Contributors: Becky L., Sarah C.
Finding the right formula is one of the most important steps in managing a gerdling. Your baby very likely has at least some level of sensitivity if you are experiencing moderate to severe reflux. To learn more about the differences between allergies and intolerances click here and click here.
These are some general guidelines that we have found over the years to work best for transitioning to a new formula:
1) Never switch cold turkey (suddenly) unless you have a VERY good reason. Working with parents in the past, these reasons have included: potential anaphylactic reaction to current formula, current formula causing severe diaper rash (other possible issues ruled out first), baby absolutely will not accept new formula mixed with current formula, no matter how much flavoring is tried. If you do switch without a gradual transition, know that it may lead to worsening symptoms, increased reflux, and even blood in the stool from the GI irritation the shock causes, which may make it seem like a fail even if it is not.
2) We give you a time frame about how long you need to give each formula to know if it’s a pass or fail. I realize it probably seems like we are pulling these numbers out of thin air but I promise you they’ve come through much trial and error.
3) Don’t start counting “how long” your baby has been on a new formula until baby is 100% on the new formula. For instance…If it takes 2 weeks to transition to a new formula and you started the transition 3 weeks ago, then Baby has been fully on the new formula for 1 week.
4) Our most common progression of formula is:
- Similac Alimentum Ready to Feed– most corn lite formula, does contain caesin (milk protein) and soy oil that are extensively hydrolyzed.
- If that is failed then our next recommendation is usually Neocate. It is totally free of both milk and soy. (Only elemental formula in the US that is soy-free; in the UK SMA Alfamino is also soy-free).
- If that is failed then a trial of the different elementals would be in order based on the differing oil contents and what is available in your country.
- For babies older than one year, parents may be able to consider Neocate Splash or Kate Farms.
We never recommend the following formulas:
- Alimentum powder
- Nutramigen (powder or RTF)
- Any milk-based formula
- Pre-thickened/AR formula
- Goat formula such as Holle
- Imported formulas such as HIPP (*UNLESS you are not in the United States and are unable to obtain Alimentum RTF, & your baby has failed the elemental options in your country).
- Soy formula
- Homemade formula (occasionally modular formula is necessary)
We rarely recommend Neocate Syneo or any of the “Junior” formulas. These are almost never tolerated better than (or even as well as) their counterparts designed for infants.
For babies older than one year, parents may be able to consider Neocate Splash or Kate Farms as alternatives.
5) Our recommendations are based on trial and error, helping thousands of babies, and much research of ingredients. If you have concerns about ingredients, please feel free to contact the manufacturer directly.
6) We have a charts to show you how to transition to a new formula. These are located at the bottom of this page! There are a few “red flag” signs to discontinue transitioning such as: new/spreading/swelling rash, new/increase visible blood in stool. Apart from that, pretty much any appearance of poop or increase in symptoms is “fair game” for the transition and trial period.
7) Yes, it REALLY does take 3 weeks to know if Alimentum RTF is a pass or fail, and 4-6 weeks for elemental formula. During this transition the poop will change several times.
8) We are more than happy to help you find the correct formula. We have our recommendations and ask that you at least give them a shot if you are seeking our advice.
9) There are of course times that we feel there’s a need to go out of order with a trial. We will explain to you the reason.
10) We do not see good results with fortifying formula for extra calories. If baby is having issues gaining weight, but there is adequate intake of formula, this points toward the formula itself being tolerated. Adding extra scoops trying to pack more calories in will not solve that problem and can quite likely make things worse. See: Weight Gain Issues.
11) YOU are the parent. YOU decide what baby eats. We will absolutely advise you. HOWEVER you must be the one to stand up and fight for your baby.
*If you are from outside the US we will do our very best to help you find the correct formula.
Diet and medication both need to be addressed to get reflux fully controlled.
The following chart compares some of the frequently used/recommended formulas for Gerdlings:
- Alimentum Powder Ingredients Source
- Alimentum Ready to Feed Ingredients Source
- Nutramigen Powder Ingredients Source
- Nutramigen Ready to Feed Ingredients Source
- Neocate Infant Ingredients Source
- Neocate Syneo Ingredients Source
- Neocate Junior Ingredients Source
- Neocate Splash Ingredients Source
- Neocate Nutra Ingredients Source
- EleCare Infant Ingredients Source
- EleCare Junior Ingredients Source
- PurAmino Ingredients Source
- PurAmino Junior Ingredients Source
- Alfamino Ingredients Source*
- Alfamino Junior Ingredients Source*
*Nestle, the makers of Alfamino, do not disclose the percentages of ingredients in their formulas on their websites/containers. You must contact the manufacturer to confirm these numbers if necessary.
Standard Formulas – Used for Routine Feeding (Non-Gerdlings)
- Cow’s milk protein
- Examples of Typical Brands: Enfamil Newborn, Enfamil Infant, Similac (Pro) Total Comfort, Earth’s Best Infant Formula with Iron, Baby’s Only Dairy (note that all Baby’s Only formulas are listed as toddler formulas but are safe for babies, as they are trying to promote breastfeeding for the first year.
- Even though soy-based artificial baby milks may be less allergenic for some babies, between 30 and 50 percent of infants who are allergic to cow’s milk are also allergic to soy.
- Some swear by it, especially the Baby’s Only brand.
- However, in more recent years, soy formula tends to cause more issues than it solves, particularly constipation.
- Slightly more expensive than routine formula.
