Specially Tailored support for a range of feeding issues - Practical guidance INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY - SMA HCP
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INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY
BREASTFEEDING IS BEST FOR BABIES
SCIENCE INSPIRED BY NATURE
Specially Tailored support for
a range of feeding issues
Practical guidance
BREASTFEEDING IS BEST FOR BABIES INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY
START HERE
Is the baby full term?
YES NO
Is there a family history of allergy? Is the preterm baby receiving breast milk exclusively?
YES NO YES NO
PAGE 32
Does the baby have special nutritional needs?
SMA H.A.®
NO YES
Infant Milk
From birth
SMA® SMA SMA SMA
Breast Milk Gold Prem® 1 Gold Prem® 2 Gold Prem® 2
Fortifier Low Birthweight Post Discharge Post Discharge
From birth Formula Formula Formula
In hospital From birth 90 ml in hospital, For use at home
In hospital 200 ml for use Prescribable
at home (UK only)
SMA® ADVANCED SMA® PRO Range SMA® Organic Range Prescribable
LITTLE STEPS® Range
Range First, Follow-on First, Follow-on & First, Follow-on & (UK only)
First, Follow-on &
& Growing Up Milks Growing Up Milks Growing Up Milks Growing Up Milks
From birth, 6 months From birth, 6 months & From birth, 6 months &
& 12 months 12 months 12 months
From birth, 6 months &
12 months
FOR MEDICALLY DIAGNOSED SPECIAL NUTRITIONAL NEEDS
For babies with For babies with For babies For cows’ milk
high energy significant intolerant to intolerant
For babies with For hungrier needs reflux lactose/sucrose babies
mild digestive babies
discomfort
PAGE 24
PAGE 28
PAGE 14
PAGE 20
SMA SMA® SMA LF® SMA® Wysoy®
High Energy ® Anti-Reflux Lactose Free Soya Infant
SMA ®
SMA Extra
®
From birth From birth From birth Formula
Comfort Hungry Prescribable Prescribable Prescribable From birth
Easy to Digest Infant Milk (UK & ROI) (UK only) (UK & ROI) Prescribable
Infant Milk From birth (UK & ROI)
From birth
This chart is intended for bottle-fed babies, as a guide only and is not a diagnostic tool.
2 | SMA® Specials Range SMA® Specials Range | 3
BREASTFEEDING IS BEST FOR BABIES INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY
The aim of this booklet is to describe Contents
some of the common feeding issues Feeding issues and protein intake
experienced by infants, and to help Understanding feeding issues..........................................................................
Importance of partially hydrolysed protein........................................................
6
8
you reassure parents by offering Role of whey dominance................................................................................. 9
practical guidance. Reflux and regurgitation
What is reflux and regurgitation?..................................................................... 10
Starch thickener + NICE guidelines.................................................................. 12
SMA® Anti-Reflux........................................................................................... 14
The advice contained within this booklet Comparison chart..........................................................................................
Preparation: instructions and comparison..........................................................
15
16
is based upon the latest guidance from Mild digestive discomfort
NICE and the Department of Health, Signs and symptoms.......................................................................................
Diagnosis criteria...........................................................................................
18
19
where appropriate. SMA® Comfort Easy to Digest Infant Milk..........................................................
Comparison chart..........................................................................................
20
21
Lactose intolerance
What is lactose intolerance?........................................................................... 22
Types of lactose intolerance............................................................................ 23
SMA LF ® Lactose Free Infant Milk..................................................................... 24
Comparison chart.......................................................................................... 25
Cows’ milk allergy or intolerance
Allergy vs intolerance?................................................................................... 26
Soya as a protein alternative........................................................................... 27
SMA® Wysoy® Soya Infant Formula.................................................................. 28
Allergy in infants
Family history................................................................................................ 30
Supporting infants at risk of allergy.................................................................. 31
SMA H.A.® Infant Milk.................................................................................... 32
NICE: National Institute for Health and Care Excellence. What do the guidelines say?........................................................................... 33
4 | SMA® Specials Range SMA® Specials Range | 5
Feeding Issues
BREASTFEEDING IS BEST FOR BABIES INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY
Feeding issues are a common Infant feeding issues are very common
part of life for young infants1 This is due to a baby’s digestive system still being immature
when born.
