Formula Series 8 – Specialty Formulas

Specialty Formulas – For whatever ails Baby…

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There is a “specialty” formula out there for every common baby ailment from crying to fussiness, gas, reflux and spit up.  In general, there is not sufficient research to back up any of these claims.  Remember that the only good research supporting a formula helping an infant condition is for hydrolysate formula and pre/probiotics preventing or helping dermatitis, and for hydrolysate formula helping prevent allergy.  Otherwise, there is no magic formula that will cure colic or eliminate gas… no matter how much we hope so.   I want parents to understand what they are getting when they buy a formula that makes such a claim.  Here’s a common list of claims/ailments, and how the formula companies have tried to address them:

Reflux and/or Spit Up: 

Formulas marketed to reduce spit up and/or reflux usually have an extra thickener added.  This simply makes the formula harder for baby to get all the way back up the esophagus.  The most common thickener used is rice starch.  Enfamil®’s A.R. formula does not stand for “acid reflux” (although the company may like you to think it does!).  It actually stands for “added rice”.  The research showing that this thickening technique reduces reflux is very lacking.  The downside to choosing such a formula is that a fair proportion of the carbohydrate source of this formula will now come from rice starch, as opposed to lactose.  This must be weighed against the potential benefit of reduced spit up.

Another tactic that may be used to prevent spit-up is to use 100% whey protein.  This is because (as discussed in article 4), whey protein empties little stomachs faster than casein protein.  The faster formula is moved out of the stomach, the less likely it is to come back up.  I have no problem with 100% whey protein formulas and if they help reduce your baby’s spit up volume, all the better!

There are positioning techniques for holding baby during and after feeding that are more likely to help with spit-up and reflux than switching to one of these specialty formulas.

Fussiness, Gas, and Colic:

Several formulas claim to prevent fussiness, gas, and colic.  Many formulas that contain partially or extensively hydrolyzed protein make the claim that they can help reduce all manner of fussiness.  The thinking is that more digestible proteins will reduce general infant indigestion and gas which will improve disposition.   That is also why some companies refer to hydrolysate as “comfort” proteins.  Similar claims are made regarding probiotics using the same line or reasoning – improving ease of digestion will decrease discomfort.  While the logic makes perfect sense, these claims are a stretch from a scientific standpoint.  While these may help a few infants, there are a million reasons why your baby may be fussy at any given time, and there is no good research to support that hydrolysate protein or probiotics will diminish gas or fussiness.  If we truly knew how to cure fussiness and colic, there would be a lot fewer sleep-deprived Mamas and Papas out there!  Don’t get me wrong – I actually approve of probiotics and hydrolysate proteins in infant formula, I simply do not want parents to have false hopes about what these ingredients will do.

Atopic (skin) Disease:

Formulas that contain partially or extensively hydrolyzed protein often claim that their formula will help prevent atopic disease on your little one’s skin.  This claim is actually legitimate!  How refreshing!  There is good research out there to support the benefits of hydrolyzed formula (7-9) and I highly recommend choosing one.

All babies spit up, have gas, cry, and are occasionally fussy.  It’s possible a specialty formula may help.  However it most likely won’t serve as a magic cure-all.  It is much better to know what type of specialty ingredients may be beneficial for your individual baby and then chose a formula accordingly.

Take-Home Messages

  • Most specialty formulas designed for a specific baby ailment lack the  research to support such a claim
  • Formula for spit up and/or reflux is usually thickened with starch (a kind of carbohydrate).  Another approach is to use 100% whey which empties the stomach faster than casein.
  • Both probiotics and hydrolyzed protein formulas may be marketed for gas, fussiness, or colic.  This is because manufacturers hope these ingredients will diminish indigestion, thereby improving baby’s disposition.  The research to support this is practically non-existent.  I do approve of both of these ingredients, but would never tell parents these would cure colic.
  • There actually is great research to support hydrolysate proteins for infants at-risk for atopic disease and food allergy.

7.         Jin, Y. Y., Cao, R. M., Chen, J., Kaku, Y., Wu, J., Cheng, Y., Shimizu, T., Takase, M., Wu, S. M., and Chen, T. X. (2011) Partially hydrolyzed cow’s milk formula has a therapeutic effect on the infants with mild to moderate atopic dermatitis: a randomized, double-blind study. Pediatr. Allergy Immunol. 22, 688-694

8.         Alexander, D. D., and Cabana, M. D. (2010) Partially hydrolyzed 100% whey protein infant formula and reduced risk of atopic dermatitis: a meta-analysis. J. Pediatr. Gastroenterol. Nutr. 50, 422-430

9.         Greer, F. R., Sicherer, S. H., Burks, A. W., American Academy of Pediatrics Committee on, N., American Academy of Pediatrics Section on, A., and Immunology. (2008) Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics 121, 183-191