Signs and Symptoms for Using Amino Acid-Based Formulas for Cow Milk Allergy

When a baby first shows possible signs and symptoms of a cow milk allergy, parents at times wonder, how do doctors approach diagnosing it, and choose the best management option? Let’s review a list of potential indicators healthcare professionals could look for when determining if hypoallergenic amino acid-based formula (AAF) like Neocate should be used for cow milk allergy.

Before we jump into these, let’s quickly review some types of baby formulas that are available. Formulas vary by the type of protein that’s used, and the extent to which protein is broken down. This determines how allergenic a formula is. Some of these formulas are available on store shelves, while others should be used under medical supervision and require a doctor’s recommendation:

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Protein Structures in Formulas Milk/Formula Protein Type Allergic Reaction
Regular formula with whole protein

Cow/Soy milk protein
Cow milk protein
Goat milk protein
Whole Protein
Casein or Whey

Most Allergenic

Least Allergenic

Soy Milk Whole soy Protein & soy isolate
Hydrolyzed Formula

Majority delivered from cow milk protein
Extensivly hydrolyzed Fragments of cow milk protein
Casein hydrolysates
whey hydrolysates
Neocate Amino Acid-Based Formula
Amino-acid based formula
100% non-allergenic free amino acid-based
Amino acid-based formula like Neocate 100% free amino acids

If you’re still curious, read more about the different types of baby formulas.

How does your little one’s doctor know which formula to recommend first? Let’s explore some of the signs and symptoms doctors look for that can indicate it’s time to consider Neocate. An infant with food allergies often shows more than one of these indicators. Sometimes, the more indicators the doctor sees, the more likely they are to recommend Neocate. They also may see some of these as stronger indicators than others to recommend Neocate. Familiarize yourself with these signs and symptoms to help spark conversations with your healthcare team:

Symptoms Not Resolved on an Extensively Hydrolyzed Formula (eHF)

Crying babyHealthcare professionals often refer to medical guidelines for managing food allergies. These recommend that, if food allergy symptoms don’t fully improve on an eHF, an amino acid-based formula like Neocate should be considered. The reason? If a child “fails” on one eHF, they will probably “fail” on other eHFs. (“Failure” means symptoms don’t fully resolve.)

If your child is taking an eHF and you still see possible signs and symptoms of a cow milk allergy, please discuss with your doctor.

Severe Gastrointestinal (GI) Symptoms

Reflux BabyCow milk allergy signs and symptoms often relate to the digestive tract (GI tract). Gastrointestinal tract is the passageway going from the mouth to the anus that allows food digestion. Also called the digestive tract, it is formed by the mouth, esophagus, stomach, small intestine or duodenum, jejunum, ileum, large intestine or colon, rectum and anus.

Some of these signs can be severe, and might indicate the need for an amino acid-based formula like Neocate. Your doctor will decide what signs are severe such as blood in the stool or severe gastroesophageal reflux. Other severe GI symptoms, like vomiting or reflux, may indicate cow milk allergy that’s part of other conditions (FPIES and EoE, respectively).

Failure to Thrive

Failure to Thrive Baby “Failure to thrive” describes a child who is not gaining weight, or growing, at the rate expected. It may also be described as “growth failure” or “faltering growth.” When healthcare teams notice this, they look for possible reasons and ways to address it.

Children whose severe food allergies aren’t under control may have failure to thrive. In fact, it’s been associated with signs and symptoms of food allergies that affect the GI tract and the skin. Because of that, medical guidelines written by and for doctors suggest that choosing an amino acid-based formula, like Neocate, can help address the symptoms. The guidelines also suggest amino acid-based formulas may reduce the risk of failure to thrive in these infants when they don’t tolerate eHFs.

Severe Eczema

Eczema, or atopic dermatitis, is a skin rash. Some patients have both eczema and food allergies. In fact, roughly one third of children with moderate-to-severe eczema also develop food allergies. It can be hard to link worsening eczema to foods because eczema flares can be delayed.

Some medical guidelines recommend that an amino acid-based formula like Neocate should be the first choice for infants with severe eczema. What’s more, this applies particularly to those infants who are failing to thrive. What if a breastfeeding infant has eczema and CMA is suspected? In those cases where formula is needed, an amino acid-based formula like Neocate has been recommended.

Multiple Food Allergies

8 common food allergy typesDid you know that about one third, or 33%, of cow milk allergy patients may develop allergies to other foods? In such cases, these patients have multiple food allergies (MFA). The more foods a child is allergic to, the greater the likelihood that they will fail an eHF. Guidance is that infants with multiple food allergies should be given an amino acid-based formula like Neocate.

Symptoms While Breastfeeding

Breast milk is the preferred nutrition for infants, and Nutricia supports breastfeeding wherever possible. However, breastfed infants can develop cow milk allergy to fragments of milk protein in mom’s breast milk. (The fragments come from the dairy in mom’s diet.) If you are experiencing symptoms while breastfeeding, please consult with your child’s healthcare professional. They can best advise how you can safely continue breastfeeding. They can also advise if a formula like Neocate is needed.


Signs and Symptoms for using amino acid based formulas for cow milk allergyAnaphylaxis reactions to food allergens can be severe and life threatening. The severe form of this reaction to cow milk can occur in anywhere from less-than-1% to up-to-9% of cow milk allergy cases. In patients who have had anaphylaxis to cow milk, guidelines recommend a hypoallergenic amino acid-based formula like Neocate.

My Baby Has One or More of These Signs and Symptoms – What Should I Do?

If you suspect food allergies, ask your child’s doctor for a thorough evaluation. They can assess whether your child is showing signs and symptoms of food allergies. Here is a list of questions you can ask that might be helpful while you wait for a diagnosis.

Once diagnosed, the doctor might recommend Neocate Syneo Infant, the first and only hypoallergenic formula with the benefits of prebiotics and probiotics. Read more about Neocate Syneo Infant and what makes it unique.

If you have an older child who was diagnosed with food allergies, your doctor may recommend Neocate Splash, the first and only hypoallergenic amino acid-based formula that’s ready to drink. Learn more about great-tasting, convenient Neocate Splash.

Have more questions? Ask us in the comments below!

-Rob McCandlish, RDN

Rob McCandlish is a member of the Medical team at Nutricia North America Rob McCandlish is a registered dietitian nutritionist (RDN) who joined Nutricia in 2010. He has spent years talking with Neocate families, working with Neocate products, and learning about the science behind Neocate and food allergy research. And… Rob has two nephews who both used Neocate for their cow milk allergies!


Published: 08/31/2018
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