Traditionally, soy protein-based formulas have been recommended as an alternative to cow’s milk formula when an infant presents with colic or suspected intolerance or allergy. However, there is evidence and caution moving away from recommendations to use a soy and now indicating a better choice would be to trial a hydrolyzed formula. See below for information regarding the concerns for use of soy formulas. (note: not an exhaustive list but includes several position papers from large pediatric organizations).
Concerns for the use of soy-based formulas in infant nutrition. Paediatr Child Health. 2009 February; 14(2): 109–113. PMCID: PMC2661347
- Both the American Academy of Pediatrics and the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Committee on Nutrition recommend extensively hydrolyzed protein (or amino acid-based formulas if hydrolyzed formulas not tolerated) for the treatment of infants with CMPA (Cow’s milk protein allergy).
- The ESPGHAN Committee on Nutrition also specified that especially for infants younger than six months of age, soy-based formulas should not be used to treat CMPA given the higher reported rate of adverse reactions to soy protein in the population.Thisis committee also recommended that before soy-based formulas are selected in older infants, tolerance to soy protein should first be established by clinical challenge.
ESPGHAN Committee on Nutrition Soy protein infant formulae and follow-on formulae: A commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2006;42:352–61.
Bhatia J, Greer F, American Academy of Pediatrics, Committee on Nutrition Use of soy protein-based formulas in infant feeding. Pediatrics. 2008;121:1062–8.
- Likewise, the Australian position statement clearly advocates for the strict avoidance of soy-based formulas in infants with CMPA.
The Australian College of Paediatrics Soy protein formula. J Paediatr Child Health. 1998;34:318–9.
- The United Kingdom and New Zealand recommendations, separately, have more strongly recommended against the use of soy-based formula for any indication, citing concerns about the unknown risk of phytoestrogens when infants are receiving the formulas as the sole source of nutrition.
Committee on Toxicity of Chemicals in Food . COT Report – Phytoestrogens and Health. Consumer Products and the Environment, Food Standards Agency, Department of Health; United Kingdom: 2003.
Tuohy PG. Soy infant formula and phytoestrogens. J Paediatr Child Health. 2003;39: 401-5.
Information from the American Academy of Pediatrics on Use of soy protein based formulas.
http://pediatrics.aappublications.org/content/121/5/1062.full.pdf+html
Abstract: Soy protein-based formulas have been available for almost 100 years. Since the first use of soy formula as a milk substitute for an infant unable to tolerate a cow milk protein-based formula, the formulation has changed to the current soy protein isolate. Despite very limited indications for its use, soy protein-based formulas in the United States may account for nearly 25% of the formula market. This report reviews the limited indications and contraindications of soy formulas. It will also review the potential harmful effects of soy protein-based formulas and the phytoestrogens contained in these formulas.
Summary of points:
- For infants with documented cow milk protein allergy, extensively hydrolyzed protein formula should be considered, because 10% to 14% of these infants will also have a soy protein allergy.
- Soy protein-based formulas are not designed for or recommended for preterm infants.
- The routine use of isolated soy protein-based formula has no proven value in the prevention or management of infantile colic or fussiness or no proven value in the prevention of atopic disease.
- Indications for use of soy formula include infants with galactosemia and hereditary lactase deficiency (rare) and in situations in which a vegetarian diet is preferred.
Bhatia J, Greer F, American Academy of Pediatrics, Committee on Nutrition Use of soy protein-based formulas in infant feeding. Pediatrics. 2008;121:1062–8.
I have had a hard time ‘selling’ a parent on going to a hydrolized formula due to expense and taste. Does anyone have recommendations on how to A) convince parents that this is worth doing B) helping them with cost.
Thanks, Martina
Thanks for the question Martina- while I am not a dietician (although always wish I were), I’ll give you my thoughts.
– Educate caregivers why you are making the recommendation! We tell families that in order for feeding to improve, we need to improve gut comfort. We can improve comfort by manipulating formula, medicines and rate (or volume).
– Give samples if possible! In our clinic, we work closely with our dieticians so when we have patients that can benefit from a hydrolyzed or predigested formula we typically give samples so that a family can try it out to determine the benefits before buying it. Our dieticians, try to assist with getting formulas covered through WIC or medicaid although many families will have to pay for formula.
– Our dieticians also give resources and tips on how to get formulas for less cost. For example, having a pharmacy order a special formula is often the most expensive way to go.
I’ll run this by my team to see if the dieticians have any more thoughts! Thanks for the question.
Good information Krisi! In 10 years of working in pediatric gastroenterology (5 years primarily with feeding disorders) I have never recommended soy. I agree with Sharon Wallace, providing samples is a great way to see if the formula will make a difference.