The Neocate range and Food Allergy - Frequently Asked Questions

21 January 2008

  My paediatrician has switched my baby’s formula to Neocate.

Why is this and what makes Neocate different from other formulas?

  Neocate is described on the label as:

 
•       Hypoallergenic. This means Neocate is not likely to cause an allergic reaction.  
 
•       Elemental. This means that the ingredients in Neocate are broken down to their simplest and purest form so they are easier for the body to process and digest.  
 
•       Containing free amino acids. Amino acids are the building blocks of protein.  
 
•       Breast milk is the best milk for infants and is recommended by the WHO and healthcare professionals around the world. A child with food allergic symptoms despite exclusive breastfeeding may be able to continue breastfeeding if his/her mother undertakes an exclusion diet. Maternal exclusion diets should only be attempted under medical and/or dietetic supervision.  
 
•       Neocate is designed to replace breast milk only in circumstances where breast milk is not tolerated, for instance if a child displays symptoms of food allergy while being exclusively breast fed and attempts to modify maternal diet have been ineffective. In such circumstances it may be necessary for your child’s doctor to prescribe Neocate.  
 
•       Your child has been switched to Neocate because their doctor considers it to be the best formula (baby milk) for your child. Neocate is most commonly used to relieve the diverse symptoms of food allergy but it may also be used for other conditions such as certain gastrointestinal problems. Typically infants are placed on Neocate because their previous formula caused symptoms or failed to relieve them as part of a previous treatment.  
 
•       Neocate contains the essential nutrients for your baby’s growth and development. It is similar to most infant formulas in many ways but there is one crucial difference. The ‘protein’ in Neocate is in the form of purified amino acids that have been blended together. Amino acids are the basic building blocks of all proteins. Other feeds use whole proteins or whole protein fragments (hydrolysates) which are made or derived from cows’ milk or soy.  
 
•       Neocate has been extensively tested in clinical studies to prove it’s nutritional adequacy and effectiveness in treating the most severe cases of food allergy. As Neocate contains no sources of milk protein or protein fragments from any other source, doctors view it as the most reliable type of hypoallergenic formula for paediatric food allergy.  

How long will it take before I see a change in my child’s symptoms?

 
•       Symptoms may start improving after 3-5 days of taking Neocate although many children take longer to see improvements. Most children tend to improve within two weeks.  
 
•       If your child has not improved within two weeks do not change your child’s formula without consulting your child’s doctor and/or dietitian first. Your child is probably taking Neocate because other infant formulas failed or because it was considered the most appropriate formula for your child’s symptoms. Changing your child to another formula may possibly make their symptoms worse.  

How long will my child be on Neocate?

 
•       Your child will be assessed by their doctor and the doctor will advise you on how long your child needs to continue taking Neocate.  
 
•       Many, but not all, children outgrow their food allergies. This can vary for different foods and depends on the individual child. The majority of children who are allergic to milk become free from their allergy by the age of 3-5 years.  
 
•       To encourage growth and avoid unnecessary restriction of your child’s diet, it is important to periodically check with your child’s doctor whether or not your child has outgrown their allergy. Attempts to reintroduce foods to which your child has a diagnosed allergy should only be conducted under the supervision of your child’s doctor and/or dietitian.  
 
•       Milk is the main food in an infant’s diet and remains a crucial food in the diets of children over one year of age. It is a vital source of nutrients such as energy, calcium and many vitamins and minerals. This means that after the age of one a child with persisting milk protein allergy still needs a nutrient-rich milk substitute. Neocate is intended for children under the age of one. However, it is sometimes still used in older children. Neocate Advance has been designed for older children and may be used from the age of one year onwards.  

What is the best way to prepare Neocate?

  Neocate is made up for your baby in the same way as a standard infant formula but it must be remembered that Neocate is designed for infants with food allergy. Extra care must be taken when you are preparing Neocate for your baby to avoid contamination of the formula with traces of other foods*. Small amounts of other foods that may be harmless in a non-allergic child could provoke an allergic reaction in your child. Possible sources of contamination include the following:

 
•       Direct contact with other foods.  
 
•       Using utensils or equipment that has just been used for other foods without thorough cleaning between uses.  
 
