- How to choose baby formula - September 4, 2023
- Best amino acid-based formulas 2024 - September 4, 2023
- Best hypoallergenic formulas 2024 - August 30, 2023
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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.
This in-depth, easy to understand guide will give you all the information you need to choose the best hypoallergenic baby formula for your family. Our team spends hundreds of hours every year working with parents and health care professionals to ensure we are creating the most well-researched and helpful content because we know how hard it can be to navigate the baby formula world.
As usual with the baby formula industry, there is a lot of confusion around what a hypoallergenic formula is and when/if a baby might actually need one. So even if you think you already know what it is, we suggest reading the section below before diving into the best hypoallergenic formula recommendations below.
Jump to a specific section
- What is a hypoallergenic baby formula?
- How small is small?
- Best hypoallergenic baby formulas 2024
- Summary of recommendations
- What is cow’s milk protein allergy (CMPA) vs cow’s milk protein intolerance (CMPI) vs lactose intolerance?
- PSA – we’re likely over diagnosing cow’s milk allergies and intolerances
- What are amino-acid (elemental) based formulas?
- What happens if your baby is still not tolerating a hypoallergenic formula?
- Final thoughts on hypoallergenic formulas
- FAQs
What is a hypoallergenic baby formula?
Hypoallergenic (HA) baby formulas, also known as extensively hydrolyzed formulas (EHF), are for babies that have been diagnosed with a cow milk protein allergy. Their little bodies aren’t able to process the larger proteins found in cow’s milk (which are quite a bit bigger than the proteins found in breast milk). The immune system essentially perceives these proteins as a threat and then attacks them.
Luckily, there are a number of formula companies that break down the proteins so small that your baby’s body likely won’t be able to recognize these proteins as any sort of threat. That means any antibodies your baby’s immune system makes, won’t bind to the protein to elicit the allergic reaction. #sciencerules
How small is small?
This is for all you fellow nerds out there. Fully intact cow’s milk proteins can range in size from 14-67 kDa whereas the proteins found in hypoallergenic formulas are 1-3 kDa. That’s a big difference. And lastly, for any babies with a truly severe or metabolic disorder, they would need to go onto an amino acid based formula which means it’s broken down into individual amino-acids.
Now that you know the actual science behind an allergic reaction to cow’s milk proteins, it’s important to note that there is no scientific definition of the term ‘hypoallergenic’ that everyone follows. That means formula companies and other websites that research baby formulas can pretty much define it how they want.
For example, you’ll likely see goat milk, soy milk, and other gentle formulas listed on other websites as a comparison for hypoallergenic formulas. We think this is only making things more confusing for parents because it’s not comparing apples to apples. Those other types of formulas do not go through extensive hydrolysis to break the proteins down enough not to elicit an allergic reaction.
Here at The Baby Swag, we think a hypoallergenic formula is one that has extensively hydrolyzed at least 80% of the proteins. That is why you won’t see any goat, soy, gentle formulas on our list. The protein source and processing is the key when it comes to hypoallergenic.
Our criteria for our best hypoallergenic baby formulas
- Prioritize formulas that most closely mimic the protein, carbohydrate and fat content found in breast milk
- Focus only on powdered formula since it’s the most economical and widely available
- Provide a global view of the formula industry since there are many European and Australian brands now available in the US
- Analyze every formula based on the cost per ounce to make it easy to compare
- Consider each formula brand’s reputation, history and customer experience
As you can see, only the first bullet point above is looking at the actual formula recipe. That’s because choosing a baby formula is not just about the ingredients, it’s about what suits your budget, lifestyle and preferences as a parent as well.
Best hypoallergenic baby formulas 2024
Best overall hypoallergenic formula
HiPP HA German
HiPP cannot claim this to be an organic formula because of the hydrolysis process to make the proteins smaller. However, families appreciate that all other ingredients in HiPP German HA are organic and non-GMO.