- Examples of Typical Brands: Enfamil Prosobee, Similac Soy Isomil, Gerber Goodstart Soy, Earth’s Best Soy Infant Formula, Baby’s Only Soy
Corn Free/Corn Lite Formulas
- Quite a few babies seem to have a corn intolerance. While milk and soy intolerance is more common, consider corn if your baby is not responding to the more advanced formulas discussed below.
- What is This About Corn in Formula? (Post)
- Note: No formula is corn free, but they can be “corn lite.” There will be hidden corn in them, to which baby may or may not react.
- Example of corn light brands: Alimentum Ready to Feed and Baby’s Only brand formulas
Lactose-Free Intolerant Formulas
- This is a rare condition when the body is unable to digest milk sugar. It is usually seen and diagnosed in school age children and up. it is highly unlikely your baby has lactose intolerance.
- Lactose Free Formula Rant (post)
- Example of Typical Brands: Baby’s Only LactoRelief
Goat’s Milk & European Formulas (HIPP, Holle, etc.)
Anke T. writes:
This is not meant to address anyone particular, I am writing this in general. I do read from a lot of moms here recently tending to change to goats formula. Having their hopes up this would be better. It will not help your baby. You might as well take just any other cow milk based formula, it is the same. Both consist of casein and that is the protein causing all the trouble. Here in Germany, we have huge shelves now in the baby aisles, with HIPP and Hölle and all these goats, I am sure we will even have something similar to to “Target brand goats” pretty soon. This is just a trick of the baby food industry to sell the same crap formula, just more expensive. Here in Germany, we don’t have milk allergies a lot, and neither infant reflux. People might feed their babies whatever and they will be fat and happy. It could even be goats milk. So this is more like a lifestyle thing here. We have Neocate and all this too, but it’s handled through pharmacies if the rare cases happens one would need it, just like a medicine. Goats formula is just a new branch to make tons of money. It will not help your baby with infant reflux. I am pretty sure this industrial wave is carrying over to the US and Australia from Germany, since I saw a lot of advertising from Mr. Hipp around the web in the last 2 years also claiming German babies don’t have reflux because they thrive so well on his chamomile tea. HIPP was a decent company for baby foods over decades, recently not so much anymore. Their purees contain tons of cornstarch, for example. So here is my advice: stay away from that crap, take reflux seriously and avoid all casein. ❤❤❤
- These formulas have added rice starch in them and are thicker. The concept is that if the formula is thicker, it won’t be able to come up as easily.
- A lot of babies become constipated on these formulas from the rice starch. They can also cause long-lasting issues for babies whose digestive tracts
- It does not treat the pain.
- Thickening is now controversial in the treatment of reflux. Other options for thickening include cereals (which can take away from needed calories from formula, lead to dehydration, and babies can react to) and gel thickeners like Gelmix.
- If your baby needs extra calories, you should be working closely with your doctor and possibly a nutritionist for the best way to accomplish this.
- If your baby is aspirating liquid, a Swallow Study should be performed. Afterwards, you will work with a speech language pathologist (SLP) who will help prescribe the right consistency of a commercial thickener for your baby.
- If your baby is choking, gagging, or gulping, a SLP can check for dysphagia. You should also have a tongue and lip tie ruled out by a preferred provider.
- When is it Time to see a Feeding Specialist?
- Tongue Ties and Lip Ties
- Articles explaining why thickening is not necessarily recommended:
Lack of Efficacy of Thickened Feeding as Treatment for Gastroesophageal Reflux
The Effect of Thickened-Feed Interventions on Gastroesophageal Reflux in Infants: Systematic Review and Meta-analysis of Randomized, Controlled Trials
A Systematic Review of Nonpharmacological and Nonsurgical Therapies for Gastroesophageal Reflux in Infants
- Example of Typical Brands: Enfamil AR, Similac for Spit Up
Partially Hyrdolyzed Formulas
- Contains partially broken down milk proteins that are supposed to be easier to digest.
- Are not hypoallergenic.
- Examples of Typical Brands: Gerber Goodstart Gentle, Gerber Goodstart Soothe, Enfamil Gentlease, Similac Sensitive, Similac Total Comfort, Earth’s Best Sensitivity
- Milk protein is broken down very small so that the body does not recognize it.
- Has a bad taste and smell. May have to do a gradual change if your baby refuses to drink it due to the taste.
- Some babies still react to the broken down milk proteins and will need an elemental formula.
- Very expensive. Can run between $300-$400 a month.
- Can take up to two weeks to see full results.
- Examples of Typical Brands: Alimentum Ready to Feed (corn free), Alimentum powder (not corn free), Nutrimagen Ready to Feed and Powder (neither are corn free), Gerber Extensive HA (not corn free).
- Abbott/Alimentum will try to help you find financial assistance with this site: http://pathwayreimbursement.com/
- Amino acid based formula, no milk protein at all.
- Contains corn syrup solids which some babies will react to if they have a corn intolerance.
- Has a bad taste and smell. Many babies need to change to this formula gradually and mix in previous formula.
- Very expensive. Can run between $500-600 a month.
- Can take 4 weeks or more to see full results.
- Examples of Typical Brands: Neocate, Elecare, PurAmino, Alfamino
- Read here about How Neocate and Elecare Work (explains hypoallergenic formulas, too!)
- Abbot/Elecare will try to help you find financial assistance with this site: http://pathwayreimbursement.com/
- Neocate will try to help find financial assistance with this site: http://www.neocate.com/reimbursement/