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Introduction to Infant
Formula
Aisling Pigott (Paediatric Dietitian)
Families First Newport
01633 414666
Breast is best
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Specifically designed to meet the needs of the child
Reduces infection and disease risk
Free
Improved gut tolerance
Improved outcomes and survival rates amongst
hospitalised neonates and infants
• Few cases where not appropriate e.g. Chylothorax,
maternal HIV, maternal medication
• Always approach issue especially with sick babies
Normal Formula
Available OTC
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Whey based
Casein based
Follow on milks
Soya Formula
Staydown
Reflux
Constipation
Colic
Partially hydrolysed
Whey based infant milks
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Closest to breastmilk
~66kcal/100mls
Lower renal solute load
Examples: Aptamil First, Cow & Gate 1,
SMA Gold
• Ready to feed / powder
• Nucleotides, probiotics, LCP’s
Casein based infant milks
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Marketed as “suitable for hungrier babies”
Limited evidence to support this
Same kcals as whey based
Slower gastric emptying
Higher solute load
Examples: Aptamil Extra Hungry, Cow &
Gate 2.
Follow On Milks
• Higher iron content
• Examples: Aptamil Follow On, Cow &
Gate 3, Heinz Nurture Growing Baby,
SMA Progress
Soya Formula
Not recommended for children under 6 months due to risks
associated with phytoestrogens
Little choice for vegan families
Other milks e.g. Staydown milk, goats milk, partially
hydrolysed protein milks and follow on milks
Strong cross reactivity with Cows Milk Protein (10-50%)
Other milks (available over the
counter)
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Staydown milk
Goats milk
Partially hydrolysed protein milks
Toddler milks
Lactose free milk
- New: Hypoallergenic formula to reduce risk of developing
allergy
** Only useful if given BEFORE cows milk containing formula
Specialist milks
• Cows Milk Allergy
• Failure to Thrive/Increased Energy
Demands/ Fluid restriction
• Prematurity/ Low Birth Weight
• Others e.g. Metabolic conditions, renal
conditions, chylothorax, GSD, ketogenic
Cows Milk Allergy
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Family h/o atopic disease/ allergy
Eczema, Asthma, GORD, Constipation
Rare - anaphylaxis
Consider symptoms and appropriateness
of CM free diet
Suitable Milk Substitutes:
Infants
• First line (0-12mo):
– Extensively Hydrolysed Formula (EHF)
• Casein or Whey
• +/- Lactose
• +/- Medium Chain Triglycerides (MCT)
– Amino Acid Formula if not resolved
• Considerations:
– Type / severity of allergy, growth, age,
palatability, cost
Extensively Hydrolysed
(Casein)
• Examples:
– Nutramigen Lipil 1 & 2
– Pregestimil (54% MCT)
• Advantages
– Proven, reduced allergenicity
– Lactose-free
– 95% of protein <1000 Daltons
• Disadvantages
– Palatability
Extensively Hydrolysed
(Whey)
• Examples:
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Pepti (40% Lactose)
Pepti-junior (50% MCT, Trace Lactose)
Aptamil Pepti
NEW * Infatrini Peptisorb (1kcal/ml)
Similac Alimentum (.66kcal/ml)
Nestle Althera
• Advantages:
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– Proven reduced allergenicity
– Palatability (?Taste advantage over AA, EHFC)
Disadvantages:
– More residual long chain peptides
– Contains Lactose
Amino Acid Formula
• Examples:
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Neocate LCP (0-1yr)
Neocate Advance
Nutramigen AA (0-1yr)
Alfamino AA (0-3 yr)
• Advantages:
– Non-allergenic
• 100% Free Amino Acids
– Lactose-free
• Disadvantages
– Palatability
– Cost
Specialist Milks
Prematurity
• Nutriprem 1 & Pre-Aptamil
• SMA LBW
• Nutriprem 2 (for community use)
• Breast milk fortifiers (not available in
community)
Faltering Growth
• Cause?
• Assessment
– Breast fed
– Formula fed
– Over six months
• High energy requirements/poor intake.
– Inorganic/organic reasons?
Faltering Growth… Continued
• Depending on local policies.. Seek dietetic
input
• RTF formula’s available
• Infatrini (1kcal/ml)
• Similac High Energy (1kcal/ml)
• SMA HE (.91kcal/ml)
Falterning Growth… cont’d
• Disadvantages
- Reduced GI tolerance
- Increased macro and micro nutrients e.g.
renal patients, patients on large volumes Na2+
containing drugs
• Other options (need dietetic
supervision)
- increasing concentration of feed
- Supplementing with a carbohydrate or fat
supplement
Try before you buy!
• Any questions?