Overview of Hypoallergenic Infant Formulas

Hypoallergenic infant formulas are usually made from cow's milk, but because of the way they are processed, most babies (and others who need them) can drink them without an allergic reaction, even if they are allergic to cow's milk. Parents should be aware that, if possible, breast milk is recommended by the American Academy of Pediatrics as a first line feeding option. Even in infants at risk for allergy, and in infants with intolerance symptoms maternal dietary modifications are recommended before turning to these formulas. 

Hypoallergenic formulas may be useful or necessary in three specific situations:

  • They may be considered for babies who are born into families where there's a strong family history of allergy-related conditions (like asthma, eczema, hay fever, or food allergies) who won't be breastfed or who need a supplementary formula.
  • They may be needed for babies who are allergic to or intolerant of formula or breast milk
  • They may be recommended for nutrition in people with eosinophilic esophagitis (a condition that causes inflammation in your digestive tract) who are allergic to a great many foods.

Types of Hypoallergenic Formulas

Hypoallergenic formulas come in three main varieties: partially hydrolyzed, extensively hydrolyzed, and free amino acid-based. While these terms sound complicated and hard to pronounce, they really just describe how much the formula in question (which likely started as cow's milk) has been processed to break down potentially allergenic proteins.

Hydrolyzed formulas have had the larger protein chains broken down into shorter, easy-to-digest proteins. The more extensively hydrolyzed the formula, the fewer potentially allergenic compounds remain, and the better your allergic baby may tolerate it.

Therefore, extensively hydrolyzed formulas, which are ore highly processed, are less likely to cause a reaction in highly allergic people than partially hydrolyzed formulas, which are less highly processed. The American Academy of Pediatrics recommends using extensively hydrolyzed formulas in babies and children with cow's milk protein allergies.

Free amino acid-based formulas don't include whole protein molecules at all. Instead, they contain all the basic amino acids, which are the building blocks of protein. These infant formulas are considered the least likely to cause allergic reactions. They're more expensive, and they're used when the baby in question reacts even to extensively hydrolyzed formula.

Similac Expert Care Alimentum, Enfamil Nutramigen, and Enfamil Pregestimil are brands of hydrolyzed formulas, while Nutricia Neocate, Abbott Nutrition Elecare, and Enfamil Nutramigen AA are amino acid formulas.

Paying for Hypoallergenic Formulas

Hypoallergenic formulas are far more expensive than regular cow's milk formulas—this is one of their major drawbacks. And unfortunately, in many cases, your health insurance company will decline to pay for these formulas.

However, if your pediatrician states that a hypoallergenic formula is medically necessary for your allergic baby or child, you may be able to appeal to your insurance company to pay for part of the cost of the formula. Your share of the cost will depend on many things, including your overall policy, your deductible, and your copayment requirements.

Unfortunately, not all insurance companies will share in the cost of hypoallergenic formula even with a letter from your doctor, but some will. The only way to find out is to contact your insurer and ask. If the formula is covered under your policy, you'll typically have to order it directly from a medical supply company designated by your insurer, as opposed to picking it up at your local pharmacy.

A Word From Verywell

Not every child responds well to every hypoallergenic formula, and you may have to try more than one before you find a brand that works for your baby.

Although the American Academy of Pediatrics has recommended extensively hydrolyzed formulas for infants who are not breastfed and who cannot tolerate cow's milk formulas due to allergy, a small percentage of babies still react to this type of formula.

Fortunately, the newer amino acid-based formulas seem to help. One study examined amino acid formulas and determined that babies who did not tolerate the extensively hydrolyzed formula grew well and were healthier when fed an amino acid formula.

What does this mean for your baby? First, make sure that your doctor is aware of the first sign of food allergy symptoms or other feeding-related difficulties in an infant (diarrhea, painful or bloody stools, consistent crying with feedings, or other unusual symptoms that seem to happen every time you feed your baby). Second, don't be discouraged if the first formula your doctor tries for your child isn't a good fit: Several options are on the market, and most families eventually do find one that works.

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Article Sources

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  1. Hays T, Wood RA. A Systematic Review of the Role of Hydrolyzed Infant Formulas in Allergy PreventionArchives of Pediatrics & Adolescent Medicine. 2005;159(9):810. doi:10.1001/archpedi.159.9.810

  2. Walker M. Formula Supplementation of Breastfed InfantsICAN: Infant, Child, & Adolescent Nutrition. 2015;7(4):198-207. doi:10.1177/1941406415591208

  3. Borschel MW, Baggs GE, Oliver JS. Comparison of Growth of Healthy Term Infants Fed Extensively Hydrolyzed Protein- and Amino Acid-Based Infant FormulasNutrients. 2018;10(3):289. Published 2018 Mar 1. doi:10.3390/nu10030289

  4. Ovcinnikova O, Panca M, Guest JF. Cost-effectiveness of using an extensively hydrolyzed casein formula plus the probiotic Lactobacillus rhamnosus GG compared to an extensively hydrolyzed formula alone or an amino acid formula as first-line dietary management for cow's milk allergy in the USClinicoecon Outcomes Res. 2015;7:145–152. Published 2015 Feb 27. doi:10.2147/CEOR.S75071

Additional Reading

  • Burks, Wesley, et al. Hypoallergenicity and Effects on Growth and Tolerance of a New Amino Acid-Based Formula with Docosahexaenoic Acid and Arachidonic Acid. Journal of Pediatrics. Aug. 2008 153(2): 266-71.

  • Greer, Frank R., et al. 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. Jan. 2008 121(1): 183-91. 25 Aug. 2008.

  • American Academy of Pediatrics Committee on Nutrition. Hypoallergenic Infant Formulas. Pediatrics. August 2000, Vol. 106, Issue 2.