HiPP HA has taken out the top spot in our list because it contains only whey proteins (no casein) and they have managed to retain lactose as the primary carb source which we love to see. In addition, HiPP HA also contains natural probiotic lactic acid cultures originally extracted from real breast milk and prebiotics to help strengthen your baby’s intestinal wall and protect against allergens and unwanted bacteria. Lastly, they source their DHA and ARA from fermented algae vs single cell oil extracted from a fungus.
To top it all off, HiPP is actually cheaper than all of the 3 major US brands and you can find it at any of our partners The Milky Box, Organics Best, or My Organic Co.
![HiPP HA [German]](https://thebabyswag.com/wp-content/uploads/2023/08/HiPP-Hypoallergenic.webp)
For 25 years, HiPP HA has been tried and scientifically tested. Each time, this formula has demonstrated success in allergy prevention. Somehow, it’s also the most affordable option on our list. Use code 'babyswag' for 5% off.
Note: HiPP HA is produced in Germany and the Netherlands. They are exactly the same except the size of the product (600g German vs 800g Dutch) and the addition of starch in HiPP German HA Stage 1, which can help satisfy a hungrier baby.
Best affordable hypoallergenic formula
Mama Bear Hypoallergenic
It wasn’t until mid 2021 that parents had a more affordable hypoallergenic formula. Up until then parents only had access to the more expensive version from Europe or from the 3 major US manufacturers (Enfamily, Similac and Gerber). But thankfully, Perrigo, who has been in the formula game for nearly 30 years, released a store brand hypoallergenic formula that has been clinically studied for cow’s milk allergy.
With non-GMO ingredients, no artificial growth hormones plus an added probiotic to help support digestive health and DHA for brain support, this formula provides complete nutrition through 12 months. This formula is also lactose-free.
Fun fact – Mama Bear is considered a ‘store brand’ formula which means you can not only buy it from Amazon under the Mama Bear brand, but you can also find it at Walmart under the Parent’s Choice brand, at Target under the up & up brand and at Walgreens, CVS, Kroger and more. Each retailer sells the same exact formula produced by Perrigo, they just slap a different label on the front of the can. This means you can shop around to find the best deals. Plus these formulas are also eligible for SNAP.
If your baby is ready to switch to a hypoallergenic formula, the price tag can come as another shock. They are typically more expensive formulas due to the extensive hydrolysis process. Luckily, this store brand offering is a bit easier on the budget.
3rd best hypoallergenic formula
Nestle Health Science Extensive HA (formerly known as Gerber Good Start Extensive HA)
If HiPP hasn’t worked for your baby, you may want to try Nestle Extensive HA (rebranded from Gerber Extensive HA). HiPP is about 86% extensively hydrolyzed while this formula is 100%. So for those babies that continue to have a reaction to HiPP, it might not be hydrolyzed enough and this would be our next test before moving to an amino-acid based formula.
Nestle Extensive HA only uses whey proteins, is palm oil free and is the only hypoallergenic formula to feature B. lactis, a probiotic that supports digestive health that’s similar to those found in breastmilk.
For babies that are really struggling, this formula could also help because it is also lactose-free. We would prefer your baby to have lactose which is one reason HiPP HA is on the top of the list, but for babies that have an allergy to cow’s milk proteins, their sensitive little tummies can sometimes do better on a lactose-free formula as well.
From our in-depth research, this formula also seems to be more widely available than the other US brands, especially since the formula shortage of 2022.
The most extensively hydrolyzed formula you can buy before switching to an amino-acid based formula. Also lactose free which can further help little ones that are struggling to tolerate other hypoallergenic formulas.
4th best hypoallergenic formula
Enfamil Nutramigen
Nutramigen is made by Enfamil, one of the large US formula brands. It has been around a long time and is likely going to be one of the formulas your pediatrician will recommend. That doesn’t mean it’s the one you should use though, which is why we’re glad you’re here reading this guide.
