Specialist Infant Formula

These guidelines aim to assist GPs, Pharmacists, Health Visitors, Dietitians and hospital medical staff with information on prescribing specialist infant formula.

Whilst these guidelines advise on the appropriate choice of specialist infant formula, breast milk remains the optimal choice for infants. This should be promoted and encouraged where it is clinically safe to do so.

The guidelines are targeted at infants 0 to 12 months; however some products may be prescribed past this age where there is clinical justification. Advice on this is included in the guidelines, where appropriate.

Certain infant formula should be bought over the counter. For example, Anti-Reflux and Lactose-Free Formula, which are widely available in supermarkets and pharmacies at a similar cost to regular formula. Patients eligible to receive help to buy food and milk (Healthy Start) may consider using this towards the cost of purchasing Anti-Reflux / Lactose-Free Formula, if required.

SWL guidance on the management and prescribing of specialist infant formula in:

And the following guidance on:

This patient information leaflet provides guidance about suitable products to use if your child needs to have a dairy-free diet, for example due to Cow’s Milk Protein Allergy.

Why is it important to use fortified dairy alternatives?

  • Dairy is a key food group for children: it is a naturally rich source of calcium, iodine, calories and protein.
  • Calcium is essential for bones, teeth, and our cells. Deficiency can cause fits or bone deformity.
  • Iodine is required to form thyroxine, which helps convert food into energy and helps with mental and physical development. Deficiency can affect brain development.
  • Fortified dairy-substitutes are required if your child cannot consume usual dairy products. Not all dairy substitutes are created equal: some are not fortified; some are low in protein or energy. This guide will help you identify suitable options.
  • Including a variety of dairy substitute products can help your child with texture development.
  • These foods also provide diversity and fun: food is there to be enjoyed!

What to look out for:

  • Always check the label for calcium fortification and prioritise products that contain calcium: look out for at least 120mg calcium per 100ml.
  • Most organic or “clean” products are NOT fortified.
  • From 1 year of age, semi-skimmed or full-fat milk can be given as a main drink. ‘Barista’ or ‘growing up’ editions are the best option for a full-fat dairy alternative. Aim to look for at least 50 kcals per 100ml.
  • Oat and pea milk are the most environmentally friendly, sustainable options.
  • Rice milk should not be used until over 5 years of age.

Other (non-dairy) allergies:

  • If your child has multiple food allergies, e.g. tree nuts (such as almond or cashew), or coconut, soya or pea allergies, always ensure that you select an option that does not contain those allergens.
  • By law, all ingredients contained in a product must be listed on the ingredient list selection of the food label. Allergens such as tree nuts and soya should be clearly listed in bold or italic.

Are calcium-fortified dairy alternatives suitable as a main ‘milk’ for my baby?

  • Only breast milk or formula can be used as main “milk” until 1 year of age.
  • However, you can introduce calcium-fortified dairy substitutes in food preparation before your baby is one year: e.g. to make a white sauce or poach some fish, to add to porridge, to make a pancake. Try to choose the products with a higher energy and protein content (e.g. “barista” style products).
  • After 1 year of age, calcium-fortified dairy products can be used as main “milk” if your child is eating a varied diet and growing well. (Tip: 300ml of a calcium-fortified milk will meet full daily calcium needs for children aged between 1 to3 years).

Dairy free products

Please be aware it is impossible to list or monitor every single product available on the market. Ingredients and or formulations can also change regularly therefore always read the label.

Calcium Fortified Milk Alternatives

Soya, oat and pea provide higher energy (calorie) and protein contents. ‘Barista’ or ‘growing up’ versions are also higher in calories.

Oat

  • Oatly® oat barista
  • Sainsbury® oat drink
  • Moma® oat barista
  • Alpro® growing up drink
  • ASDA® oat
  • Provitamil® oat
  • Minor Figures® barista oat

Soya

  • Alpro® growing up soya
  • M&S® soya
  • Provamel® soya
  • Waitroe® soya
  • Tesco® soya
  • Aldi Actileaf® soya
  • Lidl® soya

Pea

  • Sproud® barista
  • Qwrkee® pea

Potato

  • Dug® barista
  • Dug® unsweetened

Coconut

  • Koko® super
  • Koko® barista
  • Rude Health® coconut with calcium
  • M&S® coconut
  • Alpro® coconut

Almond

  • Alpro® almond barista
  • Aldi Actileaf® almond
  • Almond Breeze®
  • Califia Farms® almond
  • Morrison® almond (unsweetened)

Other nut and rice milks

Avoid rice milks under the age of 5

  • Alpro® hazelnut
  • Alpro® cashew
  • Valsoia® walnut
  • Rice Dream® + calcium

Calcium fortified yoghurt alternative

Soya

  • Alpro® soya Greek style (plain or flavoured)
  • ASDA® plain soya
  • Tesco® plant chef soya
  • Alpro® soya 125g pots

Coconut

  • Coconut collaborative® strawberry
  • Koko® plain
  • Koko® greek style
  • Little Bandits® flvoured pots

Oat

  • Oatly Oatgurt® Greek style
  • Light and Free® flavoured yoghurt
  • Petit Filous® almond based

Calcium fortified cheese alternatives

Cheddar style

  • Cathedral City® ® plant based
  • Sheese® ® cheese alternative
  • Applewood® vegan
  • ASDA Free From®

Mozzarella style

  • Violoife® ® Mozzarella flavour slices
  • M&S Plant Kitchen® not’zarella
  • Tesco Plant Chef® mozzarella grated

