Alternatives and variations on cow’s milk based formulas:
- Extensively hydrolysed – protein is broken down so good for cow’s milk protein allergy. Not very nice tasting! Can be whey-based eg Pepti (which includes lactose, so more palatable but no good for lactose intolerance), else casein-based eg Nutramigen (lactose free).
- Partially hydrolysed – better tasting but symptoms may persist if true allergy
- Anti-reflux “stay down”
- Soya – good for cow’s milk protein allergy but cross reactivity can occur, plus theoretical phyto-oestrogen effect so avoid if under 6 months. But the only one you can use if you are vegan or have galactosaemia.
Aptamil Pepti is made by Milupa (which is where GP’s will find it on electronic prescribing system).
Some are lactose free, others not. Some have medium chain triglycerides as main fat source, eg Pepti Junior, Pregestimil, Peptisorb.
Nutramigen contains prebiotics – should therefore not be given to preterm babies (theoretical risk of gut translocation), and should be made up at room temperature (so not suitable for prep machines).
The only extensively hydrolysed infant milk suitable for those who require a vegetarian or halal diet is SMA Althéra. None are vegan friendly.
Alfamino does not have coconut oil, unlike some of the others. No evidence that there is sufficient coconut protein in formula to cause an allergic reaction but it often gets accused of suspected reactions.