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Specialty infant formulas 101

For babies with certain food allergies and/or gastrointestinal concerns, your health care provider may recommend a specialty infant formula. These formulas are specifically designed to address a range of health conditions to help your baby get the nutrients he or she needs. It’s important to note that in many states health insurance providers are required to cover these formulas.

Here are some common questions – and answers – about specialty infant formulas.


What conditions may require specialty infant nutrition products?

Food allergies

As many as 5% of children under the age of five are affected by food allergies, according to the National Institute of Allergy and Infectious Diseases. The symptoms associated with food allergies can be anything from mild rashes to life-threatening breathing problems. Some children may react to these allergy-triggering foods immediately, and others may take days to develop symptoms.


EoE (Eosinophilic Esophagitis)

In some children, allergies can trigger a buildup of eosinophils (a type of white blood cell) in the esophagus, which can in turn cause inflammation and irritation. Children with EoE often have difficulty swallowing, heartburn and acid reflux.


SBS (Short Bowel Syndrome)

Children who’ve had part of their small or large intestine surgically removed, or who were born with a short bowel, may develop problems absorbing nutrients. Children with SBS may need to be fed either through enteral feeding (through a tube) or they can take formula orally.


GERD (Gastroesophageal Reflux Disease)

If a baby is spitting up constantly and has other symptoms, such as frequent vomiting, a persistent cough, difficulty eating and abdominal pain like heartburn and gas, he or she may have GERD. This disease occurs when digestive acids from the stomach enter the esophagus, irritating the area.


NEC (Necrotizing Enterocolitis)

NEC is an infection or inflammation affecting the intestines. NEC is the most common gastrointestinal disorder among preterm infants in the neonatal intensive care unit.



Severe intestinal malabsorption

There are several metabolic disorders and diseases that can occur in children that may lead to their gastrointestinal tract being unable to properly absorb nutrients.



How do hypoallergenic and amino-acid infant nutrition products differ from regular formula?

Milk- or soy-based formulas often include numerous complete proteins that can make it difficult for infants and young children with certain allergies and/or gastrointestinal conditions to tolerate and digest.

One type of hypoallergenic formulas is known as single AABE (amino acid-based elemental) formula, contains proteins that are broken down into their simplest and purest form, making it easier for the body to process and digest. These formulas provide nutrition for patients with conditions and disorders that cause maldigestion or malabsorption. Infants are typically placed on amino acid-based formulas due to difficulty in tolerating or digesting whole proteins found in other formulas.


Which states mandate coverage for specialty infant nutrition?

Several states have mandates that require coverage of specialty infant formula, including:

·         Arizona

·         Connecticut

·         Illinois

·         Massachusetts

·         Maryland

·         Maine

·         Minnesota

·         New Hampshire

·         New Jersey

·         New York

·         Oregon

·         Rhode Island

·         South Dakota

·         Texas


*Please note: Even though specialty formulas are required to be covered by health insurance in these states, the guidelines and requirements for each state differ.   


What steps do I need to take to see if my child qualifies for specialty infant formula?

While each health insurance provider’s policy and guidelines will differ, some general suggestions may be helpful:

·         Ask your child’s pediatrician to provide documentation indicating a medical necessity for the specialty infant nutrition formula. Part of this documentation may include the child’s growth charts, test results and/or a letter of explanation as to why this course of treatment option is more medically effective than alternative therapies.

·         Review your health insurance policies regarding infant formula by either looking through the EOB (explanation of benefits) packet or calling the company.

·         Edgepark Customer Care Specialists regularly work with patients to help them get the specialty infant nutrition formula they need, delivered right to their door. Edgepark can streamline the reimbursement process by working with your health insurance company so you don’t have to.


Edgepark provides specialty infant nutrition formulas for patients diagnosed with what conditions?

We provide formula for the following conditions:

·         Allergy or hypersensitivity to cow or soy milk

·         Allergic or EoE (eosinophilic enteritis)

·         Amino acid, organic acid and fatty acid metabolic and malabsorption disorders

·         Cystic fibrosis with malabsorption

·         GERD (gastroesophageal reflux disease)

·         SBS (short bowel syndrome)


Related articles:
What types of feeding tubes are available?
How does a feeding tube work?
Commonly asked questions about nutrition & enteral feeding