What’s the best formula for a baby with Reflux?

What’s the best formula for a baby with Reflux?
This is a question that comes up a lot from parents just like you who are longing for a solution to their baby's reflux. Firstly, let me be clear that formula is not a magic wand that’s going to stop your baby’s reflux*. There are many things that contribute to reflux and diet is just one of them.
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What is formula?
Infant Formula is usually made from cow's milk and it has been treated and fortified to make it suitable for babies. It differs from cows' milk in that it has been formulated with the addition of vitamins and minerals to ensure it meets the needs of a growing baby. For infants not receiving breastmilk it should be the sole form of nutrition up to 6 months at which point it should be continued alongside the introduction of solids until 12 months.

My midwife said they're all the same, is there a difference?
This is a great question because it’s partially true. All infant formula must meet infant formula compositional regulations meaning that the amount of vitamins, minerals, protein, fats and carbohydrates in all infant formulas must meet a certain standard. As all of the manufacturers have to produce their milk to the same standard they are all very similar from this point of view. 
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However, it doesn’t mean they all have the same ingredients. This is where you can find your baby is fine on one milk, but they can’t tolerate another - they are reacting to an ingredient in one, that isn’t in the other. Ingredients can even vary within the same product with powdered and ready-to-feed liquid formulas often having slightly different ingredients. 

If you are swapping from one form to another it may be worth keeping a diary so you can track symptoms and see if you notice any differences when you use powdered vs ready-made. 

What about anti-reflux/comfort milk?
These are milks that have been designed to support a specific ailment. 

Anti Reflux milk is a thickened version of formula with the aim of preventing regurgitation. The idea is that if we make the milk heavier, it’s more likely to stay in the baby’s stomach. These milks are often thickened with carob gum or maltodextrin, however, some babies can struggle to digest these leading to increased gas and often constipation. 

*Please note thickeners like carobel or medications like gaviscon should never be used alongside anti-reflux milk as this can can over thickening and lead to severe constipation.*

Comfort milk contains partially broken down (partially hydrolysed) milk proteins which are supposed to be easier for the baby to digest. There’s no evidence that they make any difference to symptoms. 

My baby has lots of wind, could they be lactose intolerant?
True lactose intolerance (AKA congenital lactose intolerance) in babies is extremely rare affecting 1 in 60,000 newborns. Babies with this condition would even react to lactose in breastmilk and have severe diarrhoea which would always be picked up in the first few days after birth. 

Some babies can struggle with lactose overload, particularly if they are overfeeding, which might be because they are in pain as feeding provides comfort. Although babies produce lactase - the enzyme that breaks down lactose, they may not have enough to digest the lactose in the additional milk. This can result in symptoms such as excess wind and watery stools that may be green in colour. 

What about Cow’s Milk Protein Allergy (CMPA)?
If you suspect your child may have CMPA it’s important to speak with your healthcare provider to see if a trial of specialist formula may be appropriate and this should be assessed on a case by case basis. 

There are 2 types of specialist formula which are commonly used in the management of CMPA.

Extensively hydrolysed formula e.g. Nutramigen LGG where the casein proteins have been broken down to make them easier to digest. However, there is still the chance of reaction due to residual cows milk peptides. It’s often used in mild to moderate cases of CMPA. 

Amino Acid-based Formula e.g. Neocate which is 100% dairy free and based purely on amino acids. Amino acids do not interact with the immune system and therefore do not lead to an allergic response. Used in moderate to severe cases of CMPA. 

Soy based formula’s are no longer recommended due to concerns around phytoestrogen content and its effect on later reproductive health. You can read more here.

So where do you go from here?
It’s important to remember that diet is just one of many factors that can contribute to the symptoms of reflux. The key is getting to the root cause and then taking steps to address that. Start by keeping a journal of all your baby’s symptoms. The most common cause of reflux is that babies are swallowing too much air (aerophagia). Are you seeing symptoms like hiccoughs, burping, positing, trapped wind, and gulping during a feed? It could be aerophagia - more on how to support this in my free Burping Guide.

If you do choose to change the formula then continue to track all symptoms and monitor any changes. 

If you’re looking for tailored 1:1 support to help get to the bottom of your baby’s reflux you can find out how I can help you here.

*It’s important to say that if you’re currently breastfeeding and you wish to continue then please do. Breast milk never causes reflux. There may be latch issues causing air swallowing or possibly something you are eating that the baby can’t tolerate. But it’s never the breastmilk that causes the problem.