Hydrolysed formula for babies: what it is and what it's for

Does your baby need hydrolysed formula? There are plenty of occasions when babies don't tolerate regular formula well, for example when your baby has a cow's milk protein allergy, digestive conditions involving poor fat absorption, or serious bowel problems. That is why the companies that make infant formula adapted to babies offer different options of special formula to meet your baby's needs. This is a stage that raises lots of questions, so if you are struggling to find formula for your baby, our midwives have prepared the following post especially for you.

Formula made from protein hydrolysates

This type of special hydrolysed protein formula goes through a pre-digestion process involving enzymatic hydrolysis, heat treatment and ultrafiltration. Its protein source can be the casein in cow's milk, whey protein, or both. Both are usually blended so that the aminogram (a schematic representation of the amino acid composition) is similar to that of breast milk. Depending on the degree of hydrolysis, they can be of two types: hypoallergenic or semi-elemental formulas and hypoantigenic formulas. Start designing your bottle

Hypoallergenic or semi-elemental hydrolysed formulas

Hypoallergenic formula is characterised by a high degree of hydrolysis, which means it is an extensively hydrolysed formula, with 85-100% of the peptides (short chains of amino acids) having a molecular weight below 5,000 daltons (a tenth of the mass of a carbon atom), and in some brands even below 1,500 daltons. This gives it a lower allergenicity, though not zero, which is why it is called hypoallergenic. This is because these peptides can keep epitopes (the part of a macromolecule that is recognised by the immune system) that may trigger allergic reactions to cow's milk proteins. The rest of the composition of hypoallergenic formula, including its macronutrients, vitamins and minerals, is practically the same as that of first infant formula. You should bear in mind, however, that in cases of anaphylaxis (a severe allergic reaction) to cow's milk, this hypoallergenic formula should be given with caution, or it may be advisable to give a soy hydrolysate or elemental diets.

Does hypoallergenic formula contain lactose?

In semi-elemental formulas or hypoallergenic formulas, when it comes to carbohydrates, we should mention that these are not provided in the form of lactose but as dextrin-maltose or glucose polymers. These preparations are lactose-free because in cow's milk protein intolerance the intestinal villi can atrophy, with a drop in intestinal lactase activity. Lipids are provided as MCTs at less than 40% of the total fat provided, and as an oil containing essential fatty acids. Start designing your bottle

Baby poo on hypoallergenic formula

Babies who are fed on special hypoallergenic formula have stools with a characteristic appearance, being more liquid and greenish. This may be explained by the lower intake of long-chain saturated fats and the presence of free amino acids, which cause a drop in neurotensin and a rise in motilin, leading to hyperperistalsis (increased contraction movements of the stomach and bowel) with less water absorption and a higher water content in the stools.

Indications for hypoallergenic formula

Hypoallergenic formula is a type of formula that must be prescribed by the paediatrician, and it is indicated for babies with an allergy to cow's milk proteins, digestive conditions involving poor fat absorption, or serious bowel problems (short bowel syndrome, enteritis caused by radiotherapy or chemotherapy, malabsorption syndromes or severe diarrhoea in infants).

Hypoantigenic hydrolysed formulas

Hypoantigenic formulas are characterised by a low degree of hydrolysis, meaning they are partially hydrolysed formulas. Their composition therefore contains peptides with a high molecular weight (antigenic and allergenic capacity) and they are similar to first infant formulas. As for their carbohydrate and fat content, they follow the recommendations for adapted formulas.

Indications for hypoantigenic formulas

This type of special hypoantigenic formula is indicated for the prevention of cow's milk protein allergy in babies with atopic risk, although indiscriminate use is not recommended, since there are no controlled studies showing its long-term effectiveness. It is also unknown whether they alter hormone secretions, enzyme activities and the absorption of certain nutrients. These formulas are not indicated for therapeutic purposes, as they are not free of residual antigens, so they should not be used in infants with a cow's milk protein allergy, as severe reactions and anaphylaxis have been reported. Start designing your bottle

Elemental or monomeric formulas

You may also be interested in elemental or monomeric formulas. These are synthetic formulas based on L-amino acids, dextrin-maltose, MCT (around 40% of the fats) and long-chain fatty acids to prevent essential fatty acid deficiency. Some brands also offer products with a low calcium and phosphorus content.

This type of elemental formula appears to have a lower degree of allergenicity than protein hydrolysates. What is more, these preparations leave no residue, as they are designed so their components can be absorbed without prior digestion, allowing the bowel to rest and reducing the number and volume of stools.

Indication for the use of elemental or monomeric formula

Its indications are very restricted, because this type of formula has the disadvantage of the high osmolarity it produces (which can cause osmotic diarrhoea and hypernatraemic dehydration) and the lack of long-term studies assessing the absorption of amino acids, vitamins and minerals.

It is therefore limited to those babies in whom other formulas have failed, and to cases of severe malnutrition. States of malabsorption and maldigestion in pancreatic insufficiency and short bowel syndrome; inflammatory bowel disease; diarrhoea that does not respond to the usual treatments; preparation for diagnostic procedures that require emptying the colon; transition from parenteral to enteral nutrition, and cow's milk protein allergy-intolerance that does not respond to the different hydrolysates.

Conclusion: hydrolysed formula for babies

If you are reading this post about “hydrolysed formula for babies”, it is probably because you are either using hydrolysed formula or you can see that your baby does not tolerate milk well. Sometimes babies accept this type of hydrolysed formula very well, while others find it a little harder (the taste is not very pleasant). Use a good bottle, be patient, and remember that this is a stage that passes. Also remember that if you have any questions, don't hesitate: we are here to help you and happy to do so.