Nutramigen offers parents a different recipe than our top 2 best hypoallergenic baby formulas. This recipe is made from only casein proteins rather than whey and is about 93% extensively hydrolyzed. This is good to know because your baby could be allergic to just one of the proteins found in cow’s milk (whey or casein). So if you’ve already tried one of the whey protein formulas above, it might be worth trying this one next.
This formula also contains a probiotic LGG which is a friendly bacteria that is found in your intestines. It is the world’s best documented probiotic strain and has been used in food and dietary supplements since 1990.
One of the benefits of this formula is that it also comes in ready to feed bottles. We have heard from some parents that their baby tolerated the liquid Nutramigen better than the powder form.
Produced by Enfamil, a leader in infant formulas for over 100 years. Trusted by many parents and recommended by many pediatricians, you can’t go wrong with Nutramigen. It’s available at most retailers around the country and is also available in ready to feed bottles.
5th best hypoallergenic formula
Similac Alimentum
Alimentum is manufactured by the other big brand you’ve likely heard of, Similac. They have also been pioneering formula research for well over 100 years. So they know what they’re doing. This will likely be the other formula your pediatrician will mention.
Similar to Nutramigen, Alimentum is also a casein based formula which is critical to know as you experiment with different formulas to try to find one that your baby tolerates the best. This is a lactose-free formula which can be good for sensitive tummies but when a formula has no lactose (the primary carb found in breast milk), they have to replace it with corn syrup and sucrose which we would rather avoid if possible.
Alimentum is the first and only hypoallergenic formula with 2’-FL HMO, a prebiotic found naturally in breast milk. According to Similac “about 80 percent of mothers make 2′-FL in their breast milk. Excluding water, HMOs are the third most abundant ingredient in breast milk after fat and carbohydrates.” We like to see this type of innovation in baby formulas which is why this formula made our list.
One of the benefits of using the big brands like Similac and Enfamil is that they are the only hypoallergenic formulas also available in ready to feed bottles.
Note: this formula is also eligible to be purchased with Supplemental Nutrition Assistance Program (SNAP) benefits in select stores.
Another good option for parents to consider given its brand name recognition, its availability, a ready-to-feed option plus some great ingredients that mimic breast milk that you won’t find in the other formulas on this list.
6th best hypoallergenic formula
Nutricia Pepticate
Nutricia is one of the OGs in the formula game. The company started in the Netherlands in 1898 and has been leading research in various therapeutic food and infant formulas ever since. Their amino-acid based formula, Neocate, has been sold in the US since the 1980’s but their hypoallergenic formula, Pepticate, is only now available starting in 2023. And we’re glad it’s arrived. It adds another option for parents that are having to find the right hypoallergenic formula (where there are already limited options).
They are the most popular hypoallergenic formula in the UK because they offer an extensively-hydrolyzed whey protein plus other key components found in breast milk, including prebiotic oligosaccharides to support infant digestive health and immune system development, nucleotides to help support the immune system, and DHA and ARA to promote brain and eye development.
We also love that they have kept some lactose as a primary carbohydrate as it’s closer to breast milk and will likely make the formula taste better.
The UKs most popular hypoallergenic formula is now available across the US. And we’re glad it’s here. This is a whey based protein formula that has lactose and prebiotics. That’s a great combo to look for in a hypoallergenic formula.
Summary of recommendations
This list was a bit easier to create than our best overall baby formulas, best goat milk formulas, best gentle formulas because these are basically the only options available. With limited choice plus the extensive hydrolysis these formulas go through, we put extra weight on the formulas that tried to continue mimicking breast milk as much as possible.
What is cow’s milk protein allergy (CMPA) vs cow’s milk protein intolerance (CMPI) vs lactose intolerance?
We get questions from parents all the time about what the difference is between an allergy and an intolerance. So let’s break it down.
