1. Introduction to Infant Formula Aisling Pigott (Paediatric Dietitian) Families First Newport 01633 414666

2. Breast is best Specifically designed to meet the needs of the child Reduces infection and disease risk Free Improved gut tolerance Improved outcomes and survival rates amongst hospitalised neonates and infants Few cases where not appropriate e.g. Chylothorax, maternal HIV, maternal medication Always approach issue especially with sick babies

4. Normal Formula Available OTC Whey based Casein based Follow on milks Soya Formula Staydown Reflux Constipation Colic Partially hydrolysed

6. Whey based infant milks Closest to breastmilk ~66kcal/100mls Lower renal solute load Examples: Aptamil First, Cow & Gate 1, SMA Gold Ready to feed / powder Nucleotides, probiotics, LCP’s

7. Casein based infant milks Marketed as “suitable for hungrier babies” Limited evidence to support this Same kcals as whey based Slower gastric emptying Higher solute load Examples: Aptamil Extra Hungry, Cow & Gate 2.

8. Follow On Milks Higher iron content Examples: Aptamil Follow On, Cow & Gate 3, Heinz Nurture Growing Baby, SMA Progress

9. Soya Formula Not recommended for children under 6 months due to risks associated with phytoestrogens Little choice for vegan families Other milks e.g. Staydown milk, goats milk, partially hydrolysed protein milks and follow on milks Strong cross reactivity with Cows Milk Protein (10-50%)

10. Other milks (available over the counter) -Staydown milk -Goats milk -Partially hydrolysed protein milks -Toddler milks -Lactose free milk -New: Hypoallergenic formula to reduce risk of developing allergy ** Only useful if given BEFORE cows milk containing formula

11. Specialist milks Cows Milk Allergy Failure to Thrive/Increased Energy Demands/ Fluid restriction Prematurity/ Low Birth Weight Others e.g. Metabolic conditions, renal conditions, chylothorax, GSD, ketogenic

12. Cows Milk Allergy Family h/o atopic disease/ allergy Eczema, Asthma, GORD, Constipation Rare - anaphylaxis Consider symptoms and appropriateness of CM free diet

13. Suitable Milk Substitutes: Infants First line (0-12mo): –Extensively Hydrolysed Formula (EHF) Casein or Whey +/- Lactose +/- Medium Chain Triglycerides (MCT) –Amino Acid Formula if not resolved Considerations: –Type / severity of allergy, growth, age, palatability, cost

14. Extensively Hydrolysed (Casein) Examples: –Nutramigen Lipil 1 & 2 –Pregestimil (54% MCT) Advantages –Proven, reduced allergenicity –Lactose-free –95% of protein <1000 Daltons Disadvantages –Palatability

15. Extensively Hydrolysed (Whey) Examples: –Pepti (40% Lactose) –Pepti-junior (50% MCT, Trace Lactose) –Aptamil Pepti –NEW * Infatrini Peptisorb (1kcal/ml) –Similac Alimentum (.66kcal/ml) –Nestle Althera Advantages: –Proven reduced allergenicity –Palatability (?Taste advantage over AA, EHFC) Disadvantages: –More residual long chain peptides –Contains Lactose

16. Amino Acid Formula Examples: –Neocate LCP (0-1yr) –Neocate Advance –Nutramigen AA (0-1yr) –Alfamino AA (0-3 yr) Advantages: –Non-allergenic 100% Free Amino Acids –Lactose-free Disadvantages –Palatability –Cost

17. Specialist Milks Prematurity Nutriprem 1 & Pre-Aptamil SMA LBW Nutriprem 2 (for community use) Breast milk fortifiers (not available in community)

18. Faltering Growth Cause? Assessment –Breast fed –Formula fed –Over six months High energy requirements/poor intake. –Inorganic/organic reasons?

19. Faltering Growth… Continued Depending on local policies.. Seek dietetic input RTF formula’s available Infatrini (1kcal/ml) Similac High Energy (1kcal/ml) SMA HE (.91kcal/ml)

20. Falterning Growth… cont’d Disadvantages -Reduced GI tolerance -Increased macro and micro nutrients e.g. renal patients, patients on large volumes Na2+ containing drugs Other options (need dietetic supervision) -increasing concentration of feed -Supplementing with a carbohydrate or fat supplement

21. Try before you buy! Any questions?