Soft cheese

  • ASDA Free From® soft cheese
  • Sheese® garlic and herb spread
  • Sainsburys Free from®

Dairy free speards

Note: often do not contain calcium

  • Flora® plant butter
  • Pure® olive spread
  • Violife® vioblock
  • Vitalife®

Dairy free creams

Note: often do not contain calcium

  • The Coconut Collab® double cream
  • Oatly® single creamy oat
  • Elmlea® 100% plant cream
  • Alpro® single soya cream

Dairy free baby rice/porridge

  • Hipp® organic baby rice
  • Organix® porridge
  • Holle® organic oat
  • Ella’s Kitchen® dairy free porridge

Dairy free desserts and ice cream

Contains calcium

  • Alpro® soya custard
  • The Coconut Collab® custard
  • The Coconut Collab® smoothie
  • Alpro® soya chocolate dessert

Does not contain calcium

  • Oatly® whippable custard
  • Ella’s Kitchen® dairy free rice pudding
  • Coconut Collab® rice pudding
  • Over the Spoon® chocolate pots

Ice cream

Note: often do not contain calcium

  • Valsoia® vegn gelato
  • Valosia®plant based cones
  • The coconut Collab® ice cream
  • Swedish Glace® soy ice cream
  • Booja-Booja®
  • Alpro® soya ice cream

Chocolate items

Note: often do not contain calcium

  • Nomo® choc bar
  • Sweet Freedom® choc shot
  • Valosia® hazelnut and cocoa spread
  • M&S made without dairy® chocolate buttons

Further Information:

Document History

Version: V 1.1

Download pdf of ‘Dairy-free products: Information leaflet for parents and guardians:

For all conditions, to avoid medicines waste, unless samples have already been trialled and tolerated, initially prescribe 2 tins of formula until tolerance and compliance are established. Following this, the formula can be added as an acute prescription (28 day supply) and regularly reviewed for ongoing prescription.

Suggested monthly quantities for powdered formula:

Under 6 months of age: 13 x 400g tins or 6 x 800g tins per 28 days

6-12 months of age: 7 to 13 x 400g tins or 3 to 6 x 800g tins per 28 days

Over 12 months of age*: 5 x 400g tins or 2 x 800g tins per 28 days

*Prescribed formula should not routinely be required over 12 months of age.

For mixed feeding, less formula will be required than the volumes listed above. Prescribe an equivalent volume of formula to the child’s usual intake and review regularly.

If the infant is under a paediatric dietitian, review recent correspondence for details on the volume to prescribe.

For infants fed via feeding tubes:

Appropriate monthly amounts should be prescribed as advised by the paediatric dietitian. The requirements for formula may exceed the guideline quantities

The Department of Health recommends:

  • Breastfed babies from birth to 1 year of age should be given a daily supplement containing 8.5 micrograms to 10 micrograms of vitamin D.
  • Formula fed infants should be given a daily vitamin D supplement only if they are taking less than 500 milliliters of infant formula daily.
  • Children aged 1 to 4 should have a daily vitamin D supplement of 10 micrograms.
  • Pregnant women and breastfeeding mothers should have a daily Vitamin D supplement of 10 micrograms to 25 micrograms.

Patients should be advised to purchase Vitamin D over the counter. Please see SWL Vitamin D Position Statement for details. Pregnant women, women with a child under 12 months and children aged up to 4 years who receive a Healthy Start card are also entitled to free Healthy Start Vitamins.

If the infant has been seen by a private paediatrician or dietitian and prescriptions are being requested on the NHS, GPs are advised to ensure that prescribing recommendations are in line with these guidelines and product choices. This is to ensure equity for all patients.

Please note there is no obligation for the GP to prescribe the recommended treatment from the private specialists if it is contrary to these guidelines and 1st line formulary choice.

Where the GP cannot accept prescribing of the requested product, a discussion with the patient’s parent and guardian and private healthcare professional should be initiated. Parents and guardians should be reminded where appropriate that they reserve the right to purchase their particular brand of product using a private prescription from the private healthcare professional who originally recommended the treatment.

Croydon

Paediatric dietitians: Croydon Health Services Nutrition & Dietetics Team. Complete referral form on DXS.

Email: [email protected]

Breast feeding support: Croydon Health Services breastfeeding support team. No referral required.

Kingston

Paediatric dietitians: Kingston Hospital Nutrition & Dietetics Team. No referral form, email patient details and reason for referral to [email protected]  

Breastfeeding support: Your Healthcare Infant Feeding Team. No referral required.

Merton

Paediatric dietitians: CLCH Nutrition & Dietetics Team. Complete referral form on DXS.

Email: [email protected]

Breastfeeding support: CLCH Infant Feeding Services. No referral required for drop in sessions. Referral through health visitor, GP or midwife for specialist feeding clinic.

Richmond

Paediatric dietitians: HRCH Nutrition & Dietetics Team. Complete referral form on DXS.

Email: [email protected]

Breastfeeding support: CLCH Infant Feeding Team. No referral required for drop in sessions. Referral through health visitor, GP or midwife for specialist feeding clinic.

Sutton

Paediatric dietitians: Sutton Health & Care Dietetics Team. Complete referral form on DXS.

Email: [email protected]

Breastfeeding support: Sutton Health & Care Infant Feeding Team. No referral required.

Wandsworth

Paediatric dietitians: St George’s Community Dietetics Service. Complete referral form on DXS.

Email: [email protected]

Breastfeeding support: CLCH Infant Feeding Team. No referral required for drop in sessions. Referral through health visitor, GP or midwife for specialist feeding clinic.