Frequency and Timing of Specialized Formula Prescriptions for Children Under 2 Years.
Abstract
Background
Infants with non-specific symptoms are sometimes labelled as cow's milk allergic and managed with specialized formula. These products differ from standard infant formula in protein and carbohydrate source, typically containing lower quality protein and free/added sugars such as glucose polymers or sucrose. We evaluated the frequency, timing, duration and estimated volume of specialized formula prescribed to young children.
Methods
We undertook a retrospective population-based cohort study of children up to age 2 years born between 2009 and 2021 who were registered with a contributing UK general practice, predominantly in England. Community prescribing and demographic data were obtained from the Clinical Practice Research Datalink (CPRD) Aurum, a de-identified primary care database representing approximately 24% of the population. National prescribing data for England were used to estimate community prescribing rates for 2022-2025.
Results
Of 4,203,276 children born between 2009-2021 in the database, 1,944,323 (46.3%) were registered by age 3 months with complete data to age 2 years and were included. Of these, 111,478 (5.7%) were prescribed specialized formula, rising from 1.7% of children born in 2009 to 7.9% in 2021 and an estimated 9.7% in 2025. Prescriptions were most commonly initiated at age 0-2 months. Multiple prescriptions were documented for 85,370 (76.6%) of these children. Children with multiple amino-acid formula prescriptions consumed an estimated mean total of 242 L; those with multiple extensively hydrolysed formula prescriptions 203 L; and those with multiple soya formula prescriptions 137 L. Among these children, the median interval between first and last prescription was 257 days for amino-acid formula, 213 days for extensively hydrolysed formula and 152 days for soya formula.
Conclusions
Community prescribing of specialized formula in England increased approximately five-fold over the study period, potentially triggering significant free sugars exposure during infancy.
