PurAmino™

Q: Where can I purchase PurAmino?

A: PurAmino is available through your local pharmacy, our online Home Delivery System, or by calling the Enfamil Resource Center at 1-800-BABY123. Although it does not require a prescription to purchase, PurAmino is not available on store shelves and needs to be special ordered.

Q: Can I get PurAmino covered by my insurance?

A: Insurance companies are not required to cover medical foods, but some do. Contact your insurance company directly to see if reimbursement is available. Click on Request Letter to download a letter you can take to your baby’s doctor. This letter establishes a medical need for the product and might help in getting your insurance company to reimburse for the product.

Q: How do I prepare a bottle of PurAmino?

A: PurAmino is mixed differently than other infant formula powders: it is mixed 1 scoop to 1 fl oz of water. Here are instructions for mixing the powder, which can also be found on the can label:

1. Wash your hands, bottles, and mixing utensils before preparing the formula. Accurate measurement and proper storage are important for safe and nutritious feeding for your baby.
2. Ask your baby’s doctor if you need to use cooled, boiled water for formula preparation and if you need to boil the clean utensils, bottles, and nipples in water before use. Note: Do not use hot tap water to prepare formula.
3. Never use a microwave oven to warm your baby’s bottle. Uneven heating can create hot spots that could burn your baby’s mouth. Put the bottle in a pan of warm water or hold it under warm tap water. Warm water is about 100°F, so it should feel neutral (neither warm nor cool) on your wrist.
   
   To make an individual bottle from powder, please refer to the chart below.

To Make*	Water†	Powder (use enclosed scoop to measure powder)	Weight
1 fl oz	1 fl oz	1 unpacked level scoop	4.5 g
2 fl oz	2 fl oz	2 unpacked level scoops	9 g
4 fl oz	4 fl oz	4 unpacked level scoops	18 g
8 fl oz	8 fl oz	8 unpacked level scoops	36 g

*Each scoop adds about 0.1 fl oz to the amount of prepared formula.
†Never use hot tap water.

4. Add the amount of powder stated in the chart to the water in the bottle. Use the scoop that came in the can to measure the powder. Store the DRY scoop in the can.
5. Attach the nipple, ring, and disc or nipple cover (depending on the type of bottle used).
6. Shake for about 5 seconds.

Q: How do I mix a quart of PurAmino?

A: Use these instructions only if your baby is drinking at least 32 fluid ounces of formula within 24 hours:

1. Wash your hands and the mixing utensils with soap and water before preparing the formula.
2. Measure 29 fluid ounces of water into a bowl or large container. This will make 32 fluid ounces of formula. The formula powder should be mixed with cool water (35 — 75°F); it should feel cool on your wrist.
3. Add 129 grams of powder to the water.
4. Beat the mixture with a clean fork until the powder is dissolved.
5. Pour prepared formula into bottles, or cover the container with a lid or plastic wrap.
6. Attach the nipple, ring, and disc or nipple cover.
7. Shake for about 5 seconds before feeding.

Q: How should I prepare PurAmino for my toddler?

A: This preparation is suitable for children older than one year:

1. Measure 29 ounces of cool tap water into a clean measuring jug or other container. This will make 1 quart of formula.
2. Add 129 grams of powder.
3. Mix well with a clean fork until the powder is dissolved.
4. Store covered in the coolest part of the refrigerator 35 — 40°F (2 — 4°C) no longer than 24 hours.

Tip: Your toddler will like the formula best if it is chilled and in a covered cup with a straw or in a drink bottle.

Q: What’s the best way to store PurAmino prior to feeding?

A: Recommendations for storing prepared formula made from powder:

Refrigeration
Store prepared bottles or covered container of formula at 35 — 40°F (2 — 4°C) no longer than 24 hours.

Room Temperature
Do not allow prepared bottles or covered cup to be at room temperature longer than a total of 2 hours.

If bottle has been warmed, discard after 1 hour.

After Feeding Begins
Feed within 1 hour or discard. Do not refrigerate for later feedings.

Q: How does cow’s milk cause an allergic reaction?

A: An allergy is an immune system response. We all have an immune system that gets rid of unwanted bacteria and viruses that make us sick. A food allergy occurs when the immune system mistakenly reacts to a food protein. The food protein causing the problem is called an allergen.

Cow’s milk protein allergy occurs when your baby’s immune system reacts to the proteins found in cow’s milk and treats those proteins as allergens. The result is an allergic reaction. The symptoms can include diarrhea, blood and/or mucus in the stools, red itchy scaly skin, vomiting, congestion, wheezing, running nose and hives.

If your baby is allergic to cow’s milk, it is possible she will also be allergic to milk from other animals, such as goat’s milk. Soy formula may also cause a reaction. It’s best to check with your baby’s doctor before trying these other formulas.

