Parent Guide - Nutricia Neocate

Parent Guide
A Guide to Understanding
Your Child’s Food Allergies
Table of Contents
General Information on Food Allergy - page 2
Parent Guide
What is Neocate? - page 4
Neocate Infant DHA and ARA - page 8
Frequently Asked Questions - page 10
Acknowledgement
Nutricia North America would like to thank Diana Buckley-Uhrich, RN, MS, CPNP with the Division
of Pediatric Gastroenterology and Nutrition at Massachusetts General Hospital for her help and
advice in the preparation of this resource guide.
Neocate Preparation and Nutrient Profile - page 14
Note
This book has been prepared as a resource guide for parents whose child has been recommended to
use Neocate.
The management of food allergy and intolerance can differ between individuals. As such, it is strongly
recommended that this guide be used in consultation with a healthcare professional.
All information provided in this guide is reflective of the most current and relevant
recommendations regarding the management of food allergies with Neocate Infant formula.
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Nutricia Family of Products - page 20
A Guide to Understanding Your Child’s Food Allergies
What is the difference between food intolerance and
food allergy?
Food intolerance is a general term used when a person has a bad reaction
to a food or food additive. Often times, food intolerance occurs even when
the affected person cannot identify the type of food eaten.
General Information on
Food Allergy
What is a food allergy?
We all have an immune system to protect us from infections. Our
immune system attacks the viruses and bacteria that can make us sick.
With a food allergy, the body’s immune system mistakenly reacts in
a similar way to certain food proteins, which are called allergens. The
immune response to the food protein and the symptoms that come
from that reaction is called an allergic reaction.
The immune response of food allergy may occur within minutes after
a child eats or drinks, or may take several hours or days to develop.
Non-life threatening symptoms may include hives, diarrhea, bloody
stools, vomiting, poor feeding, eczema, or poor growth. These types of
reactions may take longer to develop. Over time, this type of immune
response to food may cause inflammation of the esophagus, stomach,
small intestine or large intestine. Life threatening symptoms can
include swelling of the mouth or throat, difficulty breathing, wheezing,
anaphylaxis or shock. Such reactions usually occur within a few hours
of ingesting the food containing the allergen.
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A food allergy always involves an abnormal reaction of the immune
system to the food protein. Food intolerance, however, does not provoke
an immune response, but rather an abnormal physiological response,
such as abdominal pain and cramping or bloating and diarrhea. Some
children with severe allergies may experience both types of reactions.
How common are food allergies?
It is estimated that 6 to 8 out of every 100 infants, and up to 3 out
of 100 older children are allergic to one or more foods. The 8 most
common food allergens are the proteins found in milk, eggs, fish,
shellfish, tree nuts (e.g. almonds, walnuts), peanuts, wheat and soy.
However, a child can be allergic to almost any food protein. Most
children outgrow food allergies by the age of three (although an
allergy to fish and peanuts may last a lifetime).
Why does a child become allergic to
a food?
It is not clearly understood why some
children develop an immune response to
one or more food proteins. A child is
more likely to have food allergies when
other family members have a food
allergy or when there is a family
history of asthma, hives, hay
fever, or eczema.
A Guide to Understanding Your Child’s Food Allergies
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What is Neocate?
Neocate is a special formula designed for infants and young children
with milk protein allergy or multiple food protein intolerance (e.g.
allergies to soy protein, hydrolyzed protein in other infant formulas,
fish, eggs and nuts). Neocate provides the necessary nutrients
required for an infant’s growth and development. Neocate has been
recommended by your doctor or dietitian because your baby has
difficulty in tolerating or digesting other infant formulas.
Neocate is described on the label as:
Hypoallergenic
The formula is less likely to cause an allergic response.
Nutritionally Complete
All of the essential nutrients needed to grow
are supplied by the formula when consumed
in adequate amounts.
Elemental
Ingredients are broken down to their simplest and
purest form so they are easier for the body
to process and digest.
Amino Acid-Based
Amino acids are the non-allergenic building blocks
for all protein.
Dairy-Free Manufacturing
Neocate is manufactured in a dairy-free environment
providing a safe and effective formula for individuals
with dairy allergies.
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A Guide to Understanding Your Child’s Food Allergies
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The following table compares some of the different
infant formulas and identifies the protein source.
What makes Neocate different from other formulas?
