Formula for Infants with Acid Reflux

Does your baby struggle with acid reflux?

To learn more about the basics of acid reflux in infants, check out this article.

How do you know which formula may be the best for your baby?

There are so many formula choices available and as a new parent, deciphering between them can sometimes be a challenge. Hopefully this article will help to clear up any confusion you may have regarding the various types of formula that may be recommended for your baby.

What is recommended?

For the dietary management of GER in infants, the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) recommends at least a two-week trial of either extensively hydrolyzed or amino acid-based formulas.

Why hydrolyzed protein or amino acid-based formulas?

Most types of infant formula are nutritionally complete, but the biggest difference between conventional cow’s milk formula, hydrolyzed protein and amino acid-based formulas is the protein source. Studies have shown an improvement in GER symptoms in infants when their formula has been changed to hydrolyzed protein or amino-acid based formulas. It is thought that hydrolyzed protein formulas can decrease GI transit time and increase stool frequency, and in most infants, there has been a reduction in frequency of vomiting seen.

Hydrolyzed protein formulas.

These formulas have been treated and heated to break down almost all of the cow’s milk protein, however, small amounts of unhydrolyzed cow’s milk protein may still be present. There are many different types of hydrolyzed formulas available, so finding the one that works best for your child may take trial and error. Common names of hydrolyzed protein formulas are Aptamil pepti 1, Nutramigen lipil 1, Pepti junior, SMA Althera, Similac Alimentum.

Amino acid-based formulas.

These formulas have almost no remaining protein left and are completely broken down to amino acids. Because amino acid-based formulas are pricey and can sometimes not be as appetizing, these are used as more of a second-line option (meaning this could be a good option if you see no improvement with hydrolyzed protein formulas). Although amino acid-based formulas have been recommended for GER, ESPGHAN recommends that amino acid-based formulas be used for those infants with severe symptoms. Common names of amino acid-based formulas are Neocate LCP, Nutramigen Puramino, SMA Alfamino, Similac EleCare.

Something to keep in mind.

Some studies have shown a reduction in frequency of vomiting, usually within 2 weeks, after the elimination of cow’s milk protein from the diet and that reintroduction of cow’s milk protein causes recurrence of symptoms. In infants, cow’s milk protein allergy and GER can present themselves with very similar symptoms. Therefore, trialing hydrolyzed protein formulas for at least 2 weeks may help to relieve symptoms of GER which could also be misdiagnosed in place of a cow’s milk protein allergy.

As always, talk to your child’s pediatrician for further guidance on best options for your baby.


Corvaglia, L., Mariani, E., Aceti, A., Galletti, S., & Faldella, G. (2013, May 1). Extensively hydrolyzed protein formula reduces acid gastro-esophageal reflux in symptomatic preterm infants. Early Human Development. Retrieved July 19, 2022, from https://www.sciencedirect.com/science/article/abs/pii/S0378378213000807

Traves, D. (2021). All you ever wanted to know about infant formulas (but were afraid to ask). Paediatrics and Child Health. DOI:10.1016/J.PAED.2021.05.003

Rosen, R., Vandenplas, Y., Singendonk, M., Cabana, M., DiLorenzo, C., Gottrand, F., Gupta, S., Langendam, M., Staiano, A., Thapar, N., Tipnis, N., & Tabbers, M. (2018). Pediatric gastroesophageal reflux clinical practice guidelines: Joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Journal of Pediatric Gastroenterology & Nutrition, 66(3), 516–554. https://doi.org/10.1097/mpg.0000000000001889 

Phillips, S. M., Jensen, C. (2020, Nov). Dietary history and recommended dietary intake in children. UpToDate. Retrieved July 19, 2022, from https://www.uptodate.com/contents/dietary-history-and-recommended-dietary-intake-in-children#!#:~:text=Reviewing%20the%20dietary%20history%20in%20the%20context%20of,the%20increased%20morbidity%20and%20mortality%20that%20accompany%20them.

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