Q: Why is protein causing an allergic reaction in my baby?

A: Although it is not known why any particular baby will be allergic to cow’s milk protein, there are at least three things that make it possible: 1) your baby’s immune system is still very immature, meaning it is less able to distinguish harmful foreign substances from harmless protein; 2) the whole proteins in cow’s milk are made up of long strings of amino acids, which are able to stimulate an allergic response; and 3) your baby may have a stomach and intestine which are very sensitive to allergens. If the protein causes an immune system response, it causes allergic symptoms. What’s worse, if the problem goes on long enough, your baby may not gain weight and grow like he should.

Q: Do all formulas contain whole proteins?

A: The most popular routine infant formulas contain whole (intact) proteins, similar to breast milk. Formulas designed for mild intolerances, such as fussiness or gas, have the proteins partially broken down. These formulas are known as partially hydrolyzed and are not appropriate for babies with food protein allergies. There are also specialized formulas for infants with allergy symptoms who need an extensivelyhydrolyzed formula (the protein chains are broken down even further).

Q: What is a soy protein allergy?

A: Soy protein allergy is similar to cow’s milk allergy, but it is the soy protein that causes an immune system reaction.

Q: What are multiple food protein allergies?

A: Multiple food protein allergies are a reaction by the body’s immune system to the protein in two or more foods. When the food is eaten, a chain of chemical reactions occur within the body, causing symptoms such as itchy skin, hives, diarrhea, vomiting, and, sometimes, difficulty breathing. Most allergic reactions occur within 30 minutes of eating the food, but can occur as much as 4 — 6 hours later.

In young children, the foods most likely to cause allergies are cow’s milk, eggs, wheat, and peanuts.

Q: What’s the difference between a food allergy and food intolerance?

A: A food intolerance does not involve the immune system. Lactose intolerance is the most common type of food intolerance. Symptoms can include gas, bloating, stomach pain, or diarrhea. However, lactose intolerance is rare in babies and young children.

Q: I’ve heard that breastfeeding can keep my baby from developing allergies. Does this apply to cow’s milk protein allergy?

A: Although the incidence of cow’s milk protein allergy is very low in breastfed infants compared to formula-fed infants, it does happen. It is not an allergy to breast milk itself. Instead, the allergy usually begins after proteins, including cow’s milk protein, are passed from mom to her baby through breast milk. The symptoms may begin right away or it’s even possible for some very sensitive breastfed babies to develop a milk allergy from breast milk but not have a reaction until they actually drink cow’s milk.

If you are breastfeeding and your baby is showing allergic symptoms, elimination of common allergens such as cow’s milk, eggs, fish, peanuts, and tree nuts (e.g., almonds, pecans, and Brazil nuts) from your diet could help relieve the symptoms. It’s best, though, to check with your doctor or dietitian, to let them guide you on what to eat while breastfeeding.

If this doesn’t help the symptoms, check with your baby’s doctor.

Q: I have food allergies. Is it likely my child will grow up having food allergies too?

A: Even though children of parents with food allergies may develop food allergies, true food allergies are not as common as you might think. According to the American Academy of Pediatrics (AAP), 2% — 3% of infants are allergic to milk. The American Academy of Allergy, Asthma & Immunology reports that up to 8% of infants and toddlers may experience food allergic reactions, and 2% of adults experience food allergies. The common foods causing allergic reactions among adults are peanuts, tree nuts (e.g., almonds, pecans, and Brazil nuts), fish, and shellfish.

Most children outgrow cow’s milk protein allergy by the age of 3. However, this is not always the case. Doing something about the allergy as early as possible helps. Here are some other things you can do to lower the risk of food allergies for your baby:

• Don’t introduce solid foods until at least 6 months of age
• Breastfeed your baby until at least 1 year of age, if possible
• Introduce new foods in small portions and one at a time. Watch for a reaction (several days) before introducing the next food
• Talk to your baby’s doctor about delaying foods that commonly cause allergies such as peanuts, egg whites, or fish, until past age 2

Q: How is PurAmino different from other formula products?

A: PurAmino does not contain whole proteins. The protein in PurAmino is single amino acids, which are the building blocks of proteins. Because amino acids are smaller than whole protein chains, your baby’s body can digest and absorb them without risk of stimulating an allergic reaction. That means your baby can use PurAmino for normal growth and development.

Q: Where can I get more information about food allergies?

A: Here are some Web sites that will be helpful:

• Food and Nutrition Information Center of the National Agricultural Library/USDA
  Choose Topics A–Z, then highlight Allergies and Food Sensitivities
• http://www.foodallergy.org or phone 1-800-929-4040