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What Milk?

What Milk?. Jo Caines Paediatric Specialist Dietitian. Breastfeeding. 1 st choice - continuation of breastfeeding ? Mother may require exclusion diet if child has severe eczema or gastrointestinal symptoms Most evidence with maternal exclusion diets is for cow’s milk and egg

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What Milk?

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  1. What Milk? Jo Caines Paediatric Specialist Dietitian

  2. Breastfeeding • 1st choice - continuation of breastfeeding • ? Mother may require exclusion diet if child has severe eczema or gastrointestinal symptoms • Most evidence with maternal exclusion diets is for cow’s milk and egg • ? Calcium supplementation for mother if excluding cow’s milk

  3. Degree of Hydrolysis

  4. Extensively Hydrolysed Casein Formula (EHC-F) Nutramigen 1 (£8.20/400g) Well tolerated in younger infants Unpalatable Nutramigen 2 > 6 months Tastes better and has increased calcium Pregestimil (£8.91/400g) Similar formula containing increased level of medium chain triglycerides useful in fat malabsorption

  5. Extensively Hydrolysed Whey Formula • Pepti (£17.10/900g) More palatable than extensively hydrolysed casein formulas Contains lactose Larger peptides - ? Less well tolerated Useful in children who refuse EHC-F • Pepti Junior (£9.42/400g) Contains MCT’s Does not contain lactose More expensive than Pepti

  6. Amino Acid Formulas • Neocate LCP and Nutramigen AA Suitable for children with: - multiple food allergies - children with food allergy and GI symptoms/faltering growth - failure of extensively hydrolysed formula Expensive (Neocate £22.02/400g, NutramigenAA £21.22/400g) Unpalatable but very effective

  7. Amino Acid Formulas • Neocate Advance (£35.50/15x50g) • >1 year • 1kcal ml • Need large volumes to be nutritionally complete but can be used as a sole source of nutrition • Neocate Active (£49.12/14x63g) • > 1year • 1kcal/ml • Increased iron and calcium to meet requirements in 600mls • Designed as a supplement to diet

  8. Soya Formulas • Safety concerns regarding effect of phytoestrogens (COT 2003) • Cross reactivity with cow’s milk protein - Non IgE Up to 60% - IgE 17-47% • More palatable • SMA Wysoy(£7.58/860g) / Cow & Gate Infasoy (£7.44/900g) / Heinz Soya Nurture Formula • BDA Paediatric Group (2004) - Avoid < 6/12 as a precautionary measure - Vegans, Galactosaemia, CMPA refusing eHF

  9. Partially Hydrolysed Formulas • Not suitable for cow’s milk protein allergy treatment • More peptides with high molecular weight • Antigen content reduced to avoid primary sensitisation • Example: NAN HA (£4.29/400g)

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