EN Pediatric Formulas

Polymeric; Standard Volume | Polymeric; Concentrated Volume | Hydrolyzed; Standard Volume

Hydrolyzed; Concentrated Volume | Elemental | Blenderized

Back to all formula guides

Polymeric; Standard Volume

Composition	Formula Brand Name, Manufacturer	Specifics	HCPCS code	Additional Details
Milk Based	Boost® Kid Essentials 1.0 Retail, Nestlé	does not contact soy ingredients	B4158	Gluten-free, kosher, lactose
Milk Based	Boost® Kid Essentails 1.0 Instutional, Nestlé	does not contact soy ingredients	B4158	Gluten-free, kosher, lactose
Milk based	PediaSure® Reduced Calorie, Abbott	Gluten free, reduced calorie	B4160	Gluten Free, Lactose intolerance
Milk and Soy Protein	PediaSure® Enteral Formula 1.0 Cal, Abbott	contains soy	B4160	Gluten-free, halal, kosher, kosher made with dairy ingredients, suitable for lactose intolerance
Milk and Soy Protein	PediaSure® Enteral Formula 1.0 Cal with Fiber, Abbott	contains soy	B4160	Gluten-free, halal, kosher, kosher made with dairy ingredients, suitable for lactose intolerance
Milk and Soy Protein	PediaSure® Grow & Gain Therapeutic Nutrition Shake, Abbott	contains soy	B4160	Gluten-free, halal, kosher, suitable for lactose intolerance
Milk and Soy Protein	PediaSure® Grow & Gain with Fiber Therapeutic Nutrition Shake, Abbott	contains soy	B4160	Gluten-free, halal, kosher, suitable for lactose intolerance
Milk and Soy Protein	PediaSure® Grow & Gain with Fiber, Abbott	Contains soy	B4159	Gluten-free, halal, kosher, suitable for lactose intolerance
Organic Pea Protein	Pediatric Standard 1.2, Kate Farms®	Vegan, no milk, no soy, no gluten, no nuts, no corn, with fiber	B4160	Gluten-free, lactose free, kosher, NON GMO
Whey Protein	Nutren Junior®, Nestlé	Contains soy	B4160	Gluten-free, lactose, kosher
Whey Protein	Nutren Junior® Fiber, Nestlé	Contains soy	B4160	Gluten-free, lactose, kosher
Food ingredients (chicken, milk, pea protein)	Compleat® Pediatric, Nestlé	No soy, no corn	B4149	Gluten-free, lactose, Non GMO ingredients
Food Ingredients	Compleat® Pediatric Reduced Calorie, Nestlé	No soy, no corn	B4149	Gluten-free, lactose, Non GMO ingredients
Food  Ingredients	Compleat® Pediatric Original 1.0, Nestlé	Non-GMO, no corn or soy, soluble and insolulble fiber	B4149	Gluten-free, suitable for lactose intolerance
Food Ingredients	Compleat® Pediatric Standard 1.0, Nestlé	Non-GMO, no dairy, soy, corn, nut	B4160	Dairy, lactose, gluten free, plant-based, vegan, kosher

Polymeric; Concentrated Volume

Composition	Formula Brand Name	Specifics	HCPCS code	Additional Details
Milk Based	Boost® Kid EssentialsTM 1.5, Nestlé	Contains soy	B4160	Gluten-free, kosher, lactose
Milk Based	Boost® Kid EssentialsTM 1.5  with Fiber, Nestlé	Contains soy	B4160	Gluten-free, kosher, lactose
Milk Protein	Pediasure® 1.5 Cal, Abbott	Contains soy	B4160	Gluten-free, halal, kosher, suitable for lactose intolerance
Milk and Soy Protein	PediaSure® 1.5 Cal with Fiber, Abbott	Contains soy	B4160	Gluten-free, halal, kosher, suitable for lactose intolerance
Organic Pea Protein	Standard 1.4, Kate Farms®	Vegan, no milk, no soy, no gluten, no nuts, no corn, with fiber	B4160	Gluten-free, lactose, kosher, NON GMO
Pea Protein Isolate	Compleat® Pediatric Standard 1.4, Nestlé	Plant based, vegan. L-Cystine is added. Prebiotic Fiber (PHGG), pea fiber.	B4160	gluten free, vegan, plant based, lactose free, kosher

