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

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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