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Breastfeeding provides optimal nutrition for infants. Our recommendations are based on the products we have personally used or researched; they are not a substitute for professional medical advice. Please consult your pediatrician before making any changes to your child’s diet, especially in cases where your baby has dietary restrictions or allergies.
If you’ve landed on this post about the best amino acid-based formulas, we’re going to assume you already know a thing or two about choosing baby formula. These formulas are basically the last step in the journey for babies and parents that have severe immune and/or gastrointestinal responses to the proteins found in most baby formulas.
So if you haven’t yet consulted with your doctor and tried partially hydrolyzed formulas, extensively hydrolyzed formulas, goat milk formulas or anything else, we suggest you do that before switching to an amino acid-based formula. These are for babies that have been diagnosed by a medical professional.
For those of you that have already tried just about everything else and have yet to find a formula your little one can tolerate, we’ve got you covered. And we also want to say, hang in there, we know it can be really tough seeing your baby struggle to be comfortable and/or grow and develop like you want them to be. Let’s get started.
Jump to a specific section
- What is an amino acid-based formula?
- For babies that are currently tolerating breast milk
- So which formula is “best” for milk protein allergy?
- Best amino-acid (elemental) baby formulas 2024
- What is a cow’s milk protein allergy (CMPA)?
- What are the different types of food allergies?
- What if none of these options work?
- A final word
What is an amino acid-based formula?
Also known as “elemental” formulas, amino acid-based formulas offer complete nutrition for infants, toddlers and older children who are unable to tolerate extensively hydrolyzed formulas. Amino acids are the building blocks for proteins and therefore are so small that your baby’s immune system won’t even register them as a threat, and therefore won’t trigger any sort of allergic reaction when digested.
Because these formulas do not contain any intact proteins, they are tolerated by most children. Amino acid-based formulas are also known as “elemental” formulas.
These formulas can also be used by babies with multiple allergies. They tend to be the most expensive and hardest to find, so they are typically used as a last resort. Often, you will need to get a prescription from your doctor.
For babies that are currently tolerating breast milk
Typically, if a baby is tolerating breast milk well but is struggling with supplemental formula, it’s best to try to eliminate trigger foods (like that amazing cheese or yogurt you love) from the mom’s diet and see if issues resolve, but there are cases where switching to formula is necessary.
No matter how you choose to feed your baby, don’t be afraid to do some trial and error under the guidance of your health care team. It is usually recommended to give a new amino acid-based formula 2 weeks before you decide whether your baby is going to tolerate it or not.
As you’re testing out new formulas, continue to observe and record any notable changes so you can relay that information to your pediatrician. We’d also recommend sharing that information with a pediatric registered dietician if you can afford to. They can also help determine how long you should stick with each formula you are testing to ensure you’ve given your baby the appropriate amount of time to adjust.
So which formula is “best” for milk protein allergy?
The honest truth is that the “best” amino acid-based formula is whichever one your baby can finally tolerate. All of the options below are nutritionally complete.
The biggest ranking factor in our other articles on best overall formula, best goat milk formula, best gentle formula and best hypoallergenic formula is the protein source and how much they are hydrolyzed.
With the best amino acid-based formulas, the proteins are all basically the same since they are broken down into individual amino acids. With less differentiation in the products themselves. we’ve weighted our recommendations more off of:
- Speaking with pediatricians about which ones they recommend first
- Which ones help make it easy to get insurance reimbursements
- Reviews from parents we have spoken with
- Reviews that we have found online
- Brand reputation, history and customer experience
Please reach out to us in the comments or at [email protected] if you have any feedback, questions or advice to share with other parents.
Best amino-acid (elemental) baby formulas 2024
Best overall amino-acid based formula
Similac Elecare was the top choice for parents and pediatricians that we spoke with. It has DHA and ARA added and it’s considered a complete source of nutrition for babies under 12 months of age. This formula does have soy oil so if your baby is known to react to soy, it might be better to start with Neocate instead.
Many parents found their baby was quick to tolerate this formula and they didn’t have to look much further. Even better news is that it’s typically the cheapest option and the easiest to find. We sometimes see it at our local Walmart and Walgreens but we always check Amazon first as they seem to have the best price usually.
Elecare also has Pathways Plus, a service available to help determine if your insurance will cover this type of formula since it’s medically required.
Lastly, they also have two junior formulas for when your baby turns 1 which is great to know.
2nd best amino-acid based formula
Nestle Health Science Alfamino
Alfamino has recently updated its recipe to include 2’FL (2′-Fucosyllactose) and LNnt (Lacto-N-neotetraose). It is specifically designed for babies with severe cow’s milk protein allergy, eosinophilic oesophagitis, intestinal malabsorption and/or multiple food intolerances.
It contains medium chain triglycerides (MCTs) (24% of total fat) to support fat absorption as well as specially designed structured lipids to help facilitate fat and calcium absorption.
The base for this formula continues to use potato starch vs tapioca starch. Alfamino also uses soy oil, so just be aware of this if your child is very soy reactive. You might want to start with Neocate or Neocate Syneo since they are soy free.
