Why Some Infants Need Specialized Formulas
Some infants require specialized formulas like Gentle Ease or colic formulas due to food protein allergies, intolerances, or functional gastrointestinal disorders, while others tolerate regular cow's milk formula without issues. 1
Food Allergies and Intolerances
- Cow's milk protein allergy affects some infants, causing allergic reactions that may manifest as cutaneous, gastrointestinal, or respiratory symptoms 1
- Approximately 40% of children with food allergies have experienced severe reactions, with severity varying based on individual factors 1
- Some infants have co-reactivity between different proteins - for example, 20-40% of US infants with cow's milk-induced food protein-induced enterocolitis syndrome (FPIES) also react to soy 1
Formula Selection Based on Specific Conditions
For Milk Allergy:
- Extensively hydrolyzed casein formulas are a good alternative for most milk-allergic infants 1
- Elemental (amino acid-based) formulas are appropriate for infants who don't tolerate extensively hydrolyzed formulas 1, 2
- Soy formula can be an alternative for milk-allergic infants, but caution is needed due to potential cross-reactivity 1
For Soy Allergy:
- Extensively hydrolyzed casein formulas are recommended as a good alternative 1
- Elemental formulas are the best alternative for infants allergic to both milk and soy 1, 2
For Food Protein-Induced Enterocolitis Syndrome (FPIES):
- Elemental formulas are considered the best alternative 1
- Extensively hydrolyzed formulas may not be appropriate for all milk-triggered FPIES cases 1
- Soy formula may not be appropriate due to co-reactivity concerns 1
For Protein Intolerance:
- Extensively hydrolyzed casein formula is the best alternative, although a small percentage of infants may still react 1
- Elemental formula is a good alternative for those who don't tolerate extensively hydrolyzed formulas 1
For Colic or Irritability:
- Empiric switching to specialized formulas for colic or irritability is not recommended according to guidelines 1
- Despite marketing claims, there is limited evidence supporting specialized formulas for colic 3
Important Considerations
- For a formula to be considered hypoallergenic, it should be tolerated by at least 90% of individuals allergic to the parent protein 2
- Extensively hydrolyzed formulas are tolerated by approximately 95% of cow's milk allergic individuals 2
- Elemental formulas (amino acid-based) are well tolerated by virtually all individuals, including those allergic to extensively hydrolyzed formulas 2
- Partially hydrolyzed formulas cause allergic reactions in one-third to half of milk-allergic individuals and are not considered truly hypoallergenic 2
Functional Gastrointestinal Disorders
- Some infants experience functional gastrointestinal disorders (FGIDs) such as regurgitation, colic, and constipation 3
- Thickened formulas (anti-reflux formulas) may be considered in specific cases of regurgitation 3
- For constipation, formulas enriched with high β-palmitate and increased magnesium content may be considered to soften stool 3
- Generally, there is limited evidence supporting specialized formulas for FGIDs, and reassurance to parents that these conditions are typically normal is crucial 3
Cautions and Pitfalls
- Specialized formulas should only be used under medical supervision, not as parent-initiated interventions before medical consultation 3
- For breastfed infants experiencing FGIDs, transitioning from breastfeeding to commercial formulas is not recommended 3
- Growth (weight, length/height) should be monitored regularly in children with food allergies or on specialized formulas 1
- Empiric formula switching for colic or irritability is not recommended without proper medical evaluation 1
- Parents often elect to change formulas when symptoms of intolerance occur, but decisions about when and which formula to use should be made with medical guidance 4