Formulas for Reflux

Educate yourself on the composition of different formulas, and formulas for reflux and MSPI.


Using human milk as the nutritional standard, formula manufacturers follow a basic recipe that includes proteins, fats, carbohydrates, vitamins, minerals, and water. They combine various ingredients so that the nutrients in formula follow the same rough proportions as human milk. The big difference between formulas is the different sources of these elements – cow’s milk, soybeans, or something else. Most formulas are cow’s-milk based, meaning that the basic nutritional building blocks of proteins, fats, and carbohydrates are taken from this nutritional base. Formula manufacturers start with the basic nutritional elements in cow’s or soy milk and add ingredients until the mixture approximates human milk as closely as possible. They adjust levels of carbohydrates, proteins, and fat while adding vitamins and minerals.


    • Enfamil
    • Similac
    • Carnation/Good Start

The main difference between the three is whey-to-casein ratio. Carnation contains 100 percent whey. Carnation predigests the whey, breaking the protein up into smaller particles which are supposed to be easier for a baby to digest. Enfamil promotes a 60/40 whey-to-casein ratio similar to human milk. Similac and Enfamil are practically the same in carbohydrate content, both containing only lactose. Carnation, on the other hand, contains 70 percent lactose and 30 percent malto-dextrin, a table-sugar- like carbohydrate that is, according to the manufacturers, necessary to balance the biochemical properties of the whey. Let baby be the judge.


    • Prosobee
    • Isomil
    • Good Start Soy

Soy formulas are manufactured with soy protein instead of cow milk protein, casein and whey. They contain sucrose or glucose instead of lactose as sugar. This is not a cure for an allergic baby because approximately 50% of infants who are allergic to cow’s milk are also allergic to soy. Soy can be very constipating. It’s a great alternative for moms who can’t breastfeed and who would, for religious, social, cultural, or personal preferences would like to withhold animal protein from their baby. Soy doesn’t have an indication, meaning there is no instance in which a baby really needs to have it.

PARTIALLY HYDROLYZED (pre-digested) FORMULAS (reduced lactose)

    • Nestle Good Start
    • Enfamil Gentlease

Partially hydrolyzed or predigested formulas are generally much more expensive and usually taste bitter to downright bad because the technology required to predigest (hydrolyze) the protein into more easily-digestible units results in a more bitter-tasting protein.


    • Nutramigen
    • Progestimil
    • Alimentum

The milk protein is heated and treated (hydrolyzed) to break the protein down into smaller chunks. Possible carbohydrate problem. When the protein is hydrolyzed, the lactose is also taken out of the milk, so the manufacturer has to add carbohydrates — usually corn syrup, sucrose, corn starch, or even tapioca. ONLY THE ALIMENTUM RTF IS CORN-FREE. The Enfamil Progestimil is a hypoallergenic formula primarily used for babies who have malabsorption or failure to thrive problems (added MCT oil).


    • Neocate
    • Elecare
    • Nutramigen AA

Even the smaller proteins in hypoallergenic formulas still can cause problem for some babies with allergies. So, in these elemental formulas, protein is completely broken down. Amino-acid based. No intact protein to cause a problem. Completely hydrolyzed formula.


    • Similac Sensitive
    • Enfamil Lacto-Free

Lactose intolerance is extremely rare in infants. Lactose intolerance is a lifelong condition seen starting in school-age children and young adults. It results from loss of lactase in walls of intestines, usually after a stomach bug. As a result gas, bloating, and diarrhea occur. There is no real reason for the use of lactose-free formula. Babies with gastroenteritis or infections in intestinal tract. When the child gets severe viral gastroenteritis, the lining of intestinal tract becomes injured. The villi on lining of intestine contain the enzyme responsible for absorbing lactose. When the villi are damaged, babies will lose ability to absorb milk sugar which can compound diarrhea. So perhaps lactose-free formula can help for a few weeks after a severe stomach bug.


  • Good Start Natural Cultures
  • Similac Advance Early Shield
  • Enfamil Lipil with Enflora


    • Enfamil AR
    • Similac RS

Milk based formulas with added rice starch that thickens when exposed to acid in the stomach.


    • Enfamil Enfacare (22 cal); Premature (24 cal)
    • Similac Neosure

These higher calorie milk based formula for premature or low-birth weight babies.


Okay for kids; not for babies. Deficient in vitamins B, C, folate and iron. Too high in potassium, sodium, and protein for infants.


Formula Roulette is the term used for frequent formula changes attempting to solve your babies reflux or MSPI. Formula roulette can cause more harm than good because changes in formula can be upsetting to a babys GI system. Also note that formula change can take up to 2 weeks to see the effects.


Breast milk stool is seed yellow and mustard like; nearly odorless.
Standard formula—pasty, semi-formed
Soy—potential constipation
Elemental— olive/forest green in color; smelly