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How to Choose an Amino Acid-Based Formula for Your Child

With so many formula choices available, it can be easy for parents to get overwhelmed when deciding which formula is the best choice for their child.  If your child has received a diagnosis of a digestive or allergic disorder, this decision can often become even more complicated.  Here we discuss factors to consider helping make the decision of when an amino acid-based formula may be an appropriate formula choice.    

Understanding Hypoallergenic Formulas 

Most pediatric formulas contain whole or intact protein, usually derived from milk or soy.  These standard formulas are well tolerated in many children but since they contain whole proteins which can cause an allergic reaction and require a working digestive tract to break down the full protein, they are often problematic for children living with GI or food allergic disorders.   

In the United States, hypoallergenic formulas are usually recommended for children with food allergies and some digestive disorders and include extensively hydrolyzed formulas (EHF) and amino acid-based formulas (AAF). Extensively hydrolyzed formulas contain proteins that have been significantly broken down reducing the risk of allergic reaction.  However, while EHF may work for many children, an extensively hydrolyzed formula is still capable of producing an allergic reaction. In fact, studies have shown that an average of 10% of children with IgE-mediated cow’s milk protein allergy react to EHF1.  Amino acid-based formulas contain amino acids which are the building blocks of protein.  This means the proteins are completely broken down removing the risk of allergic reaction to intact protein or partially intact proteins like the ones found in EHF. For this reason, your healthcare provider might recommend an amino acid-based formula as a safer alternative.   

Early identification of factors that may suggest the need for AAF over EHF can be helpful in relieving undue stress on families and providing quicker resolution of symptoms leading to an overall improvement in wellbeing.  Children with complex disease such as those eliminating multiple foods, presenting with severe atopic dermatitis and/or gastrointestinal symptoms along with growth issues, may find more benefit in using an amino acid-based formula. It is important to make your formula decision after discussion with your healthcare provider.  One study to consider in this discussion identified the following factors as likely reasons to choose AAF over EHF1

  • When symptoms continue while on EHF 
  • Diagnosis of Eosinophilic Esophagitis (EoE) 
  • Diagnosis of Anaphylaxis to Cow’s Milk 
  • Poor growth (especially when symptoms involving the GI tract and/or skin are present along with multiple food eliminations)

When Symptoms Continue While on Extensively Hydrolyzed Formulas (EHF) 

Lack of improvement in symptoms is one of the most common reasons for changing a child’s formula.  Current guidelines agree that if symptoms do not improve on EHF (when accompanied by elimination of food triggers from the diet), that AAF should be recommended as the next step.  This change will usually be recommended after approximately four weeks using EHF without resolution of symptoms but the time frame and recommendation for a change should be guided by your healthcare provider.   

Diagnosis of Eosinophilic Esophagitis (EoE) 

With milk being one of the most common trigger foods for patients with EoE, it is no surprise that AAF is the first line formula recommendation allowing these children to avoid formulas containing intact proteins and partially or extensively broken-down proteins derived from milk which may trigger EoE symptoms.  International and national guidelines recommend AAF for patients with EoE and studies support the basis for this recommendation by showing that 90% of children using AAF will achieve resolution of their EoE symptoms.   

Diagnosis of Anaphylaxis to Cow’s Milk 

Documented cases show that some children with cow’s milk protein allergy have developed intolerance or reactions to EHF with some of these reactions leading to anaphylaxis.  In addition, some allergists have reported clinical observation of this issue in their patients as well.  Based on this data, it has been recommended that children with severe allergic reactions undergo a hospital-based challenge to EHF to ensure safety and determine tolerance.  Due to the impractical nature of conducting these challenges in large amounts of children, most guidelines recommend AAF as the first line recommendation for children with anaphylaxis to cow’s milk allergy.

Poor Growth

Children with food allergies and digestive disorders are at risk for poor growth or failure to thrive, particularly those avoiding cow’s milk and also in those avoiding three or more foods.  In fact, it is estimated that 7 to 24% of children with food allergies have stunting1.  Multiple studies have also shown that children with non-IgE-mediated allergies affecting the GI tract are less likely to tolerate EHF and often see improvement or resolution of symptoms when switched to AAF.  Although further studies are needed, it is hypothesized that children with symptoms of the gastrointestinal tract or skin (such as eczema) may continue with poor growth, due to ongoing inflammation that ultimately affects the absorption of nutrients.  It is therefore suggested that if poor growth persists with the use of EHF, that amino acid-based formula should be considered even if there has been improvement in allergic symptoms.   

What to Do When Cost is a Concern 

Hypoallergenic formulas can be expensive and often add to the financial burden of already expensive medical conditions.  Since these formulas are often medically necessary and a less expensive type of formula may not be appropriate, parents may find themselves struggling between what they can reasonably afford and what is best or necessary for their child’s health.   

Cambrooke believes that amino acid-based formulas should be accessible to all children where required, so EquaCare Jr. was created to support this mission.  It is a hypoallergenic, AAF for children over one year of age, providing complete and similar nutrition to other amino acid-based formulas.  The best part is that it costs 25% less than other amino acid-based formulas on the market.  This lower cost formula option may open doors to better treatment options and help relieve financial stress especially for those who do not have insurance coverage for these expensive formulas.   

What Type of Nutrition Can I Expect an Amino Acid Formula to Provide? 

Most amino acid-based formulas provide complete nutrition for young children and can often be adapted to support adequate nutrition in adolescents and even adults.  They are also commonly used to provide supplemental nutrition for those on restricted diets or those struggling to achieve their growth goals.  Amino acid-based formulas have many elements in common, but Essential Care Jr. stands out from the competition. It is the only AAF for children over one year of age that is free of corn and artificial ingredients. Essential Care Jr. provides Low FODMAP tapioca as an alternative to corn syrup solids and natural monk fruit instead of artificial sweeteners.  In addition, it is the only AAF containing Vit K2 which supports bone health.  Research shows this little known but mighty form of Vit K is an effective treatment in osteoporosis, may slow bone loss and inhibit a decrease in bone mineral density as well as reduce the risk of fractures.  

Learn more about each of these beneficial products by visiting us online today or calling 1-833-377-2773. 

  1. Meyer R, Groetch M, Venter C. When Should Infants with Cow’s Milk Protein Allergy Use an Amino Acid Formula? A Practical Guide. J Allergy Clin Immunol Pract. 2018 Mar-Apr;6(2):383-399.