The symptoms are very similar across these different diagnoses, so it can be really hard to spot the difference. You have to go down to the molecular level before you can distinguish between the three…
- Cow’s milk protein allergy (CMPA) is when your baby’s immune system has been triggered to create antibodies to protect itself from either the whey and/or casein proteins found in cow’s milk. The immune system perceives these proteins as a threat and therefore kicks into gear to protect your baby.
- Cow’s milk protein intolerance (CMPI) is when your baby’s immune system reacts unusually to the protein found in cow’s milk but does not create antibodies. This means that symptoms are typically less severe than an allergic reaction.
- Lactose intolerance is something completely different. This is when your baby’s body is having issues digesting lactose, the primary sugar (which is a carbohydrate, not a protein) that is generally found in most routine formulas. Lactose intolerance is very rare in babies.
As you can see in the image below, the proteins are broken down further in each category of baby formula. This results in a lower ‘allergenicity’ which refers to the ability of an antigen to induce an abnormal immune response.
We’re telling you this because these terms are sometimes used interchangeably, but the diagnosis and treatment for each can differ.
- If you have already confirmed with your doctor that your baby either has an allergy you’re in the right place.
- If you and your doctor have made the decision to start an elimination diet to confirm an allergy, then you’re in the right place.
- If you have not yet started the process of diagnosing an allergy with your doctor, we would recommend having that conversation with them asap if you’re worried. There are lots of things to observe and to test before switching to a hypoallergenic formula. We suggest reading our guide on how to choose the best formula for your family or our guide to the best gentle baby formulas instead.
PSA – we’re likely over diagnosing cow’s milk allergies and intolerances
A 2022 study by the Department of Pediatrics at the University of Rochester School of Medicine found that 26.6% of formula sold in the United States is partially hydrolyzed and 5.5% is hypoallergenic, while 59% of all formula was lactose reduced. This is despite the numbers above referring to the small % of babies that actually medically need these types of formulas.
The researchers note “the proportion of hypoallergenic formula purchased significantly exceeded the prevalence of cow’s milk protein allergy and increased over the 3-year study period from 4.9% to 7.6% of all formula sold.” Which means that pediatricians might not be providing the best advice to parents and US infants are exposed to unnecessarily high levels of non-lactose carbohydrates and hypoallergenic formula.
Not only is the health risk but it’s also a massive financial and mental burden on the parents to support a baby that needs one of these speciality formulas.
This is really disheartening to see because this essentially means we’re replacing a lot of the good, natural ingredients in cow’s milk, with less healthy substitutes (like sucrose, corn syrups, etc.) and marketing them to vulnerable parents.
The reason we’re telling you this is that you should really only be considering these formulas below if you’ve worked with your pediatrician and received a positive allergy test results with an allergist or immunologist.
If you have not received a positive test result, you would likely be better off speaking with your doctor about a partially hydrolyzed formula or other gentle formula blends.
What are amino-acid (elemental) based formulas?
While researching you may have also come across amino acid-based formulas, also known as elemental formulas. These formulas don’t include whole protein molecules at all. They are broken down into the single amino acids, which are the building blocks of protein. Amino acid based formulas are put through rigorous clinical testing and proven to be completely hypoallergenic.
You should only move to this type of formula after trying one or more of the above unless your doctor has given you other instructions.
What happens if your baby is still not tolerating a hypoallergenic formula?
First of all, we’re so sorry that you’re having to watch your little one struggle to be comfortable. We know that must be incredibly hard. You’ll likely need to explore what are called ‘elemental’ or amino-acid based formulas. Not to worry, we’ve done all the research for you.
Final thoughts on hypoallergenic formulas
This is a lot of information to consume but we hope you’ve learned a few things or gotten the last bit of information you needed to make a final decision on which is the best hypoallergenic formula for your family.
Feel free to contact us or leave a comment below if we can help in any way. And best of luck on your feeding journey!
FAQs
Why do hypoallergenic formulas smell and taste so bad?