WIC, Medicaid and SNAP Eligible and their formula4success® program offers insurance support to help you get the formula you need for your little one
They also have an Alfamino Junior formula you can switch to once your baby is 1+ years old.
3rd best amino-acid based formula
Nurticia Neocate Syneo
Neocate Syneo is the upgraded version of their flagship amino acid-based formula Neocate Infant formula. Both version are soy free, but this one has some extra ingredients compared to the regular Neocate which they describe on their website as “a patented blend of prebiotics and probiotics, backed by years of research, and designed to help support a balanced gut microbiota in food-allergic infants.”
We like to see formula companies pushing the boundaries as to what other healthy ingredients are in these types of baby formulas since they are typically missing out on some of the good stuff found in more routine formulas.
If you try this one first and it doesn’t work, maybe try the regular Neocate simply since the ingredient list is simpler.
Their Nutricia Navigator Team is ready to help with reimbursement questions or concerns.
4th best amino acid-based formula
Nutricia Neocate Infant
This is the original Neocate amino acid-based formula they have been selling for over 30 years. It’s the OG amino acid-based formulas and was the second most recommended product by the parents and pediatricians we spoke with.
It’s cheaper than the Neocate Syneo but is missing the patented prebiotic and probiotic blend. But they’ve still got the DHA and ARA, the long chain polyunsaturated fatty acids everyone likes to see in formula.
This formula is also soy free and comes in a bit cheaper than the Syneo version above.
Nutricia offers a variety of toddler products that will grow with your baby that are also great to consider as you choose which formula is right for your family.
Their Nutricia Navigator Team is ready to help with reimbursement questions or concerns.
5th best amino acid-based formula
Enfamil has been making Puramino for a long time. This one also uses soy oil as well as tapioca starch, so if your child reacts strongly to soy or tapioca, this might not be one that will work for you.
Of all the formulas we reviewed, this one seemed to work the best for parents that have kids with Food protein-induced enterocolitis syndrome (FPIES) would tolerate. It’s the most expensive (by quite a bit) so we hope one of the formulas above works before you have to get to this one. But if you’ve tried everything else it would be best to give this one a go as well since you never know.
What is a cow’s milk protein allergy (CMPA)?
Cow’s milk protein allergy (CMPA), also referred to as cow’s milk allergy (CMA), is the most common food allergy for infants. That being said, it’s quite rare. Most babies are able to tolerate a routine cow’s milk formula without any issues but some babies need a bit of help (or a lot of help) digesting the proteins found in formula.
A food allergy occurs when the body’s immune system sees a certain food as harmful and kicks into gear to try and protect the body, which is when it’s considered an allergic reaction.
Foods that cause allergic reactions are called allergens and even a small amount of an allergen can cause a reaction. That’s why children that are truly allergic to milk proteins will likely struggle to tolerate breast milk if mom has a heavy dairy diet, and they will definitely struggle with partially hydrolyzed formula (pHF) and sometimes even extensively hydrolyzed formulas (eHF).
These formulas as well as other animal milks, like goat, will still trigger an allergic reaction after being consumed with babies that have severe allergic reactions..
What are the different types of food allergies?
There are two types of food allergies: IgE mediated and non-IgE mediated.
Symptoms from IgE mediated food allergies usually occur within two hours of feeding vs many hours or even days after feeding for non-IgE mediated. The symptoms may present as:
|Non igE mediated
|Typically described as more of the classic symptoms of an allergic reaction that you can physically see like:
|Most symptoms of non-IgE mediated food allergies involve the digestive tract, including:
|Bloody, mucousy stools
|Hives and swelling
|Colic, reflux, more severe spitting up
|Severe allergic reaction (anaphylaxis)
The symptoms of non-IgE mediated food allergies usually go away when the food allergen is removed from the infant’s diet.
There are other medical conditions besides food allergy that can cause symptoms in infants and toddlers that are very rare but are worth noting and talking through with your doctor. This includes:
- Lactose intolerance: an inability to digest lactose, the primary carbohydrate found in breast milk and routine cow’s milk.
- Celiac disease: the immune system damages the small intestine when gluten is consumed.
- Crohn’s disease: rare in infants/toddlers, but may cause diarrhea or low weight gain.
If your infant or toddler is having any of these symptoms, it is important to work with your healthcare team to get accurately diagnosed.
What if none of these options work?
If you’ve already tried some of the best hypoallergenic formulas plus ALL of the best amino acid-based formulas above, then we’re truly sorry. This is a tough spot to be in and we wish we could provide more tailored advice to you, but you will need to speak with your healthcare team to determine the next best steps.
The one thing we will say though is that with any food trial, it’s likely going to require a lot of trial and error. You’ll need to do this under close supervision with your healthcare team because there are specific things you’ll want to observe and document along the way.
And lastly, just please keep in mind that most of the formula companies as well as parents we’ve spoken to recommend giving at least 2 weeks for each trial with a new formula before ruling them out whenever possible.
