Need help with prescribing a specialist infant formula?

• Exeter, Mid and East Devon: call the paediatric dietitians at the RD&E for advice on 01392 406063
• North Devon: call the Dietetic department, Munro House, NDDH, telephone 01271 322306 or fax 01271 370206

Formulas for the treatment of cow's milk allergy (CMPA)

North and East Devon: Click here for guidance on diagnoses and management of CMPA

Extensively Hydrolysed Formulas

First line choice for CMPA. Usual maximum length of treatment birth to 2 years.

SMA Althera

• Powder 400g = £11.04

Notes

1. This product is preferable as it is more palatable, particularly for infants over 4 months of age. There is no follow on version available.

Nutramigen 1 with LGG

• Powder 400g = £12.92

Notes

1. If prescribing Nutramigen, at 6 months change to Nutramigen 2 with LGG, a follow on formula with more calcium and iron.

Nutramigen 2 with LGG

• Powder 400g = £12.92

Amino acid Formulas

Used if extensively hydrolysed formulas not effective after a suitable trial or for severe CMPA symptoms. Usual maximum length of treatment birth to 2 years.

Be aware, there is a large range of hydrolysed and amino acid formulas available on the market with subtle differences. Dietitians and paediatricians may recommend other brands with clinical reasoning.

SMA Alfamino

• Powder 400g = £25.73

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.

Other common formulas

North and East Devon: Click here for guidance on

• thickened formula
• stepping down from amino acid formula
• suspected IgE and Non-IgE mediated food allergy in children
• lactose intolerance

Thickened formulas for reflux

An option for management of mild reflux symptoms, for a maximum of 6 months treatment. These products can be purchased at a similar cost to standard formula.

Lactose free formulas

For treatment of transient lactose intolerance after gastroenteritis. There is no evidence for use in colic. The usual length of treatment 6-8 weeks maximum. These products can be purchased at a similar cost to standard formula.

Post discharge formulas for premature infants born less than 35 weeks

This will be initiated on Neonatal Unit, maximum length of treatment until 6 months corrected age. If a premature baby is breast feeding but stops then one of these products should be used.

SMA Gold Prem 2

• Powder 400g = £12.28

Nutriprem 2

• Powder 800g = £13.59

High energy formulas for faltering growth

Infants with faltering growth need paediatric review, usual maximum length of treatment birth to 18 months

SMA High Energy

• Liquid 200ml = £2.43

Infatrini

• Liquid 125ml = £1.84
• Liquid 200ml = £2.94

Similac High Energy

• Liquid 200ml = £3.39
  

High energy hydrolysed formulas for faltering growth and malabsorption

Infants with faltering growth and malabsorption need paediatric review, usual maximum length of treatment birth to 18 months.

Infatrini Peptisorb

• Liquid 200ml = £5.03

There is an extensive range of other very specialist infant formulas available 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

7-9 months of age

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

10-12 months of age

• Two week trial - 6 x 400g tins or 3 x 900g tubs
• One month prescription - 11 x 400g tins or 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