In the first instance parents are likely to seek advice from their primary care health professionals about infant feeding problems. These can include:

Functional gastrointestinal disorders (FGIDs)

Cows’ milk allergy (CMA)

Lactose intolerance

There are various specialist milks available over the counter for FGIDs, on prescription for CMA, and either over the counter or on prescription for lactose intolerance.

Clinical studies have shown that specialist formula can significantly reduce symptoms of these conditions compared with standard formula milks1-6, meaning nutritional solutions can play an important role in management, for example as part of the NICE stepped-care approach for formula fed babies with frequent regurgitation7.

This product guide provides information on the Aptamil and Cow & Gate products available and their features and benefits so that, where appropriate, you can advise parents on a specialist formula milk for their formula fed infant.

NUTRITIONAL MANAGEMENT OF INFANT FEEDING PROBLEMSPRODUCT GUIDE

Aptamil Specialist Formula Milks

Aptamil Comfort

Aptamil Anti-Reflux

Nutritionally tailored with Nutricia Early Life Nutrition’s unique blend of galacto- and fructo-oligosaccharides (GOS/FOS), and contains less lactose than standard milks to help reduce gas and other intestinal discomfort8-10. Aptamil Comfort also contains partially broken down whey protein to make it easier to digest.

Specially formulated with carob bean gum so that the milk is thicker in consistency than standard infant formula. Aptamil Anti-Reflux has been shown to be thicker on preparation than other anti-reflux formulas, and it also stays thicker on contact with stomach enzymes11.

Provides greater viscosity on contact with stomach enzymes compared to starch-based thickened feeds11

Contains LCPs and nucleotides Nutritionally complete Thickened formula Suitable from birth to one year. Aptamil and Cow & Gate

Comfort and Anti-Reflux have a thicker formula

than most other feeds. We recommend using the following teats:Comfort formulas: variable flow teat or single hole teat with a medium or fast flow

Anti-Reflux formulas: single hole fast

flow teat.

Did you know?

Partially hydrolysed proteins

Special fat blend Reduced lactose Unique blend of GOS/FOS

Contains LCPs (AA/DHA)

Contains nucleotides Easy to digest Nutritionally complete Suitable from birth to one year.PIP code:*

328-7273

PIP code:*376-3232

Aptamil Specialist Formula Milks

Aptamil Pepti 1 and 2

Aptamil Lactose Free

Aptamil Pepti 1 and 2 are formulated for the dietary management of mild to moderate cows’ milk allergy and are formulated to relieve cows’ milk allergy symptoms5 with 97% efficacy6, reduce incidence of atopic dermatitis up to five years12 and reassure parents through its superior palatability13,14.

As well as being free from lactose, this special milk is also sucrose-free to help manage the symptoms of lactose or sucrose intolerance.

Free from lactose and sucrose Contains LCPs (AA and DHA) Contains nucleotides Enriched with iron to support normal cognitive development

Suitable from birth to one year.

Pepti 1: Extensively hydrolysed

whey-based formula with a composition nutritionally closer to breastmilk, encouraging normal growth and development15

Nutritionally complete

Unique blend GOS/FOS to help reduce long-term allergy risk12

Contains LCPs (AA and DHA)

Contains nucleotides Suitable from birth Available in 400g and 800g tins.

Pepti 2: Extensively hydrolysed

whey-based formula which complements a cows’ milk-free weaning diet from six months

Unique blend GOS/FOS to help reduce long-term allergy risk12

Contains LCPs (AA and DHA)

Contains nucleotides Enriched with calcium and iron

Suitable from six months Available in 400g and 800g tins.

PIP codes:*400g: 346-5689800g: 391-8976

PIP codes:*400g: 391-8950800g: 391-8968

PIP code:*386-7439

Cow & Gate Specialist Formula Milks

Cow & Gate Comfort

Cow & Gate Instant Carobel Cow & Gate Pepti-Junior

Designed to be easier to digest, Cow & Gate Comfort contains a unique mix of ingredients suitable for babies with colic or constipation.

This is a gelling or thickening agent that makes milk thicker in consistency to help babies keep more of their feed down.

Specially formulated with whey protein that has been broken down, and MCT oil which is easier to digest for babies with malabsorption or who need a milk-free diet.

Easy to digest Reduced lactose Contains LCPs and oligosaccharides

Contains nucleotides Partially hydrolysed proteins

Suitable from birth to one year.

Cow & Gate Anti-Reflux

Using a thickened formula such as Cow & Gate Anti-Reflux can help babies keep more of their milk down.

Thickened formula Contains LCPs and nucleotides

Nutritionally complete

Suitable from birth to one year.

Milk-free

Gluten-free

Lactose-free

Carob bean-based gelling or thickening agent

Can be spoon fed as a paste or added to liquids

Suitable for infants, children and adults.

Extensively hydrolysed formula

Semi-elemental formula with MCT oil

Contains LCPs (AA and DHA) and nucleotides

Suitable for babies from birth who have malabsorption and/or multiple food allergies/intolerances.

PIP code:*376-4990

PIP code:*310-5756

PIP code:*246-9450

PIP code:*049-0714

*For pharmacy only

Prebiotics are present in breastmilk, and there is evidence that prebiotics added to infant formula have beneficial effects on gut microbiota, metabolic activity, stool consistency and frequency, and the development of some immune markers16.

