Specialty infant formulas
For the minority of infants who cannot tolerate cow’s milk, choice of other types of formulas is based on the particular condition the infant has that precludes him or her from receiving either breast milk or cow’s milk-based formulas (Table 2). Specific conditions that Bhatia highlighted in his presentation were allergies, metabolic diseases (ie, galactosemia and phenylketonuria), infectious diseases (eg, tuberculosis, hepatitis, and human immunodeficiency virus [HIV]), malabsorption, and intestinal failure.
“There are very few babies, a small percentage, that actually need all the other types of non–cow milk-based formulae,” said Bhatia.
One of the most common reasons for choosing a non–cow milk-based formula is for infants with an allergy to lactase or to prevent allergies. As shown in Table 2, soy protein-based formulas are recommended for infants with galactosemia (a condition in which they cannot tolerate lactose) or those with hereditary lactase deficiency. Soy protein-based formula also can be used in infants in families who are vegetarian. However, Bhatia emphasized that soy-based formula should not be given as a routine formula unless indicated for these relatively rare conditions.
To prevent allergies from developing, evidence points to the benefits of a hydrolyzed formula to reduce the incidence of atopic dermatitis (but not asthma or other allergies) (Table 2).5 Infants born into a family with a history of allergies, specifically atopic dermatitis, are good candidates for this type of formula.
Infants who cannot tolerate hydrolyzed protein formulas, and have an allergy to the protein in cow’s milk along with multiple food intolerance, are good candidates for amino acid-based formulas. However, Bhatia emphasized that these formulas are not intended to be used to prevent an allergy but only for the small percentage of infants (about 5%) who have an intolerance to hydrolyzed protein formulas and cow’s milk-based formula.
Other infants for whom amino acid-based formulas may be warranted are those who cannot absorb nutrients for some reason or do not have a sufficient gut to absorb nutrients, such as infants who have undergone surgery. However, Bhatia again emphasized that this is a relatively rare situation.
For infants with other conditions, such as infections or issues with malabsorption, for which a non–cow’s-milk formula may seem indicated, Bhatia discussed specific issues to keep in mind when considering a switch from a cow’s milk-based formula to a specialty formula. In some infants, only a temporary switch to a non–cow’s milk-based formula will be needed, while in others no switch at all is needed.
1. Gamble Y, Bunyapen C, Bhatia J. Feeding the term infant. In: Berdanier CD, Dwyer J, Feldman EB (eds). Handbook of Nutrition and Food. 2nd ed. Boca Raton, FL: CRC Press; 2007:271-284.
2. Bhatia J. So many infant formulas: How is a pediatrician to choose? (F4004) Presented at: American Academy of Pediatrics National Conference and Exhibition; September 19, 2017; Chicago, IL.
2. American Academy of Pediatrics. Choosing a formula. HealthyChildren.org. Available at: https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Choosing-a-Formula.aspx. Updated November 21, 2015. Accessed April 11, 2018.
3. Osborn DA, Sinn JK. Prebiotics in infants for prevention of allergy. Cochrane Database Syst Rev. 2013;(3):CD006474.
4. Alexander DD, Cabana MD. Partially hydrolyzed 100% whey protein infant formula and reduced risk of atopic dermatitis: a meta-analysis. J Pediatr Gastroenterol Nutr. 2010;50(4):422-430.