The type of protein used in Neocate makes it different from other
infant formulas. Neocate is an amino acid-based formula in which the
proteins are broken down to their simplest and purest form, making
it easier for the body to process and digest. Additionally, because
Neocate is hypoallergenic, it is less likely to cause an allergic response
than other infant formulas consisting of more intact proteins.
REGULAR FORMULA WITH
WHOLE PROTEIN
HYDROLYZED FORMULA
Cow/soy milk protein
Majority derived from cow milk protein
NEOCATE
AMINO ACID-BASED FORMULA
Protein Source
Protein Type
Allergic Reaction
Cow Milk Protein
Goat Milk Protein
Whole protein
> Casein
> Whey
MOST
ALLERGENIC
Soy Milk
Whole soy protein & soy isolate
Extensively Hydrolyzed
Fragments of cow milk protein
> Casein hydrolysates
> Whey hydrolysates
Neocate Infant
Amino acids
> Protein in its simplest form
LEAST
ALLERGENIC
Why is the protein source so important?
Allergic reactions to food are mainly caused by the
body’s reaction to the protein present in the food
we eat (e.g. milk, soy, eggs, wheat, fish and nuts).
Infants and young children are much
more sensitive to these proteins
as their immune systems are
still quite immature. Some
infants and young children
may be allergic to several food
proteins, including cow and
soy milk proteins. They can
also be allergic to the small
protein fragments contained in hydrolyzed infant formulas.
Infants and children require a certain daily amount of protein to help
support normal growth and development. For children with protein
allergies, it can be difficult for them to meet these needs as they must
avoid various types of nutritious foods that could potentially initiate
an allergic response. However, a nutritionally complete, amino acidbased formula such as Neocate can provide the child with the
required daily nutrition.
100% non-allergenic free amino acid-based
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A Guide to Understanding Your Child’s Food Allergies
7
Neocate Infant DHA and ARA
The first amino acid-based formula
to have DHA and ARA
to help your infant develop.
DHA and ARA are two important nutrients naturally found
in breast milk. They are important for healthy infant growth and
development. Studies have shown a direct consumption of these key
ingredients will promote your baby’s:
• Visual development
• Brain development
Like all Neocate products, Neocate Infant DHA and ARA is:
• • • • Hypoallergenic
100% non-allergenic free amino acids
Nutritionally complete
Manufactured in a milk protein-free environment
Grams per 100 g of Fatty Acids
DHA and ARA levels of Neocate are in line with the
recommendations of Koletzko et al. (2001),* Child Health Foundation,
ensuring beneficial amounts of DHA and ARA for your baby.
0.40
0.30
0.20
0.10
0.00
DHA
ARA
Child Health Foundation (Koletzko, et al.)
Neocate Infant DHA and ARA
* B Koletzko, et al. Long chain polyunsaturated fatty acids (LC-PUFA) and perinatal
development. Acta Paediatr. 2001; 90:460-464.
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A Guide to Understanding Your Child’s Food Allergies
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Frequently Asked
Questions
When will I see an improvement after starting Neocate?
If your child has been experiencing negative symptoms for some
time, his or her condition may take time to improve. Severe allergies
can cause inflammation and irritation to the affected areas. This,
like a cut or burn, will take time to heal. It is important during this
time to keep your child exclusively on Neocate and not give any
other formula or foods unless otherwise directed by the doctor or
dietitian. If your child has been on solids, it is important to make
sure that those foods suspected of causing a problem are completely
eliminated from the diet. Use only those foods recommended by
your child’s doctor or dietitian.
In clinical studies an elimination diet using Neocate has been shown
to improve gastrointestinal symptoms of cow milk allergy such as
diarrhea, blood in the stools and vomiting associated with milk protein
allergies in just 3-days and improving gastroesophageal reflux and skin
irritations, such as eczema and atopic dermatitis in just 14-days.
How long will my child need Neocate?
Many, but not all children, outgrow their food allergies. This will
vary for different foods and depends on the child. Your child’s doctor
will determine how long your child may need Neocate.
Will Neocate Infant formula meet all of my child’s
nutritional needs?
Neocate Infant is formulated to meet the daily nutritional
requirements of an infant. If you are concerned that your child is not
gaining weight or growing adequately consult your doctor and/or
dietitian. They will be able to assess if nutritional needs are being
met and if dietary adjustments are necessary.
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A Guide to Understanding Your Child’s Food Allergies
11
Neocate tastes and appears different than other
infant formulas. Is this normal?
