Specialist Formulas

Select a link wherever you see this group of topics, to take you directly to whatever you are interested in reading about.

Cows Milk Protein Intolerance - Lactose Intolerance - Thickened Formulae for Reflux - High Energy for Faltering Growth - Soy Formulae - Goats Milk Formulae (opens in new window) - Off-the-Shelf modified formulas for minor digestive problems - Prescription Only Partially-Hydrolysed - Premature and Low Birth Weight

We have also compiled a handy print-off guide to the main non-standard formula brands. NOTE - this list is not exhaustive, not necessarily up-to-date, and is not to be seen as any kind of recommendation: the information is provided for interest only.

Specialist formula are intended for babies with specific dietary or nutritional needs, where these have been diagnosed by a doctor. Most specialist milks are available on prescription: some are exclusively available on prescription only, however some are available only in the shops.

This article explains the differences between the types of infant formulas available and the conditions for which they are recommended. There is some information on specialist formulas and also on how to prepare and store infant milk safely.

Cows Milk Protein Intolerance

A baby with a Cows' Milk Protein allergy (CMPA) will need a protein hydrolysate powdered infant formula - so one where the CMPs have been extensively broken down already. Historically even up to a few years ago they used to automatically prescribe soya formulae (before there was the technology to extensively hydrolyse the CMP) but the Dept of Health's Chief Medical Officer has recently issued new guidance on soy formulae, below.

Protein hydrolysate formula

Nutramigen is made by Mead Johnson, and is for babies with allergies caused by cows milk. It tastes bitter because the amino acids are broken down, or hydrolysed.
Breaking down the amino acids in the milk proteins (ie partially digesting it, which is what hydrolysing means) tends to make the formula taste bitter, though this is less of an issue with whey based formula than casein based apparently.
There is also a version (Nutramigen 2) with added fructose, to make it taste nicer, which is therefore only for babies over 6m.

Pepti is made by Cow & Gate, is also for babies with allergies caused by cows milk, and was brought in by C&G after soya milk was removed as atopic baby's formula of choice! It has reasonably low allergenicity and is said to be accepted by 97% of the atopic population. It made from 100% hydrolysed whey protein, and has a sugar profile of 60% glucose and 40% lactose, making it reduced lactose, but not lactose free, which is very important because if a baby is NOT lactose intolerant then they need lactose in order to not BECOME lactose intolerant as other wise the lactase production in the body will shut down - it's a supply and demand thing. Its fat is 100% vegetable oil.

Cow & Gate Pepti is is the cheapest of the protein hydrolysate formulae on the market at the moment (about 50p per 100mg cheaper than for example Nutrmigen) but they are both only available on prescription so this is largely irrelevant to most parents.

Pregestamil is a little like Nutramigen but with added medium chain fatty acids. It is made from extensively hydrolysed casein and 55 % of its fat is MCT (Multitriglyceride) which helps with malabsorption issues. It is recommended for cows milk protein and /or lactose intolerance, malabsorption, and short bowel syndrome.

Hypo-allergenic Formulae

Neocate is an amino acid-based, nutritionally complete hypoallergenic infant formula for the management of cow's milk, and other food, allergies, and is made by Nutricia, who are the parent company of Cow and Gate, and of Milupa, who make Aptamil

Nutramigen A which has added amino acids, is made by Mead Johnson. Another extensively hydrolysed casein dominant formula, the protein is a mixture of free amino acids with no peptide chains.

Cows Milk Protein Intolerance - Lactose Intolerance - Thickened Formulae for Reflux - High Energy for Faltering Growth - Soy Formulae - Goats Milk Formulae - Off-the-Shelf modified formulas for minor digestive problems - Prescription Only Partially-Hydrolysed - Premature and Low Birth Weight

Formulae for Lactose Intolerance

These are based on modified cows' milk, but the lactose has been replaced with glucose.

Parents may try these formulas for babies with colic, but they are most useful for infants with temporary lactose intolerance following a gastrointestinal infection.

A baby which has a short term lactose intolerance, usually the result of a tummy upset or some other virus, and therefore short-acting, could be given a clinically lactose free milk like SMA LF or others, which are not thought to be nutritionally complete and their manufacturers state that they are not to be used for long periods of time: the recommendation is 6 weeks or so - and in fact should continue to be breastfed if they are currently breastfed.

However, a baby with galactosemia, which is an extremely rare condition in which the baby does not make lactase, the enzyme require to digest lactose, or primary lactose intolerance, would need a longer term, nutritionally-complete milk like C&G Pepti Junior or Nutramigen.

SMA LF is available on prescription, or in the pharmacy, and is for babies who have a temporary lactose intolerance. It is casein based but partly broken down - partially hydrolysed.