•       Handling of Neocate immediately after handling other foods without washing your hands.      
        (* - This does not include the mixing of Neocate with weaning foods approved by your child’s doctor or dietitian.)  

  A simple yet effective way to protect your child’s Neocate formula from contamination with other food proteins is to use dedicated kitchen utensils and employ good basic hygiene practices.

 
•       Excessive or prolonged heating of Neocate can cause nutrient loss and tends to adversely affect taste.  

Neocate is different to other infants formula in appearance and taste. Why?

 
•       If you are familiar with standard infant formulas you may notice that Neocate looks, tastes and smells different. Do not be alarmed as this is normal for Neocate. It is the amino acids in Neocate which give it these different qualities.  
 
•       Adult taste preferences are different to those of an infant. Neocate will probably taste different to any other food or drink you have consumed but this does not mean your child will dislike or refuse it. Neocate has been designed for maximum taste acceptability for your baby. Young children however can sometimes be resistant to any new taste sensations and so it may take a few attempts to establish your child on Neocate.  
 
•       Neocate may appear paler than a typical formula but, again, this is normal. Do not be tempted to add more Neocate powder to give the formula a deeper colour. Neocate must only be made up in accordance with the instructions on the can or given to you by your child’s doctor and/or dietitian.  

My child’s bowel movements have changed since beginning Neocate. Is this normal?

 
•       Yes this is perfectly normal! One of the most common concerns of parents with children on Neocate is the change that occurs in their baby’s bowel motions. If your child is on Neocate and little or no other food it is perfectly normal and harmless for their stools to turn khaki or green, sometimes a very dark green or that is close in colour to black.  
 
•       The reason for this is that Neocate is a very simple form of nutrition. It tends to get absorbed by the body high up in the gut meaning that very little of its nutrients pass into the large intestine. The large intestine is home to millions of bacteria that perform a number of functions including the breakdown of bile (a green substance) which your body naturally produces. These bacteria get less nutrition while your child is on Neocate and their numbers fall, so reducing the breakdown of bile. This means that more bile is present in your child’s stool giving them a green colour. This process is a natural effect of taking Neocate and does not effect your baby.  
 
•       These changes in your child’s gut bacteria can lead to differences in the wind your child produces. Again this is not a cause for concern.  

My baby’s appetite has increased since starting Neocate, is this normal?

 
•       This is commonly reported in infants taking Neocate. It may be that Neocate is the first formula your child has consumed which does not cause your child discomfort and distress. Feeling generally unwell and/or having gut inflammation can impair appetite. As Neocate resolves these symptoms, a child’s general mood and health should improve which will tend to improve appetite.  
 
•       Neocate has been shown to promote catch-up growth in food allergic children whose physical development has been unsatisfactory. As children grow their energy demands, and thus their need for the formula will increase.  
 
•       To further facilitate this catch-up growth, your child’s dietitian may suggest concentrating Neocate or supplementing it to increase your child’s intake of nutrients. It is very important that this advice is followed carefully.  

My child is now 6 months old and still requires Neocate as a main part of his diet. However the older he gets, the more Neocate he needs. I have been thinking about weaning my child onto solids. Do you have any advice on how I could do this while taking Neocate?

 
•       The WHO recommends that infants receive exclusive breast feeding until six months of age prior to introducing solid foods to their diet (weaning).  
 
•       For formula fed infants the recommendation in many countries (e.g. the UK) is to commence weaning at some stage between four and six months after birth.  
 
•       Both of the above recommendations are for infants in the general population. They may not apply to your child.  
 
•       If you feel your baby is ready to start eating solid foods consult your child’s doctor and/or dietitian. The basic principles of weaning a food allergic child are slightly different to those involved in weaning a non-allergic child. New foods need to be introduced carefully to test if they are tolerated. Follow exactly your doctor or dietitian’s instructions about the amount and the type of foods to offer.  
 
•       Extra care must also be taken with the allergic child to ensure none of the foods your child is allergic to are consumed. Equally it is important not to over-restrict the diet of an allergic child as this may leave them at risk of nutritional deficiencies.  
 
•       Neocate can be added to weaning foods. More detailed practical information on this and other topics related to weaning is available in the SHS Neocate weaning guide.  

