A small percentage of infants and children develop cow’s milk protein allergy which is usually treated with exclusive breastfeeding or extensively hydrolyzed formulas. Some children might still be reactive to hydrolyzed formulas and would need elemental amino acid-based formulas. Elemental formulas are also frequently employed in treating very low birth weight babies with significant intolerance to regular preterm formulas and the resulting poor growth. All pediatric formulas are usually prepared as per international guidelines to fulfill the macro- and micronutrient requirements of growing children across a wide range of volume intakes. However, an interesting correlation is being reported recently, between the use of a specific elemental formula and the development of hypophosphatemia and significant metabolic bone disease. We discuss this phenomenon by exploring the available evidence and report 2 similar cases that we managed in our practice.
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