Research shows that Functional gastrointestinal disorders (FGIDs)
occur in up to 55% of all infants in the first 6 months of life.1 • FGIDs include a number of symptoms that affect the
gastrointestinal tract in otherwise healthy infants3
INFANTS WHO HAVE FEEDING ISSUES • These symptoms are often frequent, age dependent,
and related to the ongoing physiological development
of the gut that occurs naturally after birth
• Although they usually resolve as the infant matures,
they can cause considerable distress and anxiety
for the parents as well as the infant
• As well as FGIDs, feeding issues also encompass lactose
OVER HALF intolerance and cows’ milk protein allergy (CMPA),
both of which have a defined organic cause
THE MOST COMMON FGIDs ARE:2
• The prevalence of lactose intolerance varies according to
30% REFLUX & REGURGITATION
cause and ethnicity.4 CMPA affects between 1.8%-7.5% of
20% COLIC infants in the first year of life.5
15% CONSTIPATION
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BREASTFEEDING IS BEST FOR BABIES INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY
What is partially hydrolysed protein Partially hydrolysed, 100% whey
and why is it important? protein encourages easy digestion
Infants who have a FGID may benefit from partially hydrolysed protein in a formula. Breast milk contains partially hydrolysed proteins for easier digestion and
absorption.7 Partially hydrolysed formulas have been shown to accelerate
Partially hydrolysed means the protein is broken up into smaller pieces that are gastric emptying, making the formula easy for infants to digest.8
easier for the infant to digest.
40
39%*
% remaining in stomach
Plasmin 35
30
Big protein molecule Hydrolysis Small, more easily digested peptides
25 26%
• Breast milk contains enzymes that hydrolyse proteins6
• Gastrointestinal symptoms such as constipation, fussiness, colic or spitting 20
Breast Milk
18%
up are very common at an early age1
16% 100% whey, partially hydrolysed formula
15
• Some trials have demonstrated the efficacy of partially hydrolysed formula Intact whey-predominant formula
in the community when CMPA was not considered to be the cause Intact casein-predominant formula
0
of the infant’s colic symptom2
Type of milk
Partially hydrolysed formula may offer some advantage over After 120 minutes only 16% of 100% whey, partially hydrolysed formula
intact protein in the dietary management of common functional remains in the stomach compared with 26% of intact whey-predominant formula
gastrointestinal symptoms.2 and 39% of intact casein-predominant formula.8
Both the UK and Ireland Department of Health recognise
that whey protein is easier to digest.9,10
FGID: Functional gastrointestinal disorder. * p
BREASTFEEDING IS BEST FOR BABIES INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY
What is infant reflux and regurgitation? The importance of whey protein
Gastro-oesophageal reflux (GOR) is an involuntary passage of gastric contents
from the stomach into the oesophagus. Reflux is a normal physiological process
for infants with feeding issues
in otherwise healthy infants and is a common FGID in an infant’s first year.11 Breast milk is whey-dominant during the first 6 months of life.7
regurgitation
Reflux and
• When reflux is high enough to be seen, it is known
as regurgitation2,3
WHEY-BASED INFANT FORMULAS:
• Regurgitation or reflux occur daily in about 50%
of infants under 3 months of age2 • Are more easily digested than those which are
casein-based7
• This is primarily due to the functional immaturity
• Contain an adequate supply of essential amino acids
of the stomach inlet11
and higher protein quality, closer to that of breast milk12
In some cases, reflux may lead to complications and/or troublesome symptoms,
which require further medical investigation and treatment – this is when gastro-
oesophageal reflux disease (GORD) occurs.2,11 Rate of gastric emptying after 120 minutes, according to the
type of milk8
40
39%*
Lower Oesophagus
% remaining in stomach
35
oesophageal
spincter (valve)
30
Duodenum 25
Stomach
20
Pyloric 16%
15
spincter (valve) 100% whey, partially hydrolysed formula
0 Intact casein-predominant formula
Type of milk
FGID: Functional gastrointestinal disorder. * p
BREASTFEEDING IS BEST FOR BABIES INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY
The effect of a starch thickener What the NICE guidelines say
on symptoms of reflux In 2015, NICE recommended the following measures for managing formula-fed
infants with frequent regurgitation associated with marked distress:11
Starch thickener reduces the frequency of regurgitation in infants.13
• Offer parental reassurance
• Starch is an appropriate thickener for infants with reflux and
regurgitation, as it is digestible by the infant • Review feeding history, suggest smaller, more frequent feeds
(while maintaining appropriate daily milk volume intakes)
• Starch-thickened formulas have shown efficacy in reducing
the number of daily regurgitation episodes13 • Trial of a thickened formula
If a thickened formula does not work, stop the thickened formula and offer
alginate therapy for a trial period of 1–2 weeks.
