If your baby has difficulty processing standard formula—or sometimes even breastmilk—a milk protein allergy could be to blame. In those cases, a pediatrician may prescribe a hypoallergenic baby formula to help your little one get the nutrients they need. Some doctors may also recommend hypoallergenic formula for babies with a strong family history of allergies.
Excessive crying, gas, or trouble sleeping are clues that something's wrong, while common symptoms of an allergy also include a runny nose, wheezing, eczema, vomiting, diarrhea, and extreme irritability. If you suspect your baby has allergies, talk to your doctor before switching to a hypoallergenic formula to confirm that's actually the problem.
Food allergies are on the rise, but studies have shown that the prevalence of milk protein allergies in infants is still only 2-3 percent. In those rare instances, hypoallergenic formula may be the only thing an infant can digest, says New York-based registered dietitian Natalie Gillett.
"Hypoallergenic formulas are absolutely necessary for infants who cannot tolerate regular formula," she says. "Without it, they will not properly absorb nutrients and will not grow."
Although hypoallergenic formulas are usually made with cow's milk, they're processed so that the allergy-causing protein is broken down in order to be more easily digestible for baby. The two main types are extensively hydrolyzed and amino acid-based infant formulas, both of which are proven to be tolerated by at least 90 percent of babies with allergies.
You may also notice partially hydrolyzed formulas (such as Enfamil Gentlease) when you're comparing formula brands. Although these options may relieve fussiness and gas in some infants, it's important to note that they are not in fact hypoallergenic, and aren't intended for babies with confirmed allergies.
Gillett notes that the different levels of pre-digestion in different formulas should be considered alongside the severity of the child's allergies. "Similac Alimentum and Enfamil Nutramigen contain fully broken down proteins," Gillett says. "One step further is an amino acid-based formula such as Neocate. The more broken down the proteins, the easier it is to digest, but it also comes with a higher price."
Hypoallergenic formulas can be up to three times more expensive than standard formulas, but there may be hope for families on a budget, according to childbirth educator Genevieve Howland of Mama Natural. "Although hypoallergenic formulas can be very costly, it may be medically necessary for your baby, based on the severity of their allergy and symptoms," she says. "In some cases, health insurance may supplement—or even pay for—hypoallergenic formula if your pediatrician deems it medically necessary."
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Your pediatrician may be able to help you choose between extensively hydrolyzed formulas (like Gerber Extensive HA, Enfamil Nutramigen, Similac Expert Care Alimentum, and Enfamil Pregestimil) and amino acid-based hypoallergenic baby formulas (like Abbott Nutrition Elecare, Enfamil PurAmino, Enfamil Nutramigen AA, and Nutricia Neocate) based on your child's symptoms.
Still, it may also be necessary to try a few different brands before finding one that works best for your baby, says maternal child health expert Crystal Karges of Crystal Karges Nutrition. "Thankfully, there are multiple options available on the market today. If you try one recommended by your doctor that your baby doesn't seem to tolerate well, there are other brands that might work better," she says.
Karges suggests asking your doctor for formula samples to see which brand your baby tolerates best. "Once you have found a brand that works well for your baby, you can feel more confident in purchasing a larger size." She mentions Enfamil Nutramigen and Similac Expert Care Alimentum as two reliable hypoallergenic formula brands.
Howland favors two European brands, including HiPP HA Combiotik, which contains only hydrolyzed proteins to help prevent allergic reactions. "Plus it has all the same great benefits of the brand's more traditional organic counterpart," she says. She's also a fan of Holle's hypoallergenic formulas. "This goat formula is made with all organic and non-GMO ingredients," Howland says.
The most obvious alternative to hypoallergenic formula, but still worth noting, is breastmilk. The American Academy of Pediatrics considers breastfeeding the ideal source of nutrition for infants, and the incidence of food allergies is very low in breastfed infants. In those cases, the elimination of cow's milk, eggs, fish, and other foods from the mother's diet will often ease the infant's symptoms.
Soy formulas are another common alternative to hypoallergenic formulas. Infants with symptoms of IgE-associated cow's milk allergy (runny nose, wheezing, eczema, vomiting, and difficulty breathing) have a particularly high success rate with soy formulas—although some experts discourage the use of soy formula. "It's worth noting that soy-based formulas contain high levels of plant-based estrogen-like compounds," Howland says. "Studies show infants who consumed soy-based formula as newborns had differences in some reproductive-system cells and tissues, the long-term effects of which are unknown."
Howland notes that goat milk-based formula is generally well tolerated, because it contains smaller fat molecules, and rice protein-based formulas may also work for a severely allergic child.
While the options can seem dizzying, finding the right formula could transform your fussy, allergy-suffering baby into a happy, healthy child. Talk to your pediatrician about finding the right hypoallergenic baby formula or alternative for your little one.