and see how they get on.
"That's something I have to think about over the next few sleepless nights."
Stewart Downing, who fired home Boro's second goal against Sunderland, insists he could be a possible answer to the club's striker shortage.
"I can get forward more with the players we've brought in this season," said the England star.
"I want to take more responsibility for scoring. We're missing Mido and other strikers so we're a bit short of numbers but we have to get on with it.
"If the boss wants me to play through the middle I will - I did it when I was little."