NICE Guideline on gastro-oesophageal reflux11
• Regurgitation of foods is a normal and common occurrence in infants
• Does not usually require investigation
• Reassure and advise parents and carers
• Look out for ‘red flags’ that may indicate a need to refer, e.g. blood in stool, fever
• In formula-fed infants with frequent regurgitation associated with marked
distress, use a stepped-care approach:
– Review feeding history
–R educe food volumes only if excessive for the infant’s weight
– T rial of smaller, more frequent feeds (while maintaining appropriate total
daily amount of milk)
– T rial of thickened formula
– If above is unsuccessful, stop the thickened formula and offer alginate
therapy for a trial period of 1–2 weeks
NICE: National Institute for Health and Care Excellence.
12 | SMA® Specials Range SMA® Specials Range | 13
BREASTFEEDING IS BEST FOR BABIES INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY
SMA® Anti-Reflux How does SMA® Anti-Reflux compare?
SMA® Aptamil Cow & Gate HiPP Enfamil A.R.
REDUCES FREQUENCY Anti-Reflux14 Anti-Reflux 15 Anti-Reflux16 Anti-Reflux 17 (‘Anti-Reflux’)18
OF REGURGITATION13
Starch-thickened formulas Whey:casein 100:0 40:60 40:60 60:40 NS
have shown efficacy in
reducing the number Partially
Type of protein Intact Intact Intact Intact
of daily regurgitation hydrolysed
episodes13
Protein content
1.3 1.3 1.3 1.4 1.72
(g/100 ml)
Carob bean
THICKENED FORMULA Type of thickener Potato starch Carob bean gum Carob bean gum Rice starch
gum
2015 NICE guidelines
recommend trial of a Vegetarian
thickened formula in
formula-fed infants with
Halal
GOR11
SPECIALLY TAILORED
Unique combination of
easily digestible starch
and 100% whey, partially
hydrolysed protein, to
help manage reflux and
regurgitation13-14.
GOR: Gastro-oesophageal reflux.
NICE: National Institute for Health and Care Excellence. NS: Not stated.
14 | SMA® Specials Range SMA® Specials Range | 15
BREASTFEEDING IS BEST FOR BABIES INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY
SMA® Anti-Reflux is easy to prepare Comparison of AR formulas*
1 Ptheulllid.theLiftsafetythe seal
SMA® Aptamil Cow & Gate HiPP
and open the lid. The scoop is provided under Anti-Reflux14 Anti-Reflux15 Anti-Reflux16 Anti-Reflux17
tab, pull on the foil seal, carefully and safely Step 1 Wash hands and sterilise all utensils according to the manufacturer’s instructions.
remove the seal and dispose of it. Boil 1 litre of freshly run water. Do not use artificially softened or repeatedly boiled water.
Allow to cool for no more Leave kettle to cool for Measure the required amount Leave to cool for no longer
Step 2 than 30 minutes. no longer than 45 mins. of boiled water into a large than 30 minutes.
2 Wtoashmanufacturer’s
Measure the required amount sterilised bottle. Seal bottle
hands well. Wash and sterilise all utensils according of water into a sterilised and allow to cool for
bottle. Be careful of scalding. 45 minutes.
instructions.
Place the sterilised teat Using the scoop provided Using the scoop provided, Measure the required amount
and cap on the bottle. Cool level off the powder with the level the powder with the of water into a sterilised bottle,
bottle under cold running built in leveller. Do not press/ built-in leveller. Do not following the feeding guide
water or in a bowl or jug of heap the powder. press/heap the powder. on the pack. Using the scoop
3 BMeasure
cold water until lukewarm, provided, add the correct
oil 1 litre of tap water. Allow to cool for no more than 30 minutes. Step 3
do not immerse the teat. number of scoops of powder
– one level scoop of powder
the required amount of water (see feeding guide) into a for each fluid ounce of water
(approx. 30 ml). Level off
sterilised bottle, carefully – the water is hot. Do not use artificially the powder with the back of
softened or repeatedly boiled water. a clean dry knife, but don’t
press the powder down into
the scoop.
4 Pcoldlacerunning
Using only the scoop Add one scoop per Add one scoop to every Place the sterilised teat and
the sterilised teat and cap on the bottle. Cool bottle under provided, add the correct 30ml (1 fl oz) of boiled and 30ml (1 fl oz) of boiled cap on the bottle and shake
number of scoops of powder cooled water. Add the correct cooled water. Add the correct well until all the powder
water or in a bowl or jug of cold water until (see feeding guide), levelling number of scoops to the water. number of scoops to the water. has dissolved (approx.
off each scoop with the back Adding too many or too few Adding too many or too few 15 seconds).
lukewarm, do not immerse the teat. of a clean, dry knife. Store scoops can be harmful. scoops can be harmful.
the scoop in suspension inside Place the sterilised teat and Replace seal on bottle and
the can and replace lid.
