Formula Options for Kids with Food Allergies
Cow’s milk allergy (usually just called “milk allergy”) and soy allergy are very common food allergies among children.
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What to Feed Your Infant or Toddler If They Have Food Allergies
Infants can develop food intolerances or allergies. A small subset of infants fed human milk (either by breast or bottle) can show symptoms due to food proteins the mother or lactating person eats passing through into the human milk. Formula-fed infants can show symptoms due to not tolerating the food proteins (milk or soy) in infant formula. Babies should ideally drink human milk or formula for at least the first year of life.
A food allergy occurs when the body’s immune system sees a certain food as harmful and reacts by causing one or more symptoms. This is known as an allergic reaction.
Foods that cause allergic reactions are called allergens. Even a small amount of an allergen can cause a reaction. Allergic reactions usually occur after your child eats a food they are allergic to.
There are two types of food allergies: IgE mediated and non-IgE mediated.
Symptoms from IgE mediated food allergies usually occur within two hours of feeding and can present as:
- Severe allergic reaction (anaphylaxis)
This is the “classic” type of food allergy that causes symptoms like hives and swelling. An IgE-mediated food allergy can get worse over time. Some food allergies are more likely than others to be outgrown as children age. When a child is diagnosed with this type of allergy, your health care provider should provide you with an epinephrine auto-injector to treat severe allergic reactions.
Symptoms from non-IgE mediated food allergies are usually delayed after feeding and may present as:
- Bloody, mucousy stools
- Colic, reflux, more severe spitting up
Most symptoms of non-IgE mediated food allergies involve the digestive tract. Types of non-IgE mediated food allergies include:
- Eosinophilic [EE-oh-sin-oh-FILL-ick] esophagitis (EoE) – an allergic swallowing disorder caused by an inflamed esophagus (part of the throat)
- Food protein-induced enterocolitis syndrome (FPIES) [eff-PIES] – inflammation in the small intestine and colon (large intestine)
- Allergic proctocolitis [prahk-toe-koh-LIE-tis] – inflammation in the lower intestine caused by an allergy to cow’s milk or soy proteins found in formula or breast milk
The symptoms of non-IgE mediated food allergies usually go away when the food allergen is removed from the infant’s diet.
There are other medical conditions besides food allergy that can cause symptoms in infants and toddlers. Examples include:
- Lactose intolerance (an inability to digest lactose, a sugar found in cow’s milk)
- Celiac disease (the immune system damages the small intestine when gluten protein found in wheat, rye, or barley is eaten)
- Crohn’s disease (rare in infants/toddlers, but may cause diarrhea or low weight gain)
If your infant or toddler is having symptoms after eating foods, it is important to see a doctor to get accurately diagnosed.
Human Milk Is Beneficial
Human (breast) milk provides optimal nutrition for an infant. Even babies with food allergies can benefit from human milk. Very rarely, the food proteins pass through the milk and can cause symptoms in an infant or toddler. If this happens, the doctor may recommend the lactating parent avoid eating the foods their child is allergic to (sometimes known as an “elimination diet”). Most often nursing/breastfeeding/pumping can continue if the foods that trigger their child’s symptoms are removed from the from the breastfeeding mother’s or lactating parent’s diet. It is important to make sure you eat a healthy variety of foods. Seeing a registered dietitian can be helpful to plan how to replace nutrition that may be lost from avoiding specific foods.
If the child doesn’t have food allergy symptoms, no foods need to be removed from the diet of the lactating person.
Formula Options for Infants and Children with Food Allergies
If human milk isn’t an option, what formula should you introduce to your baby who is showing signs of allergy or intolerance? The formula you give your baby will depend on the condition they have.
Here are different types of formula available you can discuss with your child’s doctor.
Milk-Based Formulas (e.g., Similac® Advance®, Pro-Advance or Enfamil® NeuroPro®)
Milk-based formulas offer complete nutrition. But babies sometimes develop an allergy or intolerance to the cow’s milk in these formulas. These formulas are not recommended for children diagnosed with cow’s milk allergy. Cow’s milk allergy is one of the most common types of infant food allergy.