A final word
A quote from one of our readers sums up our thoughts on this subject better than we can do it ourselves…
“Please share this with any of your other parents that are struggling with a baby that is dealing with allergies. Just know that it can and it will get better. We ended up finally finding a formula our little girl tolerated after trying 8 different formulas. We know this can be a very scary and emotional time but keep pushing through because it will be totally worth it once you see them thriving for the first time.”The Stevenson family whose daughter has FPIES
We hope our article on the best amino acid-based formulas was exactly what you were looking for. We’re always looking to improve it and love talking with parents that have had experience in this area because it can be so helpful to share stories with our other readers who are embarking on a similar journey. Please leave a comment below or email us at [email protected] if you have any questions, comments or feedback.
Best of luck!
Who can prescribe an amino acid-based formula?
They are usually prescribed by a consultant allergist or clinical immunologist, pediatric gastroenterologist or pediatrician, or family doctors in consultation with a consultant allergist, clinical immunologist or pediatric gastroenterologist.
How do I switch from one amino acid-based formula to another?
If you’ve ever smelt or tasted an amino acid-based formula, you know that it’s pretty awful. Luckily our babies, especially before 5 months, don’t have a very mature palette yet so it’s not as bad as you might think if your baby is already drinking an amino acid formula because they are likely to accept a different brand fairly easily. Ensure you follow the instructions on the tin for making up the formula. Scoop sizes can vary between brands.
– Here are some ideas to help make the switch:
– Offer the formula when the baby is really hungry or quite sleepy.
– Offer it repeatedly over the course of several days.
– Offer formula instead of food for a few days so your baby needs to drink to be satisfied.
– Remain calm, it takes patience by the person feeding the baby to encourage them to accept the new taste. Our babies are smart, they can pick up on body language more than you might realize.
Note that it is important to record how much formula the baby takes in a day until they are taking adequate amounts.
Will my insurance cover amino acid-based formulas?
Each company has their own customer service team that helps parents through the insurance and reimbursement process. Our team has not specifically gone through any of these programs so if you have any feedback that might be helpful for other parents, please share in the comments below or email us directly at [email protected].
Elecare = https://elecare.com/insurance-coverage
Neocate = https://www.neocate.com/reimbursement/
Puramino = https://www.enfamil.com/my-puramino/
Alfamino = https://www.nestlehealthscience.us/formula4success/overview
Who should we consult with before choosing these formulas?
Always consult with your pediatrician as the starting point in this journey. They can help identify any specialists that you might also want to see along the way. Outside of your pediatrician, we’ve had many parents recommend working with a pediatric registered dietitian if possible. They can help to make sure that your child is meeting all of their nutrient needs. This is not intended as medical advice.
Why do amino acid-based formulas taste and smell so bad?
The hydrolysis process is what makes these formulas taste and smell the way they do. It’s unavoidable at this stage but hopefully the formula companies continue to find ways to make them more palatable.
You can help your baby tolerate the bad odor and taste by not making it worse yourself. Your baby obviously can’t speak, but they are intuitive and can pick up on your body language. So when you’re making the formula, pretend like you’re making them a bottle filled with birthday cake. They will appreciate it. Make sure you tell grandma and grandpa or whoever else might be doing feeds to try to do the same.
Also remember, if your baby is under 5 months old, their taste and smell has not evolved a whole lot. To them it probably doesn’t taste that bad even if you want to puke.
If your baby is over 5 months old, then we have heard some parents have added a TINY drop of vanilla extract which has helped get them over the hump until their baby tolerates the formula on their own. You MUST check with your pediatrician before doing this. And yes, splurge and get the most organic, natural extract you can if you decide to do this.
Why is there so much corn in amino acid-based formulas?
The ingredients in these formulas usually have a heavy amount of corn product because they have to replace other more traditional ingredients to keep the calorie and nutritional content at the required levels. This is important to note if your child is super sensitive to corn. We’ve heard from many parents that their child does better with the Ready to feed (pre-mixed) version of Alimentum.
- How to choose baby formula
- Best baby formulas
- Best hypoallergenic baby formulas
- Best goat milk baby formulas
- Best organic European baby formulas
- Best baby formula alternatives
- Where to buy baby formula & how to save
- Transitioning from one amino acid formula to another | Sydney Children’s Hospital Network
- Tolerability of a new amino acid-based formula for children with IgE-mediated cow’s milk allergy | Italian Journal of Pediatrics
- Evaluation of an Amino Acid−Based Formula in Infants Not Responding to Extensively Hydrolyzed Protein Formula | NIH
- The efficacy of amino acid-based formulas in relieving the symptoms of cow’s milk allergy: a systematic review | NIH
- Formula Options for Kids with Food Allergies | Kids With Food Allergies
- Amino Acid-Based Formula vs. Extensively Hydrolyzed Formula in the Treatment of Feeding Intolerance in Preterm Infants: Study Protocol for a Randomized Controlled Trial | Frontiers