5 Uofsingpowder
cap on the bottle. roll the bottle upright between
Step 4
only the scoop provided, add the correct number of scoops Hold the bottle horizontally the palms of hands – roll it
strongly for 5 seconds.
and shake from left to right
(see feeding guide), levelling off each scoop with the for 10 seconds, then hold it The time between adding the
scoops and rolling the bottle
back of a clean, dry knife. Store the scoop in suspension inside vertically and shake from top
to bottom for 10 seconds. The should be as short as possible.
the can and replace lid. time between adding the
scoops and shaking the bottle
should be as short as possible.
6 Sbyhakeshaking
bottle well until powder has fully dissolved. Test temperature Shake bottle well
until powder has
Leave the bottle to stand for
5 minutes to allow it to
Shake the bottle for
20 seconds and then
Cool the milk to drinking
temperature (approx 37°C)
a few drops on to the inside of your wrist – milk should fully dissolved. thicken. Turn the bottle leave to stand for 7 minutes by holding the bottle under
be lukewarm. Test temperature by upside down just before
feeding. Check temperature
to allow it to thicken. Turn
the bottle upside down just
cold running water. ALWAYS
test the temperature of
shaking a few drops
Step 5 on to the inside of your of feed. Feed immediately. before feeding and test the the milk before feeding by
temperature on your wrist. dripping a bit onto the inside
Reconstitute SMA® Anti-Reflux as per pack instructions for wrist – milk should
be lukewarm. of your wrist; the milk should
feel warm, not hot.
baby’s age and shake bottle. SMA Anti-Reflux should
usually not thicken after
it has been prepared.**
* The preparation instructions have been taken from label and website information (accessed February 2020).
Thicker formula, may require a fast flow teat. SMA Anti-Reflux, because of use of potato starch, usually thickens when the powder is dissolved in water.
** If prepared according to preparation instructions, it should not thicken after the bottle has been prepared.
16 | SMA® Specials Range SMA® Specials Range | 17
BREASTFEEDING IS BEST FOR BABIES INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY
Mild digestive disorders are common Rome IV diagnostic criteria3
in an infant’s first weeks or months • About 20% of infants are reported by caregivers to have the
prolonged periods of crying known as colic20
• At this time an infant’s digestive system is still developing
• The prevalence of constipation in the first year of life is 2.9%3
• Mild digestive disorders can present as colic-like symptoms,
constipation, wind or crying after a feed
Diagnostic criteria for Diagnostic criteria for
• Tummy troubles can be difficult for both infant
infant colic3 functional constipation3
and parents/caregivers
Mild digestive
For clinical purposes, must include all Must include 1 month of at least two of
discomfort
of the following: the following in infants up to 4 years of age:
• An infant who isBREASTFEEDING IS BEST FOR BABIES INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY
SMA® Comfort Easy to Digest How does SMA® Comfort compare?
Infant Milk
SMA® Comfort Aptamil Cow & Gate HiPP
Easy to Digest22 Comfort 23 Comfort 24 Comfort 25
EASY TO DIGEST Whey:casein 100:0 100:0 100:0 100:0
Contains partially hydrolysed,
100% whey protein which is Partially Partially Partially Partially
Type of protein
easier to digest than intact protein hydrolysed hydrolysed hydrolysed hydrolysed
molecules8.
Protein content
1.6 1.5 1.5 1.25
(g/100 ml)
NUTRITIONALLY COMPLETE
Contains all essential nutrients to No added thickener
support babies’ nutritional needs.