Pepti Junior made by Cow & Gate has 0% lactose and 100% glucose and its fat source is 50% vegetable oil and 50% MCT oil - (multitriglyceride) which is there to help babies with malabsorption issues.

A similar milk is Nutramigen 2 made by Mead Johnson, and is only suitable from 6 months, as it has added fructose to mask the bitter taste of the casein hydrolysate. It is available on prescription only.

Pregestamil (Mead Johnson) is a little like Nutramigen but with added medium chain fatty acids. It is made from extensively hydrolysed casein and 55 % of its fat is MCT (Multitriglyceride) which helps with malabsorption issues. It is recommended for cows milk protein and /or lactose intolerance, malabsorption, and short bowel syndrome.

Enfamil O-Lac is Mead Johnson's lactose-free offering - but is not suitable for babies with a Cows Milk Protein Allergy

Cows Milk Protein Intolerance - Lactose Intolerance - Thickened Formulae for Reflux - High Energy for Faltering Growth - Soy Formulae - Goats Milk Formulae - Off-the-Shelf modified formulas for minor digestive problems - Prescription Only Partially-Hydrolysed - Premature and Low Birth Weight

Thickened Formulae for Reflux

Enfamil, made by Mead Johnson, can be purchased from a pharmacy. It has added LCPs and uses rice starch as a thickener. This means that it needs cooler water to be made up effectively, as too-hot water will mean the rice starch thickens in the bottle rather than baby's tummy - this means that the guidelines for safe preparation of formula cannot be followed with this formula.

Thickeners can be added to standard formulas for infants with GOR. However, two formulas have added constituents that thicken them on reaching the stomach. Formulae specifically designed for Gastro-Oesophageal Reflux, or GORD, include:

Enfamil AR, available on prescription only, for babies who suffer from reflux and possetting (AR stands for Anti Reflux), which Mead Johnson say tends to be a transient thing which will go after 4-6 weeks, and so this therapy isn't necessary long term. They advocate staying on the formula no longer than 6 weeks before returning to the child's previous formula. RESEARCH

StayDown made by SMA Nutrition, available at the pharmacy and on prescription, is a nutritionally complete infant formula which has been thickened with an easily digestible pre-cooked corn starch that thickens on contact with stomach acid. This allows the feed to flow smoothly through a normal teat.

Cows Milk Protein Intolerance - Lactose Intolerance - Thickened Formulae for Reflux - High Energy for Faltering Growth - Soy Formulae - Goats Milk Formulae - Off-the-Shelf modified formulas for minor digestive problems - Prescription Only Partially-Hydrolysed - Premature and Low Birth Weight

High energy for faltering growth

SMA Hi Energy is a prescription only, high calorie, nutrient-dense formula for babies who are failing to thrive. It provides 91 kcal per 100ml

Infatrini, made by Nutricia, provides 100 kcal per 100ml

Cows Milk Protein Intolerance - Lactose Intolerance - Thickened Formulae for Reflux - High Energy for Faltering Growth - Soy Formulae - Goats Milk Formulae - Off-the-Shelf modified formulas for minor digestive problems - Prescription Only Partially-Hydrolysed - Premature and Low Birth Weight

Soy Formulae

"The Chief Medical Officer is reiterating advice that soya-based infant formulas should not be used as the first choice for the management of infants with proven cow's milk sensitivity, lactose intolerance, galactokinase deficiency and galactosaemia.
Soya-based formulas have a high phytoestrogen content, which could pose a risk to the long-term reproductive health of infants, according to a 2003 report from the Committee on Toxicity (COT), an independent scientific committee that advises the Department of Health and other government agencies.
Furthermore, the Scientific Advisory Committee on Nutrition (SACN), another independent advisory body, has advised that there is no particular health benefit associated with the consumption of soya-based infant formula by infants who are healthy (no clinically diagnosed conditions). SACN also advised there is no unique clinical condition that particularly requires
the use of soya-based infant formulas.
As an alternative to soya-based products, more appropriate hydrolysed protein formulas are available and can be prescribed.
Soya-based formulas should only be used in exceptional circumstances to ensure adequate nutrition. For example, they may be given to infants of vegan parents who are not breast-feeding or infants who find alternatives unacceptable."

They are all marketed as nutritionally complete, and suitable for babies who are intolerant to CMP, lactose, galactose and sucrose.