My child has been on Neocate for a while now and has lately started refusing to take it. Can you advise why this would be? Are there any suggestions for encouraging him to take his formula?

  Formula refusal can be distressing for both you and your child. This is a common problem but help is at hand! Try to remain calm. Feeding your baby is best achieved in a relaxed atmosphere.   Food refusal can occur for many reasons. It may be something as simple as your child showing independence. Your child’s dietitian can provide you with many useful hints on how to get your baby to take enough Neocate. Some suggestions are as follows:

 
•       Try to feed your child in a relaxed atmosphere with the minimum of distractions.  
 
•       If your child is receiving solids in addition to Neocate, try feeding your child Neocate before the solid foods of a meal for a few days. Once your baby is re-established on Neocate and taking sufficient amounts, change back to giving solids first.  
 
•       If your child is over six months of age and already receiving solids, giving Neocate mixed in with solid foods can sometimes help improve acceptability of Neocate formula (click here for a link to the SHS Neocate weaning guide for recipe ideas and further information). If your child is taking Neocate this way it may be possible to give less Neocate direct from the bottle. Care should be taken to ensure your child always receives an adequate fluid intake.  
 
•       Even if you are struggling to get your child to consume enough feed, do not dilute or concentrate the feed to a concentration other than that recommended by your child’s doctor and/or dietitian. Over-concentration can lead to dehydration and under-concentration can lead to your child receiving insufficient nourishment. Contact your child’s doctor or dietitian for further advice or reassurance.  
 
•       Your child is taking Neocate because other formulas have failed to treat his/her symptoms or because it was felt by your child’s medical team that Neocate was the most suitable feed for your child’s condition. For these reasons it is vital that you do not change your child’s formula from neocate to another formula without first discussing it with your child’s doctor and/or dietitian.  
 
•       If your child is over the age of six months, it may be appropriate for them to have flavourings added to their Neocate formula to help aid compliance. SHS International produces a range of flavour products that can be added to Neocate that may be suitable for a child with food allergies.  
 
•       If your child is over the age of one year and is taking Neocate Advance, this product is produced in a ready-flavoured variety (Banana-Vanilla) in addition to the unflavoured version. Use of this ready-flavoured product may be suitable for a child with food allergies. Changing to the flavoured version of Neocate Advance or adding SHS flavours to unflavoured Neocate Advance may help aid compliance.  
 
•       It is vital that you discuss adding flavours or changing to a ready-flavoured product with your child’s doctor and/or dietitian before making such a change. It may be the case that one or more of the flavour products is not suitable for your child.  

How can I prevent tooth decay when bottle feeding Neocate to my child?

  Sugars are an easily digestible form of carbohydrate and are found in all infant formulas and breast milk. They are an important source of energy for normal growth and development of babies. However consumption of sugars increases the risk of tooth decay. To reduce the risk you should follow the advice below:

 
•       Follow the instructions on the usage and dilution of Neocate unless otherwise directed by your child’s doctor or dietitian.  
 
•       Keep drinking times as short as possible.  
 
•       Never put a baby to bed or to sleep with a bottle. They should finish it 30 minutes before sleep to allow the saliva to help clean and protect the teeth.  
 
•       Babies should be encouraged to drink from a trainer cup or beaker by 6-9 months of age. Feeding from a bottle should be discouraged after twelve months but it may be an important way to achieve an adequate intake of Neocate. If your child is struggling to transition from bottle to cup seek advice from his/her doctor and/or dietitian.  
 
•       Clean your baby’s teeth twice a day with a soft toothbrush and a smear of suitable toothpaste. Do not give your baby anything to eat or drink other than water after teeth have been brushed at bedtime.  

Is Neocate available in other countries?

 
•       Neocate is available in many different countries and in many of these countries the product is exactly the same. In other counties, Neocate has a slightly different formulation. These differences are minor and are for regulatory reasons only.  
 
•       If you and your family are considering traveling to another country it is best to contact your national Neocate distributor to obtain practical details on obtaining Neocate in the country to which you are traveling. The contact details of your national distributor will be written on the Neocate packaging. If your visit is intended to be short it may be best to bring your own supplies accompanied by a letter from your doctor explaining what the product is and why your child needs it. This letter can be shown to customs officers if requested.