Lactose (g/100 ml) 3.9 2.7 2.7 2.7
SPECIALLY TAILORED
Contains an SN-2-enriched fat Contains SN-2
blend20 and reduced lactose
to help manage mild digestive
discomfort21. Vegetarian
Halal
20 | SMA® Specials Range SMA® Specials Range | 21BREASTFEEDING IS BEST FOR BABIES INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY
What is lactose intolerance? Types of lactose intolerance
In infants who are unable to metabolise lactose, undigested lactose stays in the Primary lactose intolerance is the most common cause of lactose intolerance
intestine, where it can cause diarrhoea, abdominal distension, nausea, bloating worldwide with prevalence related to ethnicity.4
and wind:4,26
Secondary lactose intolerance is common but a temporary cause of diarrhoea.4
• These symptoms can be distressing for both infant and
• Secondary lactose intolerance often occurs because
parents/caregivers
of damage to the intestinal brush border – the site of
• Infants fed lactose-free formulas have shown comparable lactase production
growth and key nutrient absorption to those fed formula
• Secondary lactose intolerance may also develop in
containing lactose27,28
some children with gut-related symptoms associated
• Studies have also shown that infants with diarrhoea fed with non-IgE-mediated CMPA, which resolves following
a lactose-free formula recovered in significantly less time exclusion of cows’ milk protein
than those fed a formula containing lactose29-31
• Temporary lactose intolerance is due to immaturity of the
Normal Lactose Digestion Lactose intolerant small intestine
• Usually improves as affected babies get older and their gut
intolerance
fully develops
Lactose
Lactose Small Lactose
intestine
Congenital lactose intolerance is a rare condition where newborn babies produce
very little or no lactase as a result of an inherited genetic fault that runs in families.
No/Insufficient Water
Lactase
Developmental lactose intolerance can be a problem with preterm babies born
Lactase
before the 34th week.4
Bacteria ferment
Glucose
Large
Galactose intestine
Irritation
caused
Acids and gases
22 | SMA® Specials Range SMA® Specials Range | 23BREASTFEEDING IS BEST FOR BABIES INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY
SMA LF® Lactose Free Infant milk How does SMA LF® Lactose Free Infant
milk compare?
SMA LF® Aptamil Enfamil
MANAGES SYMPTOMS OF Lactose Free 33 Lactose Free 34 O-Lac 35
LACTOSE INTOLERANCE
For use in conditions
where dietary lactose is Whey:casein 60:40 0:100 20:80
contraindicated32
Lactose content
(g/100 ml)BREASTFEEDING IS BEST FOR BABIES INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY
What’s the difference between cows’ Protein is vital for infants’ growth
milk allergy and lactose intolerance? When infants are intolerant to cows’ milk protein,
In some infants, cows’ milk can cause the following problems (both of which have
an alternative must be found.
a defined organic cause but are otherwise unrelated): Under 6 months
To ensure infants receive adequate protein, it is acknowledged that there is
• Cows’ milk protein allergy (CMPA) a clinical need for soya formulas for infants under 6 months in the following:36,37
• Lactose intolerance • Infants with CMPA or intolerance who refuse extensively
There is often confusion between an allergy and an intolerance, both of which hydrolysed or elemental formulas
can affect breast- and formula-fed infants.
• Infants whose parents want to offer a vegan diet.
A food allergy occurs when the immune system reacts to a usually harmless food Vegan parents/caregivers who are unable to breastfeed
protein. This immune response leads to the release of substances, such as histamine,
resulting in allergic symptoms, such as gut, skin and respiratory symptoms: or choose not to do so
• A common food allergy is CMPA which affects approximately • Infants with galactosaemia, galactokinase deficiency
1.8%-7.5% of infants in the first year of life and lactose or sucrose intolerance
Contrastingly, a food intolerance does not involve the immune system, and may be From 6 months
enzymatic or pharmacological: • The BDA and FSAI state that soya infant milk may be used
for babies from 6 months with CMPA and/or lactose
• Lactose intolerance is one example of an enzymatic food
intolerance when soya is being used/considered
intolerance that occurs in infants causing gastrointestinal
for the weaning diet36-37
symptoms such as diarrhoea and bloating
intolerance
Cows’ milk
* Child has been shown to have no soya allergy.
BDA: British Dietetic Association.
FSAI: Food Safety Authority of Ireland.
26 | SMA® Specials Range SMA® Specials Range | 27BREASTFEEDING IS BEST FOR BABIES INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY
SMA® Wysoy® Soya Infant Formula SMA® Wysoy® Suitability
The only soya-based infant
formula in the UK and Ireland.*
Suitable for:
SMA® Wysoy® Soya Infant Formula
is a nutritionally complete, soya protein-based
A nutritionally
infant formula that is suitable from birth onwards.
complete formula.38 It can be used as the sole source of nutrition for infants
up to 6 months of age and used as the milk part of
a mixed weaning diet. SMA® Wysoy® is lactose free,
cows’ milk free and is suitable for vegetarians.
Suitable for vegetarians.
It is prescribable for milk protein intolerance,
lactose and sucrose intolerance, galactosaemia
and galactokinase deficiency.
