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What Milk?
Jo Caines
Paediatric Specialist Dietitian
Breastfeeding
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1st choice - continuation of breastfeeding
? Mother may require exclusion diet if
child has severe eczema or
gastrointestinal symptoms
Most evidence with maternal exclusion
diets is for cow’s milk and egg
? Calcium supplementation for mother if
excluding cow’s milk
Degree of Hydrolysis
Extensively Hydrolysed Casein
Formula (EHC-F)
Nutramigen 1 (£8.20/400g)
Well tolerated in younger infants
Unpalatable
Nutramigen 2 > 6 months
Tastes better and has increased calcium
Pregestimil (£8.91/400g)
Similar formula containing increased level
of medium chain triglycerides useful in fat
malabsorption
Extensively Hydrolysed Whey
Formula
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Pepti (£17.10/900g)
More palatable than extensively hydrolysed
casein formulas
Contains lactose
Larger peptides - ? Less well tolerated
Useful in children who refuse EHC-F
Pepti Junior (£9.42/400g)
Contains MCT’s
Does not contain lactose
More expensive than Pepti
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Amino Acid
Formulas
Neocate LCP and Nutramigen AA
Suitable for children with:
- multiple food allergies
- children with food allergy and GI
symptoms/faltering growth
- failure of extensively hydrolysed
formula
Expensive (Neocate £22.02/400g, NutramigenAA
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£21.22/400g)
Unpalatable but very effective
Amino Acid Formulas
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Neocate Advance (£35.50/15x50g)
>1 year
1kcal ml
Need large volumes to be nutritionally complete
but can be used as a sole source of nutrition
Neocate Active (£49.12/14x63g)
> 1year
1kcal/ml
Increased iron and calcium to meet requirements
in 600mls
Designed as a supplement to diet
Soya Formulas
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Safety concerns regarding effect of
phytoestrogens (COT 2003)
Cross reactivity with cow’s milk protein
- Non IgE
Up to 60%
- IgE
17-47%
More palatable
SMA Wysoy(£7.58/860g) / Cow & Gate Infasoy
(£7.44/900g) / Heinz Soya Nurture Formula
BDA Paediatric Group (2004)
- Avoid < 6/12 as a precautionary measure
- Vegans, Galactosaemia, CMPA refusing eHF
Partially Hydrolysed
Formulas
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Not suitable for cow’s milk protein
allergy treatment
More peptides with high molecular
weight
Antigen content reduced to avoid
primary sensitisation
Example: NAN HA (£4.29/400g)