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Need help with prescribing a specialist infant formula?
South Devon and Torbay:
Initiate in primary care and refer to Paediatric Dietitian. Refer to full guidance on diagnosis and management of Cows Milk Protein Allergy in Primary Care: The MAP Guideline
Use first line unless Amino Acid Formula indicated. Usual maximum length of treatment is birth to 2 years.
Whey based formula: from birth, preferred from 4 months as more palatable:
Casein based formula: from birth
Follow on formula: from 6 months
Use only for the following:
Not for under 6 months of age due to phytoestrogens. Not recommended for CMPA treatment due to cross-reactivity. Usual maximum length of treatment is from 6 months old to 2 years. These products can be purchased at a similar cost to standard formula.
Thickened Formulas are an option for management of GORD and can be purchased at a similar cost to standard infant formulas.
Caution: Do not prescribe alginates with thickened feeds. For full guidance see here.
Primary lactose intolerance among Caucasian infants is almost unheard of but may affect those of South Eastern Asian descent. Secondary lactose intolerance may follow gut injury and may require 4 – 6 months lactose free diet.
Lactose free formulas are available and can be purchased at a similar cost to standard infant formulas; they are also available using Healthy Start vouchers.
This will be initiated on neonatal unit if infant is discharged on formula. If the mother is breastfeeding on discharge and chooses to stop breastfeeding before the infant is 6 months corrected age, formula to be initiated in primary care. If growth is excessive advise standard formula and prescribe pre-term infant supplements.
Infants with faltering growth need paediatric review, formula may be initiated in primary care. Usual maximum length of treatment birth to 18 months
There is an extensive range of other very specialist infant formulas available for infants with malabsorption and for rare conditions including inherited metabolic disorders. These formulas should only be initiated by a paediatric dietitian or paediatrician in secondary care.
Ask how many 400g tins/900g tubs of formula they use weekly - prescribe a similar volume
If unsure/moving on from breastfeeding:
0.3 months of age
4-6 months of age
7-12 months of age
1-2 years of age
Some infants may drink more – increase at parental request
Any child still prescribed cows' milk protein free milk by at least 24 months of age should be weaned onto supermarket bought milk e.g. calcium enriched soya milk.
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