Not suitable for:
1. Soya protein intolerance/allergy.
2. The inborn error of metabolism; phenylketonuria.
For suitability in vegan diets,
please contact our SMA Careline.
*As of July 2015.
28 | SMA® Specials Range SMA® Specials Range | 29BREASTFEEDING IS BEST FOR BABIES INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY
Supporting infants at risk of allergy Supporting infants at risk of allergy
• SMA H.A.® Infant Milk uses a unique two step process to reduce
the level of allergenicity in the protein: a heat treatment and a two
stage enzymatic hydrolysis (a process which imitates natural digestion)
One in three babies has
a family history of allergy39
2. Specific
1. Heat
enzymatic
treatment
• Allergies are increasing – with a three-fold increase hydrolysis
in the prevalence of atopic eczema over 15 years40
Whole protein Unfolds the protein Cuts the protein
• 60–80% of babies with two parents with allergy will
develop allergies41
• Supporting infants at risk of allergy – if exclusive breastfeeding
is not possible, formulas that have been clinically proven to • This unique process cuts the proteins in exactly the right place to reduce
allergenicity while retaining some larger protein strands to help train
reduce the risk of allergy are recommended41
the immune system42
Family history
of allergy
30 | SMA® Specials Range SMA® Specials Range | 31BREASTFEEDING IS BEST FOR BABIES INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY
SMA H.A.® Infant Milk Supporting infants at risk of allergy
SMA H.A.® is an infant milk clinically proven to reduce the risk of developing What do the guidelines say?
eczema in infants with a family history of allergy.43
EAACI Food Allergy and Anaphylaxis Guidelines (2014)41
In SMA H.A.®, cows’ milk “If breastfeeding is insufficient or not possible for the first 4 months, infants at high
proteins have been broken risk can be recommended a hypoallergenic formula with documented preventive
up into smaller pieces, effect for the first 4 months of life”
which reduces the risk
of infants developing
an allergic response.
ESPGHAN (2014)44
“In high-risk infants, when breast-feeding is not possible, hydrolysates of documented
Partially hydrolysed whey
safety and efficacy have an indication in infant feeding up to the age 4 to 6 months.”
protein formula containing
1.3 g protein per 100 ml.
SMA H.A.® Infant Milk reduces
the risk of developing eczema
by over 50% in the first year
of life;43 it is easy to digest
and available on the Healthy
Start scheme (UK only).
Important:
• SMA H.A.® Infant Milk should NOT be used if a baby
has already been diagnosed with allergy to cows’ milk
protein or is suspected of already having an allergy to
cows’ milk protein
• Use from first formula feed
32 | SMA® Specials Range SMA® Specials Range | 33BREASTFEEDING IS BEST FOR BABIES INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY
References: 1. Iacono G et al. Dig Liv Dis 2005; 37(6): 432–438. 2. Vandenplas Y et al. JPGN 2015 (61); 5: 531–537. 3. Benninga M et al. Gastroenterology 2016; IMPORTANT NOTICE: The World Health Organisation (WHO) has recommended that pregnant women and new mothers be informed on the benefits
150: 1443–1455. 4. Heyman MB. Pediatrics 2006; 118(3): 1279–1286. 5. NICE (2019). Clinical Knowledge Summaries: Cows’ milk protein allergy in children. Available and superiority of breastfeeding – in particular the fact that it provides the best nutrition and protection from illness for babies. Mothers should be given
at https://cks.nice.org.uk/cows-milk-protein-allergy-in-children#!topicsummary (accessed February 2020). 6. Armaforte E et al. International Dairy Journal 2010; guidance on the preparation for, and maintenance of, lactation, with special emphasis on the importance of a well-balanced diet both during pregnancy
20: 715–723. 7. Martin CR et al. Nutrients 2016; 8(5): 279. 8. Billeaud C et al. Eur J Clin Nutr 1990; 44: 577–583. 9. NHS (2019). Types of formula milk. Available and after delivery. Unnecessary introduction of partial bottle-feeding or other foods and drinks should be discouraged since it will have a negative effect
at https://www.nhs.uk/conditions/pregnancy-and-baby/types-of-infant-formula/ (accessed February 2020). 10. DoH (2006) https://www.hse.ie/eng/services/ on breastfeeding. Similarly, mothers should be warned of the difficulty of reversing a decision not to breast-feed. Before advising a mother to use an
publications/children/unit-7-food-and-nutrition.pdf (accessed February 2020). 11. NICE (2015). Gastro-oesophageal reflux disease in children and young people. infant formula, she should be advised of the social and financial implications of her decision: for example, if a baby is exclusively bottle-fed, more than
Available at https://www.nice.org.uk/guidance/ng1 (accessed February 2020). 12. Sidnell A et al. British Nutrition Foundation Nutrition Bulletin 2009; 34: 395–400. one can (400 g) per week will be needed, so the family circumstances and costs should be kept in mind. Mothers should be reminded that breast milk
