Prescribing Baby Milks For Cow’s Milk Protein Allergy (CMPA) Faltering Growth Gastro-oesophageal Reflex Disease (GORD) Lactose Intolerance Pre-term Babies

Cow’s Milk Protein Allergy (CMPA) SOYA or LACTOSE-FREE formulae are NOT SUITABLE for these babies Extensively Hydrolysed Formulary choices Similac Alimentum® (1st Line) Althera® Aptimil Pepti® 1 or 2 Nutramigen Lipil® If Cow’s Milk Protein Allergy (CMPA) is suspected please refer to paediatric dietetics for advice on: 1. Appropriate Formula choice and confirmation of CMPA 2. Weaning and assuring nutritional needs are met 3. Reintroduction of cow’s milk.

Cow’s Milk Protein Allergy (CMPA) SOYA or LACTOSE-FREE formulae are NOT SUITABLE for these babies Amino-acid based Formulary choices that may be advised by Dietitians or Secondary care Nutramigen Puramino® Neocate® Alfamino® Review and refer to paediatric dietetics if the baby: Can tolerate any milk containing foods Is >18 months old on Extensively hydrolysed Formula Is > 13 months old on Amino-acid Formula The formula has been prescribed for >1year The quantity prescribed >recommended amount

Faltering Growth Can only be detected using a growth chart and usually when infant: crosses 2 centiles down is 2 centiles below length is under 0.4th centile All babies with faltering growth should be referred to a paediatric dietitian for urgent assessment

Gastro-oesophageal Reflux Disease (GORD) Overfeeding should be ruled out Give advice and reassurance on positioning post feed Recommend purchase of over the counter anti-reflux formula from Community Pharmacy or Supermarkets: Cow & Gate® or Aptamil® anti-reflux Anfamil AR® SMA Staydown® Infant Gaviscon® can be given up to six times per day Refer infants with severe faltering growth to secondary care

Congenital lactase deficiency requires specialist management Lactose Intolerance Primary Lactase Deficiency – usually occurs after 2 years of age and resolution of symptoms occurs within 48 hours of reducing lactose in the diet Secondary Lactose Intolerance – Usually occurs following infectious GI illness (usually resolves in around eight weeks), but can occur alongside new or undiagnosed Coeliac Disease Recommend purchase of Over the Counter (OTC) Lactose-free formula from Community Pharmacy or supermarkets: Enfamil-O-Lac with Lipil® SMA LF® For Older Children, recommend purchase of lactose-free cow’s milk and yoghurt from supermarkets Congenital lactase deficiency requires specialist management

Do not prescribe liquid formula Pre-term Formulae These infants will have commenced on their pre-term formula on discharge and be under regular review by paediatricians Formulary Choices to prescribe are: SMA Gold Prem 2® Powder Formula Nutriprem 2® Powder formula Do not prescribe liquid formula