Hydrolyzed; Standard Volume

Composition	Formula Brand Name	Specifics	HCPCS code	Additional Details
Whey Protein	Peptamen Junior®, Nestlé	60% of fat from MCT, hydrolyzed whey	B4161	Gluten-free, suitable for lactose intolerant, kosher, not suitable for galactosemia or cow's milk protein allergy
Organic Pea Protein with added L-Cysteine and L-Tryptophan	Pediatric Peptide 1.0®, Kate Farms®	Vegan, no milk, no soy, no gluten, no nuts, no corn, with fiber	B4161	Gluten-free, suitable for lactose intolerance, kosher
Whey Protein	Peptamen Junior® HP, Nestlé	high protein, with partially hydrolyzed soluble fiber	B4161	Gluten-free, suitable for lactose intolerance,  not for individuals with galactosemia or cow's milk protein allergy
Whey Protein	Peptamen Junior® Fiber, Nestlé	1.0kcal/mL,  with 4g/L partially hydrolyzed soluble fiber and 4g/L insoluble fiber	B4161	Gluten-free, lactose, not appropropriate for cow milk protein allergy, not appropriate for galactosemia
Whey Protein	Peptamen Jr  PHGG, Nestlé	1.2kcal/mL, contains milk protein, 12g/L plant based prebiotic fiber is from partially hydrolyzed guar gum (PHGG)	B4161	Gluten-free, suitable for lactose intolerance, not for individuals with galactosemia
Whey Protein hydrolysate and hydrolyzed sodium caseinate	PediaSure® Peptide 1.0 Cal Institutional-Retail (237mL), Abbott	hydrolyzed whey, Prebiotics from Nutraflora® scFOS®, DHA (32 mg per 8 fl oz) and lutein	B4161	Gluten-free, halal, kosher, suitable for lactose intolerance, not for galactosemia

Hydrolyzed; Concentrated Volume

Composition	Formula Brand Name	Specifics	HCPCS code	Additional Details
Whey Protein	Peptamen Junior® 1.5, Nestlé	Not appropriate for cow milk protein allergy, with 6 g/L partially hydrolyzed soluble  fiber	B4161	Gluten-free, lactose, kosher, not for galactosemia
Whey Protein/Casein	PediaSure® Peptide 1.5 Cal, Abbott	with fiber (5 g/L with 4.6g of fiber from scFOS), 32mg DHA per 8oz	B4161	Gluten-free, halal, kosher, suitable for lactose intolerance, not for galactosemia
Organic Pea Protein	Pediatric Peptide 1.5®, Kate Farms®	Vegan, no milk, no soy, no gluten, no nuts, no corn, no eggs, no fish, no shellfish, no wheat, no sesame with 20 g/L fiber	B4161	Gluten-free, lactose, kosher
Pea Protein, added L-cystine, Food Ingredients	Compleat® Pediatric Peptide 1.5, Nestlé	Plant-based and non-GMO* Ingredients; no dairy, soy, nut or other common food allergens; no corn ingredients. Contains prebiotic fiber PHGG	B4161	gluten free, vegan, plant based, lactose free, kosher

Elemental

Composition	Formula Brand Name	Specifics	HCPCS code	Additional Details
Free Amino Acid	EleCare® Jr, Abbott	No milk, no soy, no fructose, no galactose, clinically documented hypoallergenic	B4161	Gluten-free, halal, suitable for lactose intolerance, kosher, vanilla flavor contains phenylalanine
Free Amino Acid	PurAmino Jr, Mead Johnson	hypoallergenic, 100% free amino acids. Contains soy oil. Contains DHA.	B4161	lactose-free, kosher, halal, non-GMO
Free Amino Acid	Alfamino® Junior, Nestlé	nutritoinally complete, hypoallergenic formula. 65% of fat as MCT. Contains soy oil.	B4161	Gluten-free, lactose
Free Amino Acid	Vivonex® Pediatric, Nestlé	nutritionally complete, hypoallergenic formula, 70% of fat from MCT, contains soy oil.	B4161	Gluten-free, kosher, lactose
Free Amino Acid	Neocate® Junior: Unflavored without prebiotics, Nutricia	No dairy, no soy oil, hypoallergenic, no fiber	B4161	Kosher
Free Amino Acid	Neocate® Junior with Probiotics, Nutricia	No dairy, no soy oil, hypoallergenic, contains prebiotic fiber	B4161	Kosher
Free Amino Acid	Neocate® Splash, Nutricia	Ready to feed, sterile. No dairy, no soy oil, no casein, hypoallergenic	B4161	Kosher, gluten free, lactose free
Free Amino Acid	EquaCare Jr, Ajinmoto / Cambrooke	"same nutritional profile as Elecare Jr"	B4161
Free Amino Acid	Essential Care Jr, Ajinmoto / Cambrooke	No Milk, Lactose, Wheat, Gluten, Eggs, Nuts, Soy or Corn, includes DHA &  Lutein, no corn syrup, low FODMAP ingredients	B4161