13. Indrio F, et al. Effect of a Partially Hydrolysed Whey Infant Formula Supplemented with Starch and Lactobacillus reuteri DSM 17938 on Regurgitation and Gastric is not only the best, but also the most economical food for babies. If a decision to use an infant formula is taken, it is important to give instructions on
Motility. Nutrients 2017, 9, 1181. 14. SMA® Anti-Reflux data card. Available at https://www.smahcp.co.uk/formula-milk/anti-reflux-formula (accessed February correct preparation methods, emphasising that unboiled water, unsterilised bottles or incorrect dilution can all lead to illness. SMA® Wysoy® milk-free
2020). 15. Aptamil Anti-Reflux datacard (June 2018). Available at https://eln.nutricia.co.uk/range/specialist-milks/ (accessed February 2020). 16. Cow & Gate formula is intended to meet the nutritional needs of babies and children who are intolerant to cows’ milk protein, lactose or sucrose. Soya infant formulae
Anti-reflux datacard. Available at https://eln.nutricia.co.uk/range/specialist-milks/ (accessed February 2020). 17. Hipp Organic anti-reflux datacard. Available at are not recommended for preterm babies or those with kidney problems, where medical guidance should always be sought. SMA® PRO Follow-on
https://www.hipp4hcps.co.uk/resources/helpsheets/data-sheets/ (accessed February 2020). 18. Enfamil AR datacard. Available at https://hcp.nutramigen.co.uk/ Milk and SMA® Organic Follow-on Milk are only suitable for babies over 6 months as part of a mixed diet. They should not be used as a substitute
files/6614/6304/6719/Filofax_Insert_UK_June_2015_8.pdf (accessed February 2020). 19. St James-Roberts I et al. Early Dev Parent 1995; 4: 177–189. 20. Yao for breast milk during the first 6 months of life. The decision to start weaning or to use a follow-on milk before 6 months, should be made only on the
M et al. J Pediatr Gastroentrol Nutr 2010; 50(Suppl 2): PO-N-444. 21. Infante D et al. World J Gastroenterol 2011; 17: 2104–2108. 22. SMA® Comfort Easy to Digest advice of a doctor, midwife, health visitor, public health nurse, dietitian or pharmacist, based on baby’s individual needs. SMA® PRO Growing up
Infant Milk datacard. Available at https://www.smahcp.co.uk/formula-milk/comfort-infant-milk (accessed February 2020). 23. Aptamil Comfort datacard. Available at Milk is suitable for young children from 1-3 years, as part of a healthy balanced diet and it is not a breast milk substitute. SMA® Organic Growing
https://eln.nutricia.co.uk/product-info/aptamil-comfort-from-birth-2/ (accessed February 2020). 24. Cow & Gate Comfort datacard. Available at https://eln.nutricia. up Milk is suitable for young children from the 12th month, as part of a healthy balanced diet and it is not a breast milk substitute. The following
co.uk/product-info/cow-gate-comfort-from-birth-2/ (accessed February 2020). 25. Hipp Organic Comfort Milk datacard. Available at https://www.hipp4hcps.co.uk/ products must be used under medical supervision. SMA® Anti-Reflux is a special formula intended for the dietary management of bottle-fed
resources/helpsheets/data-sheets/ (accessed February 2020). 26. Thomas B, Bishop J (eds.) Manual of Dietetic Practice. Fourth Edition. Oxford: Blackwell Publishing babies when significant reflux (regurgitation) is a problem. It is suitable as the sole source of nutrition up to 6 months of age, and in conjunction with
2007: 458–459. 27. Moya M et al. Acta Paediatr 1999; 88: 1211–1215. 28. Heubi J et al. J Am Diet Assoc 2000; 100: 212–217. 29. Saneian H et al. Iran J Pediatr solid food up to 12 months of age. If the baby’s reflux does not improve within 2 weeks of starting SMA® Anti-Reflux, or if the baby fails to thrive,
2012; 22: 82–86. 30. Xu JH et al. Contemp Pediatr 2009; 11: 532–536. 31. Vandenplas Y et al. Nutrition 2013; 29: 184–194. 32. NHS (2019). Lactose Intolerance. the family doctor should be consulted. SMA LF® is a lactose-free milk based formula for babies and young children who are intolerant to lactose or
Available at https://www.nhs.uk/conditions/lactose-intolerance/ (accessed: January 2020). 33. SMA® LF ® Lactose Free Infant Milk datacard. Available at https:// sucrose, or who are experiencing symptoms such as diarrhoea, tummy ache or wind caused by temporary lactose intolerance. It is suitable as the sole
www.smahcp.co.uk/formula-milk/lactose-free-formula (accessed February 2020). 34. Aptamil Lactose Free datacard. Available at: https://www.eln.nutricia.co.uk/ source of nutrition up to 6 months of age, and in conjunction with solid food up to 18 months of age. SMA High Energy® is a milk based formula for
media/4354/datacard_aptamil_ lactose_free.pdf (accessed December 2018). 35. Mead Johnson, Enfamil 0-Lac, information from Mead Johnson customer careline, the dietary management of babies and young children with medically determined high energy requirements as identified by a healthcare professional.
