From the Guidelines
Switching from Nutramigen to an amino acid-based formula should be considered when a baby continues to show symptoms of cow's milk protein allergy despite using Nutramigen for at least 2-4 weeks, as this approach has been shown to be effective in resolving symptoms in 92%–98% of patients with eosinophilic esophagitis 1. When deciding to switch, it is essential to consider the severity of the baby's symptoms and the potential benefits of an amino acid-based formula.
- Signs that indicate a need to switch include persistent symptoms such as excessive crying, irritability, vomiting, diarrhea, blood in stool, eczema, or poor weight gain.
- Amino acid-based formulas like Neocate, EleCare, or PurAmino are completely broken down and contain individual amino acids rather than peptides, making them more tolerable for infants with severe allergies. Before switching, it is crucial to consult with a pediatrician or allergist who may recommend a trial period on the new formula to assess improvement, as suggested by the guidelines for managing gastroesophageal reflux in infants 1. The switch should be gradual over 3-5 days by mixing increasing amounts of the amino acid formula with decreasing amounts of Nutramigen. While amino acid formulas are more expensive than extensively hydrolyzed formulas like Nutramigen, they may be necessary for babies with severe allergies or multiple food protein intolerances, and insurance coverage may be available with a doctor's prescription documenting medical necessity 1.
From the Research
Switching from Nutramigen to Amino Acid-Based Formula
- The decision to switch from Nutramigen (a hypoallergenic infant formula) to an amino acid-based formula depends on the individual infant's response to the current formula and the severity of their cow's milk protein allergy (CMA) symptoms 2, 3, 4.
- Infants who do not respond to extensively hydrolyzed protein formulas (EHFs) may benefit from switching to an amino acid-based formula, as it can improve weight gain and reduce allergic symptoms 3, 4, 5.
- Studies have shown that amino acid-based formulas can be well tolerated by infants with CMA and can support healthy weight gain and improvement in allergic manifestations 2, 3, 5, 6.
- The optimal time to switch to an amino acid-based formula is not specified in the studies, but it is recommended to consider switching if an infant:
- It is essential to consult with a healthcare professional before making any changes to an infant's formula, as they can assess the individual infant's needs and provide personalized guidance 2, 3, 4, 5, 6.