Systematic review summary

When should we use partially hydrolysed formulae for frequent gastrointestinal symptoms and allergy prevention?

Vandenplas Y et al. Acta Paediatr 2014; 103: 689–695.

About the paper

  • A review article published in Acta Paediatrica
  • Authored by an international group of experts addressing the benefits and indications for partially hydrolysed formula

Why it’s important

  • The paper discusses the use of partially hydrolysed (PH) formula, as well as other key formula modifications, for the management of infants with gastrointestinal (GI) symptoms
  • It provides a concise summary of the data reported in the literature and a summary of the benefits and indications for recommending a partially hydrolysed infant formula as part of the medical management of an infant’s GI symptoms

Background on GI symptoms – key points

  • The incidence of GI symptoms / feeding intolerance is lower in babies fed breast milk compared to infant formula
  • It has been documented that GI symptoms such as stooling problems, fussiness and crying and reflux are very common at an early age and many times a result of normal developmental process in infants and not a manifestation of GI disorder or disease
  • Up to 47% of infants may have a change in formula in the first 6 months of life for perceived GI problems
  • Parental concern over GI symptoms is a common topic of discussion at routine paediatric care visits

Review conclusions

  • In fussy babies, crying and excessive gas can be associated with low lactase activity or secondary lactose malabsorption. Hard stools are infrequent in breastfed infants (1.1%); standard formula-fed infants have a higher rate of firm or hard stools (9.2%). A formula rich in palmitic acid in the beta position (SN2) is likely to soften stools
  • The authors point out that data is limited but experience suggests partially hydrolysed protein can be a useful option for colic-like symptoms (when cows’ milk protein allergy is NOT suspected)


In summary, the authors state that partially hydrolysed formula with additional formula modifications (such as reduced lactose and lipid blends with SN2), show certain benefits in the management of common functional GI intolerance such as fussiness, hard stools and colic-like symptoms.*


*When cows’ milk allergy is not suspected

IMPORTANT NOTICE: Breast milk is best for babies and breastfeeding should continue for as long as possible. Good maternal nutrition is important for the preparation and maintenance of breastfeeding. Introducing partial bottle-feeding may have a negative effect on breastfeeding and reversing a decision not to breastfeed is difficult. Caregivers should always seek the advice of a doctor, midwife, health visitor, public health nurse, dietitian or pharmacist on the need for and proper method of use of infant milks and on all matters of infant feeding. Social and financial implications should be considered when selecting a method of infant feeding. Infant milk should always be prepared and used as directed. Inappropriate foods or feeding methods, or improper use of infant formula, may present a health hazard.