2016. 36. British Dietetic Association. Paediatric Group Position Statement Use of Infant Formulas based on Soy Protein for Infants. BDA, April 2019. 37. Food Safety It is suitable as the sole source of nutrition up to 6 months of age, and in conjunction with solid food up to 18 months of age. SMA High Energy® is not
Authority of Ireland, Best Practice for Infant Feeding in Ireland (2012). Available at https://www.lenus.ie/handle/10147/252765 (accessed February 2020). 38. SMA® intended for use with preterm babies, for whom fortified breast milk or a low birthweight formula such as SMA Gold Prem® 1 is more appropriate.
Wysoy® Soya Infant Formula datacard. Available at https://www.smahcp.co.uk/formula-milk/soya-infant-formula (accessed February 2020). 39. Bergmann RL et al. SMA® Breast Milk Fortifier is a nutritional supplement designed to be added to expressed breast milk for the dietary management of feeding preterm
Clin Exp Allergy 1997; 27: 725–760. 40. Eichenfield LF et al. Pediatrics 2003; 111: 608–616. 41. Muraro A et al. EAACI Food Allergy and Anaphylaxis Guidelines. low birthweight babies. SMA Gold Prem® 1 is a special formula intended for the dietary management of preterm low birthweight babies who are not
Primary prevention of food allergy. Allergy 2014; 69(5): 590–601. 42. Jost R et al. Bibl Nutr Dieta 1991; 48: 127–137. 43. von Berg A et al. J Allergy Clin Immunol solely fed breast milk. It is suitable for use as the sole source of nutrition for preterm babies from birth. SMA Gold Prem® 1 is not intended for use with
2008; 121: 1442–1447. older preterm babies, for whom a special catch-up formula such as SMA Gold Prem® 2 is more appropriate. SMA Gold Prem® 2 is a special catch-up
formula intended for the dietary management of preterm low birthweight babies who are not solely fed breast milk. It is a nutritionally complete formula
for use on discharge from hospital or when a low birthweight formula is no longer appropriate. It is suitable for use as the sole source of nutrition up to
6 months corrected age. SMA Gold Prem® 2 is not intended for use with newborn preterm babies, for whom fortified breast milk or a low birthweight
formula such as SMA Gold Prem® 1 is more appropriate.
NWP089; CHLWP022; FRJNP008;
IRFI1P002; NWH200-1; IRGMAP005; FRJNP008; NLNW031; DSHL003-1; DENWHS016;
DSS005-1; DEDWHL008; DSHL001-2; DSH204; DSH001; NW102; LE136; JN070; NW101; LE135 ;JN069
NWHP315F; NWHP315G; NWHP315H
34 | SMA® Specials Range SMA® Specials Range | 35INFORMATION FOR HEALTHCARE PROFESSIONAL USE ONLY
BREASTFEEDING IS BEST FOR BABIES
SMA® Nutrition’s Specialist formula range:
Individually tailored to meet the challenges
of specific infant feeding issues
The broadest, most comprehensive range
of solutions for feeding issues
Based on latest advances in scientific
and clinical research
Wide availability in retail or to be ordered
via pharmacy
SMA Nutrition, 1 City Place, Gatwick, RH6 0PA
In the Republic of Ireland: SMA Nutrition, 3030 Lake Drive, Citywest Business Campus, Dublin 24, Ireland
Learn more:
UK 0800 081 81 80
www.smahcp.co.uk
ROI 1800 931 832
www.smahcp.ie
SMA® Nutrition UK and Ireland
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