Thickening agents are used in formulas for reflux and regurgitation to increase the viscosity and help the feed stay down. A study has shown infant formulas thickened with carob bean gum significantly reduce regurgitation compared with standard formula17. Carob bean gum-based formulas provide greater viscosity on contact with stomach enzymes compared to starch-based thickened feeds11.

Product comparison

Format

Size

Foods for special medical purposes

Nucleotides

Thickener to help feed stay down

Low degradation by salivary amylase

Temperature for preparation

Aptamil Anti-Reflux

EaZy pack

900g

4

4

Carob bean gum

4

Hand hot

Cow & Gate Anti-Reflux

EaZy pack

900g

4

4

Carob bean gum

4

Hand hot

SMA Staydown

Tin

900g

4

4

Corn starch

8

Chilled

HiPP Anti-Reflux

Bag in box

800g

4 8

Carob bean gum

4

Hand hot

Enfamil AR

Tin

400g

4

4

Rice starch

8

Room temperature

Comfort formulas

Format

Size

Foods for special medical purposes

Partially hydrolysed whey protein to aid digestion

Structured fat blend for softer stools

Starch to minimise air swallowing

Nucleotides

Prebiotic oligosaccharides to benefit gut microbiota

Reduced lactose to aid digestion

Aptamil Comfort

EaZy pack

900g

4

4

4

4

4

4 0.8 g/100ml (GOS/FOS)

4 2.7 g/100ml

Cow & Gate Comfort

EaZy pack

900g

4

4

4

4

4

4 0.8 g/100ml (GOS/FOS)

4 2.7 g/100ml

SMA Comfort

Tin

800g

8

4

4

8

4

8

4 3.9 g/100ml

HiPP Comfort

Bag in box

800g

4

4

4

4

8

4 0.3 g/100ml (GOS only)

4 2.7 g/100ml

Anti-reflux formulas

It is important to provide parents with advice on how to make up specialist infant milk, as they may not be aware that this can differ from making up standard formula. General guidance on making up Aptamil and Cow & Gate formula milk:

Making up specialist infant formula

STEP 1 Wash hands and sterilise all utensils according to manufacturer’s instructions.

STEP 3 Using the scoop provided, level off the powder with the built-in leveller or use the back of a clean knife. Do not press or heap the powder.

STEP 4 Add the correct measure of powder to the water. Adding too many or too few scoops can be harmful. Cap the bottle and shake vigorously (different products suggest different amounts of time) to dissolve the powder.

Remove cap and replace with a sterilised teat.

For anti-reflux products: Cap the bottle and strongly roll the bottle upright between the palms of hands for five seconds. The time between adding the scoops and rolling the bottle should be as short as possible.

STEP 5 Cool under running tap. Check temperature of feed. Feed immediately.

For anti-reflux products: Shake bottle for 20 seconds and then leave to stand for seven minutes to allow it to thicken.

Check temperature of feed. Feed immediately.

STEP 2 Boil one litre of fresh water. Leave kettle to cool for no longer than 30 mins (45 mins for Aptamil and Cow & Gate Anti-Reflux milks). Measure the required amount of water (refer to feeding guide)

into a sterilised bottle. Be careful of scalding. Do not use artificially softened or repeatedly boiled water.

RefeRences: 1. Savino F et al. Acta Paediatr Suppl 2003; 441: 86–90.

2. Savino F et al. Eur J Clin Nutr 2006; 60: 1304–1310.

3. Vandenplas Y et al. Acta Paediatr 2014; 103: 689–695.

4. Borrelli O et al. Ital J Gastroenterol Hepatol 1997; 29: 237–242.

5. Verwimp JJ et al. Eur J Clin Nutr 1995; 49(Suppl 1): S39-48.

6. Giampietro PG et al. Pediatr Allergy Immunol 2001; 12: 83-6.

7. NICE Guidance. Gastro-oesophageal reflux disease in children and young people: diagnosis and management. 2015. Available at: https://www.nice.org.uk/guidance/ng1 [Accessed December 2016].

8. Moro G et al. J Pediatr Gastroenterol Nutr 2002;34:291-5.

9. Knol J et al. J Pediatr Gastroenterol Nutr 2005; 40:36-42.

10. Kanabar D et al. J Hum Nutr Dietet 2001;14:359-63.

11. Danone Research [Data on file].

12. Arslanoglu S et al. J Biol Regul Homeost Agents. 2012;26:49-59.

13. Pedrosa M et al. J Investig Allergol Clin Immunol. 2006; 16(6):351-6.

14. Venter C. Cows milk protein allergy and other food hypersensitivities in infants. [Online] Available at: https://www.jfhc.co.uk/Cows_milk_protein_allergy_and_other_ food_hypersensitivities_in_infants_20679.aspx [Accessed December 2016].

15. Vandenplas Y et al. J Pediatr Gastroenterol Nutr. 1993;17(1):92-96.

16. Vandenplas et al. Br J Nutr 2015; 113: 1339–1344.

17. Wenzl TG et al. J Pediatr 2003; 111: e355–e359.

No part of this publication may be reproduced without the written permission of the publishers, Nutricia Early Life Nutrition in association with CIG Healthcare Partnership. ©2017 CIG Healthcare Partnership.HCP560

For further resources and our CPD-approved learning modules, visit www.eln.nutricia.co.ukHealthcare professional helpline: 0800 996 1234