Yes, this is quite normal. The protein source in Neocate is different
than milk-based or hydrolyzed formulas. The free amino acids give
the formula its characteristic taste, smell and an appearance similar to
breast milk. However, our exclusive formulation gives it superior taste,
smell and texture.
My baby’s appetite has increased since starting
Neocate. Is this normal?
Your appetite can be impaired when you are generally not feeling well
and/or have gut inflammation. It may be that Neocate is the first
formula your child has taken which does not cause discomfort and
distress. As an elimination diet using Neocate improves gut discomfort
and distress, a child’s mood and health should improve, which may
help to improve appetite. Neocate has also been shown to promote
catch-up growth in children with food allergies. As children grow,
energy demands increase, as well as their need for formula intake.
My baby has had a change in stools since starting on
Neocate. Is this normal?
insurance company to assist you with any specific questions you
may have. For additional suggestions and helpful documents that
may assist in obtaining coverage, please contact our Nutrition
Department at 1-800-NEOCATE.
Where can I purchase Neocate?
You can order Neocate directly from Nutricia North America at
www.Neocate.com or by calling 1-800-NEOCATE. Neocate is also
available to order through your local pharmacy.
Why is Neocate only available through the pharmacy
and not on my grocery store shelf?
Neocate falls under an exempt infant formula classification. Such
formulas typically are prescribed by a physician and must be requested
from a pharmacist. Exempt infant formulas are generally represented
and labeled solely to provide dietary management for specific diseases
or conditions that must be used under medical supervision.
Always consult your doctor or dietitian if you have
questions or concerns regarding your child’s health.
Yes, this is perfectly normal! Stools can change in consistency and
color when a child is introduced to an elemental formula such as
Neocate. This is because Neocate is a low residue formula. Low
residue formulas lower the number of bacteria in the gut leading to
reduced breakdown of bile. More bile is present in the stool making
it darker in color.
Will my insurance company cover the cost of Neocate?
Insurance coverage will depend on your plan, as well as the
state in which you reside. There are several states that mandate
Neocate coverage, for an up-to-date listing of these states visit
www.Neocate.com. Hints and tips for successful reimbursement
are also available online. Consult with your doctor and/or
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A Guide to Understanding Your Child’s Food Allergies
13
Neocate Preparation
and Nutrient Profile
How do I prepare Neocate?
Neocate Infant may be mixed with warm or cool sterile water*. Do
not boil formula or use a microwave to prepare or warm formula.
For standard dilution, use enclosed scoop (4.75 g) to mix one level
scoop per fluid ounce of prepared formula.
How to make a 5 fluid ounce bottle:
1. Add 5 scoops of Neocate Infant to a clean, sterile container.
2. Fill up to the 5 fluid ounce line with warm or cool sterile water.
3. Shake for 15-20 seconds or until the powder dissolves. Check
the volume. Add additional water if necessary to fill to the 5 fl oz
level and shake again.
1
2
3
Freshly mixed formula is best. Refrigerate pre-mixed formula
immediately and use within 24 hours of mixing. Shake immediately
before use. Throw away formula left in the bottle one hour after
feeding. Tube feeding hang time should not exceed 4 hours.
* Boiling is the preferred method for sterilizing water, bottles, nipples, and mixing utensils.
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How do I make different volumes?
Desired Volume
Amount of Neocate Powder
Water to Add
8 fl oz
12 fl oz
24 fl oz
48 fl oz
8 scoops or 38 g
12 scoops or ½ cup or 57 g
24 scoops or 1 cup or 114 g
48 scoops or 2 cups or 228 g
7 fl oz
11 fl oz
21 fl oz
42 fl oz
Use a gram scale for the most accurate results.
Household measurements
1 cup
½ cup
⅓ cup
¼ cup
1 Tbsp
1 tsp
½ tsp
114 g
57 g 35 g
30 g 7 g
2 g
1g
Household measurements are approximations only. For accuracy use a gram scale.
How can Neocate be stored?
• Prepared formula can be stored in a refrigerator for up to 24 hours
• Once a bottle is introduced to your infant’s mouth, all formula
remaining in the bottle should be discarded after one hour
• Opened cans of Neocate with plastic lid securely fastened should
be stored in a cool, dry place and used within one month
• Sealed cans of Neocate should be stored in a cool, dry place and
used by the expiration date, which is located on the bottom of
each can
What is the best way for me to warm the Neocate
once it has been prepared?
As with any other infant formula, a microwave oven should not be
used to reheat Neocate, as this can lead to “hot spots” in the formula.
