Need help with prescribing a specialist infant formula?

South Devon and Torbay:

• Dietetic referral guidelines and further information
  

Western Locality:

• Call the main Dietetic department - 01752 432243

Formulas for the treatment of cow's milk allergy

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

Extensively hydrolysed

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:

SMA Althera

• Powder 400g = £11.04

Aptamil Pepti 1

• Powder 400g = £10.98

Notes

1. Change to Aptamil Pepti 2 at 6 months of age, if Aptamil Pepti 1 is tolerated

Casein based formula: from birth

Similac Alimentum

• Powder 400g = £10.01

Nutramigen 1 with LGG

• Powder 400g = £12.92

Notes

1. Contains less lactose and could be used if Aptamil Pepti, or Althera are not tolerated
2. Change to Nutramigen lipil 2 at 6 months of age

Follow on formula: from 6 months

Aptamil Pepti 2

• Powder 400g = £10.98

Nutramigen 2 with LGG

• Powder 400g = £12.92

Amino acid Formulas

Use only for the following:

• Breastfeeding infants symptomatic of CMPA where mother chooses to introduce formula
• Infants with severe symptoms of CMPA
• Extensively hydrolysed formula is not effective after trial period; approximately 10% of infants will react to protein residues in extensively hydrolysed formulas.

SMA Alfamino

• Powder 400g = £25.73

Nutramigen PurAmino

• Powder 400g = £22.98

Neocate LCP

• Powder 400g = £24.82

Soya formulas

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 for Gastro-Oesophageal Reflux Disease

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.

Lactose free formulas

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.

Post discharge formulas for premature infants born less than 34 weeks

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.

SMA Gold Prem 2

• Powder 800g = £12.28

Nutriprem 2

• Powder 800g = £13.59
• Liquid 200ml = £2.26

High energy formulas for faltering growth

Infants with faltering growth need paediatric review, formula may be initiated in primary care. Usual maximum length of treatment birth to 18 months

SMA High Energy

• Liquid 200ml = £2.43

Infatrini

• Liquid 200ml = £2.94

Similac High Energy

• Liquid 200ml = £3.39

Highly specialist infant formulas

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.

Guide to sensible prescription volumes

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

• Two week trial - 6 x 400g tins or 3 x 900g tubs
• One month prescription - 12 x 400g tins or 5 x 900g tubs

4-6 months of age

• Two week trial - 8 x 400g tins or 3 x 900g tubs
• One month prescription - 14 x 400g tins or 7 x 900g tubs

7-12 months of age

• Two week trial - 6 x 400g tins or 3 x 900g tubs
• One month prescription – 7-13 x 400g tins or 3-6 x 900g tubs

1-2 years of age

• Two week trial - 4 x 400g tins or 2 x 900g tubs
• One month prescription - 7 x 400g tins or 4 x 900g tubs

Some infants may drink more – increase at parental request

Stopping prescription formula:

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.