Blenderized

Composition	Formula Brand Name	Specifics	HCPCS code	Additional Details
Food Ingredients	Compleat® Pediatric Organic Blends (chicken garden blend), Nestlé	Organic, non-GMO, no dairy, soy, corn, fortified with a vitamin/mineral to be complete nutrition	B4149	Gluten-free, lactose
Food Ingredients	Compleat® Pediatric Organic Blends (plant based), Nestlé	Organic, non-GMO, no dairy, soy, corn, fortified with a vitamin/mineral to be complete nutrition	B4149	Gluten-free, lactose, vegan
Food Ingredients	Compleat® Pediatric Original Reduced Calorie 0.6, Nestlé	Reduced calorie, non-GMO, no corn or soy, soluble and insolulble fiber	B4149	Gluten-free, suitable for lactose intolerance
Food Ingredients	Compleat® Pediatric Original 1.0, Nestlé	Non-GMO, no corn or soy, soluble and insolulble fiber	B4149	Gluten-free, suitable for lactose intolerance
Food Ingredients	Compleat® Pediatric Standard 1.0, Nestlé	Non-GMO, no dairy, soy, corn, nut	B4160	Dairy, lactose, gluten free, plant-based, vegan, kosher
Food Ingredients	Compleat® Pediatric Standard 1.4, Nestlé	Non-GMO, no dairy, soy, corn, nut	B4160	Dairy, lactose, gluten free, plant-based, vegan, kosher
Food Ingredients	Nourish, Functional Formularies®	Organic, vegan, no dairy, no nuts, no soy, no corn	B4149	Gluten-free, lactose
Food Ingredients	PediaSure Harvest®, Abbott	No milk, gluten, lactose, eggs, treenuts, peanuts, wheat, shellfish, or fish-containing ingredients, contains soy	B4149	Gluten-free, suitable for lactose intolerance
Food Ingredients	Pediatric Blended Meals -Mango and Straw, Kate Farms®	No milk, eggs, fish, shellfish,treenuts, peanuts, wheat, soybean or sesame		Gluten-free, lactose-free, plant-based, vegan
Food Ingredients	Pediatric Blended Meals - Squash and Carrot, Kate Farms®	No milk, eggs, fish, shellfish,treenuts, peanuts, wheat, soybean or sesame		Gluten-free, lactose-free, plant-based, vegan
Food Ingredients	Pediatric Blended Meals - Banana and Blue, Kate Farms®	No milk, eggs, fish, shellfish,treenuts, peanuts, wheat, soybean or sesame		Gluten-free, lactose-free, plant-based, vegan
Food Ingredients	Real Food Blends® -Orange Chicken, Carrots, and Brown Rice, Real Food Blends®	Free from soy, corn, dairy, peanuts, and artificial color/flavor	B4149
Food Ingredients	Real Food Blends® - Salmon, Oats, and Squash, Real Food Blends®	Free from soy, corn, dairy, peanuts, and artificial color/flavor	B4149	Gluten Free
Food Ingredients	Real Food Blends® - Quinoa, Kale and Hemp, Real Food Blends®	Free from soy, corn, dairy, peanuts, and artificial color/flavor	B4149
Real food ingredients	Real Food Blends® - Beef, Potatoes, and spinach, Real Food Blends®	Free from soy, corn, dairy, peanuts, and artificial color/flavor	B4149
Food ingredients	Real Food Blends®- Eggs, Apples, and Oats, Real Food Blends®	Free from soy, corn, dairy, peanuts, and artificial color/flavor	B4149	Gluten Free
Food Ingredients	Real Food Blends® - Turkey, Sweet Potatoes, and Peaches, Real Food Blends®	Free from soy, corn, dairy, peanuts, and artificial color/flavor	B4149
Organic Pea Protein	Nourish Peptide, Functional Formularies®	Organic, vegan, no dairy, no nuts, no soy, no corn	B4149	Free of tree nuts, gluten, dairy, soy, corn and BPAs.
Organic Pea Protein	Nourish Peptide - Berry Medley, Functional Formularies®	Organic, vegan, no dairy, no nuts, no soy, no corn, 8grams prebiotic vegetable fiber	B4149	Free of gluten, dairy, soy, corn and BPAs.
Organic Pea Protein; Food Ingredients	Compleat® Pediatric Peptide 1.5, Nestlé	Plant-based, non-GMO, MCT, soluble, insoluble fiber, no dairy, soy, nut corn	B4161	Non-GMO, Vegan, Dairy-free, Lactose-free, Gluten free, Plant-Based, Kosher
Organic Pea Protein; Food Ingredients	Compleat® Pediatric Peptide 1.0, Nestlé	Plant-based, non-GMO, MCT, soluble, insoluble fiber, no dairy, soy, nut corn	B4161	Non-GMO, Vegan, Dairy-free, Lactose-free, Gluten free, Plant-Based, Kosher