It is recommended to place the prepared bottle either under warm,
running water, or in a container filled with warm water.
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Nutrient Profile
Nutrients Per 100 g
Per 100 kcal
Calories 421
100
Protein Equivalent, g
13
3.1
Fat, g
19.1 4.5
Carbohydrate, g
49.3 11.7
Linoleic Acid, mg
2850
677
Vitamins
Vitamin A, IU (mcg RE)
1648 (495)
391 (118)
Vitamin D3, IU (mcg)
252 (6.3)
59.9 (1.5)
Vitamin E, IU (mg a T.E.)
4.8 (3.2)
1.14 (0.76)
Vitamin K, mcg
37 8.79
Thiamine, mcg 390 92.6
Riboflavin, mcg
580
137.8
Vitamin B6, mcg
520
123.5
Vitamin B12, mcg
1.1
0.26
Niacin, mcg
6500
1544
Folic Acid, mcg
43
10.2
Pantothenic Acid, mcg
2610 620
Biotin, mcg 13 3.1
Vitamin C, mg
39
9.26
Choline, mg
55
13.1
Inositol, mg
98
23.3
Minerals
Calcium, mg
522
124
Phosphorus, mg
392 93.1
Magnesium, mg
52 12.4
Iron, mg
7.8
1.85
Zinc, mg
7
1.66
Manganese, mcg
380
90
Copper, mcg
520
124
Iodine, mcg
65
15.4
Molybdenum, mcg
20
4.75
Chromium, mcg
15 3.56
Selenium, mcg
15.7
3.73
Sodium, mg
157
37.3
Potassium, mg
653
155.1
Chloride, mg
325 77.2
Energy Distribution
Protein
12%
Carbohydrate
47%
Fat (MCT 33% / LCT 67%) 41%
Osmolality @ 20 kcal/oz
375 mOsm/kg 18
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Ingredients:
Corn Syrup Solids (57%), Refined Vegetable Oil (Medium Chain Triglycerides
(Palm Kernel and/or Coconut oil) (7%), High Oleic Sunflower (7%), Soy
(6%)), Calcium Phosphate Dibasic (2.5%), and less than 2% of each of the
following: L-Arginine L-Aspartate, Tripotassium Citrate, L-Leucine, L-Lysine
Acetate, L-Glutamine, L-Proline, L-Valine, Glycine, L-Isoleucine, CAEM (an
emulsifier), L-Threonine, L-Phenylalanine, L-Tyrosine, L-Serine, L-Histidine,
L-Alanine, Sodium Chloride, L-Cystine, L-Tryptophan, L-Methionine,
Magnesium Acetate, Magnesium L-Aspartate, Potassium Chloride, M. Alpina
Oil*, Choline Bitartrate, M-Inositol, C. Cohnii Oil**, L-Ascorbic Acid, Ferrous
Sulfate, Zinc Sulfate, Taurine, L-Carnitine, Sunflower Oil, Niacinamide,
DL-alpha Tocopheryl Acetate, Calcium D-Pantothenate, Cupric Sulfate,
Manganese Sulfate, Pyridoxine Hydrochloride, Riboflavin, Vitamin A Acetate,
Thiamine Chloride Hydrochloride, Ascorbyl Palmitate, Potassium Iodide,
Chromium Sulfate, Mixed Tocopherols, DL-alpha Tocopherol, Phylloquinone,
Sodium Molybdate, Folic Acid, Sodium Hydrogen Selenite, D-Biotin,
Vitamin D3, Cyanocobalamin
* A source of Arachidonic Acid (ARA)
** A source of Docosahexaenoic Acid (DHA)
A Guide to Understanding Your Child’s Food Allergies
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Nutricia Family of
Products for Infants
and Children
Notes
Infant - 10 Years of Age
A family of nutritionally complete elemental formulas and
medical foods for indications which can include:
• • • • • • multiple food protein intolerance
cow and soy milk allergy
gastrointestinal tract impairment
eosinophilic esophagitis
gastroesophageal reflux
malabsorption
For product information or to place an order call
1-800-NEOCATE or visit our website
www.Neocate.com
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21
Order direct and SAVE!
For lowest prices, free shipping and product specials,
s,
order Neocate Infant DHA and ARA at
www.OrderNeocate.com or call 1-800-Neocate.
Free of dairy, full of nutrition
Nutricia North America • Rockville, MD 20850
Tel: (800) 365-7354 • Fax: (301) 795-2302
www.Neocate.com
ZNPG 09/09