InfaSoy made by Cow & Gate

Wysoy made by SMA

Heinz Nurture Soya

Isomil made by Abbot Nutrition

Enfamil ProSobee made by Mead Johnson

Cows Milk Protein Intolerance - Lactose Intolerance - Thickened Formulae for Reflux - High Energy for Faltering Growth - Soy Formulae - Goats Milk Formulae - Off-the-Shelf modified formulas for minor digestive problems - Prescription Only Partially-Hydrolysed - Premature and Low Birth Weight

Off-the-Shelf Specialist Formulae

This section refers to new formulae which have been introduced recently that are slightly modified for babies with minor digestive problems. They contain partially hydrolysed protein, prebiotics, modified fat and thickeners.

The evidence for their use is based on limited research studies of small numbers of infants. However many health visitors now recommend them as parents have reported positive results.

Aptamil Easy Digest was launched in June 2007 and is a reduced lactose, partically hydrolysed 100% whey based formula, aimed at babies with colic, mild reflux, constipation and gassy episodes. It is similar to C&G Comfort. Lactose is reduced to 40% with the other 60% being from glucose and has added prebiotics which are said to give a softer consitency to baby's poo. The fat blend is apparently closer to the profile of the fat blend in breastmilk. It is partically hydrolysed rather than extensively hydrolysed in the 'protein hydrolysate' formulas, above. Interestingly it prefers to be made up with hotter water, so the manufacturers recommend that water is left for no more than 15 minutes after boiling before mixing with the powdered formula.

Cow & Gate Comfort was renamed from Omneo Comfort in 2007. It is a 100% whey based, partially hydrolysed, reduced (40%) lactose formula with added prebiotics and a vegetable fat blend. Cow & Gate recommend this is not used in conjunction with other milks, and that it is tried for at least 2 weeks consistently to see any effect. The whey basis means baby will most likely produce softer stools on this type of formula than on a whey dominant or indeed casein dominant formula, and its vegetable fat blend, which is intended to mimic the fats in breastmilk, may, say Cow and Gate, lead to green stools. It comes in an infant formula form, (labelled as 'First') and a follow-on milk form.

Heinz Nurture Gentle is a new-to-the market formula released in Summer 2008. It is a partially hydrolysed (they describe it as 'acidified') formula, made with 50% whey and 50% casein, which is intended to aid better digestion of protein and lactose, and in doing so provide relief for formula-fed infants suffering from colic, constipation, sensitive tummies and other common feeding disorders. It has a fat blend which improves palmitic acid and calcium absorption (and so gives softer stools), and includes prebiotics. It comes in an infant formula form, ('Newborn') and a follow-on milk form ('Follow-On').

Cows Milk Protein Intolerance - Lactose Intolerance - Thickened Formulae for Reflux - High Energy for Faltering Growth - Soy Formulae - Goats Milk Formulae - Off-the-Shelf modified formulas for minor digestive problems - Prescription Only Partially-Hydrolysed - Premature and Low Birth Weight

Prescription Only Partially hydrolysed formulas

The protein in these formulas is 100 per cent whey protein that has been hydrolysed or broken down into smaller particles and peptide chains.

The formulas are promoted for allergy prevention but extensively hydrolysed formulas (see below) may be more suitable, particularly for babies whose mothers have eczema. Infants at risk of allergic disease are those with an atopic family history, that is, a mother, father or sibling with asthma, eczema, hayfever or food allergy. They are not suitable for babies with allergy or intolerance to cows' milk protein as the partially hydrolysed protein could cause an allergic reaction. They are:

• Nan HA1 – Nestle

• Nan HA2 (from six months) – Nestle

Cows Milk Protein Intolerance - Lactose Intolerance - Thickened Formulae for Reflux - High Energy for Faltering Growth - Soy Formulae - Goats Milk Formulae - Off-the-Shelf modified formulas for minor digestive problems - Prescription Only Partially-Hydrolysed - Premature and Low Birth Weight

Formulas for Premature and low birth weight babies

Specialist formulas for very low weight preterm babies in hospital are not available outside the hospital. This formula is formulated for pre-term babies and contains higher levels of some nutrients than the standard whey or casein dominant formulas. In particular it is higher in iron and vitamin D to meet the higher requirements of pre-term babies. They include:

• Aptamil Preterm – Milupa

• Nutriprem 1 – Cow & Gate

• Pre-Nan – Nestle

• SMA Gold Prem – SMA Nutrition

Before discharge pre-term babies will be changed to the only post-discharge formula:

• Nutriprem 2 – Cow & Gate

 






Mead Johnson, who make eg Nutramigen, Pregestamil, and Enfamil, say that they are not advocating infant formulae, but providing various therapies for children already on formula who have problems with allergy, possetting, colic, reflux and so on.
Essentially what they are saying is that they make foods with a special medical purpose, and should not be subject to the rules governing the advertising of infant formula.