Soy Formulas (e.g., Similac® Soy Isomil®, Enfamil® ProSobee® or Gerber Good Start Soy®)
Soy formulas are no less allergenic than cow’s milk-based formulas. Eight to 14% of infants with cow’s milk allergy will react to soy. If your child has cow’s milk allergy, ask your child’s physician if a soy formula is recommended. These formulas are not recommended for children diagnosed with soy allergy.
If your infant has allergic proctocolitis or enterocolitis, they have a 25 to 60% chance of reacting to soy formulas. Other options below may be more appropriate for your child.
Partially Hydrolyzed Formulas (e.g., Enfamil NeuroPro™ Gentlease®, Gerber® Good Start® Gentle or Similac® Pro-Total Comfort™)
Partially hydrolyzed formulas take cow’s milk proteins (whey, casein) and break them into smaller pieces. Some formulas have a whey and casein blend that is partially hydrolyzed, while others may have 100% whey protein that is hydrolyzed. These formulas are NOT used for infants allergic to cow’s milk.
Extensively Hydrolyzed Formulas (e.g., Enfamil® Nutramigen®, Enfamil® Pregestimil®, Similac® Alimentum® or Similac® Expert Care®)
Extensively hydrolyzed formulas offer complete nutrition for infants who are allergic to cow’s milk protein. Casein is a cow’s milk protein that is a common cause for allergy symptoms. Extensively hydrolyzed formulas break casein into pieces. About 90% of babies with cow’s milk allergy will tolerate these formulas.
Amino Acid-Based Formulas (e.g., Neocate®, EleCare®, PurAmino™, Alfamino™)
Amino acid-based formulas offer complete nutrition for infants, toddlers and older children who need additional nutrition support. These formulas are appropriate for children who are unable to tolerate extensively hydrolyzed formulas. Amino acids are the building blocks for proteins. Because these formulas do not contain any intact proteins, they are tolerated by most children. Amino acid-based formulas are also known as “elemental” formulas.
Don’t make your own baby formula. Homemade formula may be harmful to your child. It may not provide your child with the right nutrition. It may cause dietary deficiencies. Infant formulas are carefully balanced to supply your child with the proper nutrition they need.
What Can I Do If I Can’t Afford Formula?
The cost of formula can add up. But there are options to help you cover the cost.
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) – Low-income women and children under 5 may qualify for benefits under WIC. If you qualify, you may receive checks or vouchers so you can purchase formula. You can apply for WIC online or contact your local office. Each state’s WIC program has a list of which formula options they cover. Check with your local WIC office for more information.
Supplemental Nutrition Assistance Program (SNAP) – SNAP is another food assistance program for eligible families. This program provides a debit card that allows you to buy food in retail food stores.
Temporary Assistance for Needy Families (TANF) – TANF is a program funded by the Office of Family Assistance (OAF). OAF provides grants to various states to give temporary help to families in need. Check with your state’s assistance office to see if help is available.
Food banks – Many food banks distribute free formula. Feeding America has many locations throughout the U.S. Local nonprofit organizations and churches in your area may operate food banks as well.
Local resources (211) – Dial 211 on your phone to speak to someone in your community who may be able to direct you to local programs and resources.
Formula discount programs – Some formula companies have discount programs and coupons to help reduce the cost of formula.
- Enfamil® coupons
- Gerber® coupons
- Nutramigen® savings and support
- Similac® savings and reward program
Sample and assistance programs – Talk to your doctor, pharmacist, or registered dietitian if you can’t afford your baby’s formula. They may be able to provide some samples or know of local assistance programs.
Insurance – Formula may be covered by your health insurance. If it is covered, it is usually covered as durable medical equipment (DME). You would get a prescription from your doctor to purchase it through a DME supplier that would file it with your insurance. Call your insurance company to find out if the formula is covered. For children with certain medical conditions, your doctor may be able to help you appeal for insurance to cover the costs.
Although these formulas are suggested in children at least the first year, an RD can help to devise a nutritionally sound diet in children over one year with sufficient food intake and commercially available plant-based foods.
Medical Review: September 2020 by Carina Venter, PhD, RD, and Michael Pistiner, MD, MMSc
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