Formulas that are extensively hydrolyzed break up the larger intact proteins into super small, ‘pre-digested’ proteins which make them easier to digest. The actual manufacturing process is quite intense to do this and when the proteins are breaking down, they release these somewhat volatile compounds that have a bad odor and funky taste.
What can I do if my baby isn’t accepting a hypoallergenic formula?
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.
What is causing my baby’s protein intolerance?
It could be either the whey or the casein protein found in formulas that are causing your baby to have a reaction. The best way to start to identify which one it is, is to test out different formulas that are more heavily whey or casein and closely observe how your baby tolerates each one. Chat with your pediatrician to get some advice on how to do this and what to look out for.
Should I go with a whey or casein hypoallergenic formula?
Because the proteins are chopped up so small, it is generally not believed to make much of a difference. That being said, there is not extensive research here that we could find. Our advice is to start with one and if it’s not working, that might be one thing you could alter if you end up trying a different one. We tend to prefer whey based proteins simply because there is more whey than casein in breast milk.
Can I use a goat milk formula if my baby is allergic to cow’s milk?
This is something you should consult your pediatrician on before trialing. It’s likely that your baby will react to goat’s milk formulas as well but we have heard stories from other parents that their baby was able to tolerate a goat milk formula well.
Will my insurance cover hypoallergenic formulas?
Insurance companies may cover the cost of hypoallergenic formula if it is deemed medically necessary, either by reimbursing you what you’ve spent on it, or if you get it as a prescription through your pediatrician. Many doctors don’t know this, so they likely won’t give you a prescription for it unless you ask for one.
We’ve heard from parents that have had to have their doctor provide 1) a signed letter stating the condition it’s needed for, 2) a copy of the diagnosis in the baby’s chart, and 3) a copy of the prescription.
There is a website dedicated to helping with this. We cannot vouch for their services as none of our team have used them but it might be worth using if you need some help.
https://insurancecoveredbabyformula.com/covered-formulas/hypoallergenic-formula/
Related guides
- How to choose baby formula
- Best baby formulas
- Best gentle baby formulas
- Best amino acid-based formulas
- Best goat milk baby formulas
- Best organic European baby formulas
- Best baby formula alternatives
- Where to buy baby formula & how to save
Things you should know
*Mama Bear formulas are not associated with Abbot Laboratories or Mead Johnson, the manufacturers of Similac and Enfamil formulas, respectively. Mama Bear formulas, manufactured by Perrigo, do not contain the identical proprietary ingredient blend ingredients found in Similac or Enfamil formulas.
Any product prices are accurate as of publication and are subject to change.
We do not take any liability for the products or services we recommend. Please ensure you consult with your medical professional and look at your countries safety guidelines.
- Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial | NIH
- Lactobacillus reuteri (American Type Culture Collection Strain 55730) versus simethicone in the treatment of infantile colic: a prospective randomized study | NIH
- Lactobacillus reuteri DSM 17938 for the management of infantile colic in breastfed infants: a randomized, double-blind, placebo-controlled trial | NIH
- Partially hydrolyzed cow’s milk formula has a therapeutic effect on the infants with mild to moderate atopic dermatitis: a randomized, double-blind study | NIH
- The Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Hydrolyzed Formulas, and Timing of Introduction of Allergenic Complementary Foods | NIH
- Dietary intervention in infancy and later signs of beta-cell autoimmunity | NIH
- Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants | NIH
- Should partially hydrolyzed infant formula be given to the general infant population for the primary prevention of allergic disease? | NIH
- Assessment of Evidence About Common Infant Symptoms and Cow’s Milk Allergy | NIH
- Formula choices in infants with cow’s milk allergy | NIH
- Pediatric Cow’s Milk Protein Intolerance | Children’s National
- Evaluation of an Amino Acid−Based Formula in Infants Not Responding to Extensively Hydrolyzed Protein Formula | NIH
- Controversies on special products for managing cow’s milk protein allergy in infants: safety and suitability | EAACI
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