The Role of Specialist Formula Milks

Breastfeeding is the best way to feed a baby and is important for both mum and babyThe World Health Organization recommends that babies are exclusively breastfed until six months of age, after which breastfeeding is complemented with the introduction of solid foods until the age of two.

However, when a baby with specific nutritional requirements due to an underlying medical condition does not receive breast milk, the only alternative source of nutrition which is suitable and safe is a scientifically formulated infant formula. The terms “special formula milks” or “specialist formula milks” refer to a range of formula milks for specialist conditions for which standard formula is not suitable.

It can be difficult for parents to discover that their baby needs a specialist product to meet their nutritional requirements; in such cases, specialist expertise, support and guidance from a healthcare professional is needed.

Special formula milks address a number of conditions; it is essential that babies get the right formula for their individual requirements so that they can grow and thrive.

Faltering growth

Faltering growth is a term used when an infant is not putting on weight and / or gaining length as expected over a period of time. Causes of faltering growth can include:

  • An inability to consume enough nutrients to meet requirements due to a poor suck or swallow function due to muscular disorders, or symptoms such as vomiting or diarrhoea due to underlying disease
  • Poor absorption or metabolism of nutrients - such as digestive disorders including cystic fibrosis or chronic kidney disease  
  • Increased nutritional requirements - such as in chronic heart disease or respiratory disease

Faltering growth may be treated with a specialist high energy infant formula, which provides more calories and protein than a standard infant formula to help achieve catch-up growth. 


Cow’s milk protein allergy


Cow’s milk protein allergy (CMPA) in formula-fed babies is an allergic reaction to the milk protein found in standard formula and can result in a variety of symptoms including:

  • Digestive issues – such as diarrhoea, constipation or vomiting
  • Respiratory symptoms – such as wheezing, sneezing, breathing problems
  • Skin problems – such as eczema, hives, swelling

CMPA is managed by removing cow’s milk protein from the diet. In some cases, mothers are advised to eliminate dairy from their diet so that they can continue to breastfeed. If this is not possible, a healthcare professional will prescribe a specialist formula, such as an extensively hydrolysed formula (EHF) or an amino acid formula (AAF).

In an EHF, the protein has been broken down (or hydrolysed) into its component parts - small peptides and free amino acids, which the immune system does not recognise as cow’s milk protein and therefore does not react. EHF is suitable for approximately 90% of infants with CMPA. In the most severe cases of CMPA, an AAF - a formula made up of free amino acids - is recommended. 

Lactose intolerance

Babies with lactose intolerance are intolerant to the lactose in standard formula because they lack the enzyme lactase which breaks down lactose. There is often confusion between lactose intolerance (intolerance to the sugar lactose in milk-derived products) and CMPA (an allergy to the protein in cow’s milk-based products). Symptoms of lactose intolerance usually occur in the baby’s digestive system and include diarrhoea, bloating and stomach cramps. 

Lactose intolerance is managed by removing or limiting lactose in the diet; this may be achieved by using a lactose-free specialist formula. These formulas are based on standard formula with the lactose removed; they still contain cow’s milk protein so are not suitable for babies with CMPA. 

Gastro-oesophageal reflux

Gastro-oesophageal reflux disease (GORD) is a common condition where stomach acid leaks back into the oesophagus and is usually caused by a weakened muscle at the bottom of the oesophagus. Symptoms of GORD include spitting up of milk during or after feeds, difficulty in feeding such as refusal or gagging and excessive crying.

Pre-thickened formulas or formulas that thicken on contact with the stomach acid are used to manage GORD. Because they are thicker, they are more likely to remain in the stomach and relieve the symptoms of GORD. 

Why specialist milks are on prescription

Specialist milks are available on prescription and must be used under medical supervision for the full duration of the condition.

When infants are chronically upset and potentially in pain, parents can become worried and distressed. Any parent who is concerned about their infant should be encouraged to see a healthcare professional for appropriate advice, management options, regular review and support.

Breastfeeding is the preferred way to feed a baby. But when that is not possible for medical reasons, specialist formulas can provide a lifeline to vulnerable infants. Every child needs and deserves the right nutrition to grow and develop and lead a fun-filled life.