Neocate, an “elemental formula” for infants and young children manufactured by Nutricia, has been linked to a number of disorders that result in soft, brittle bones and skeletal deformities. The root cause is a condition known as hypophosphatemia(HPP), usually caused by insufficient phosphorus in the diet. Lawsuits allege that the manufacturer was either aware or should have been aware of the problem and failed to warn consumers.

Common sources of phosphorus include eggs, legumes, nuts, and dairy products. Once ingested, the body’s metabolic processes combine phosphorus with oxygen to produce phosphate, which is necessary to bone health. Unfortunately, some infants and children are unable to tolerate these foods because of digestive disorders.

Elemental or amino-based formulas such as Neocate were developed to address this problem. Such formulas are literally created from the ground up, using amino acids, the basic building blocks of life. This makes them more easily digested, and are therefore indicated for infants and children with various types of protein intolerance and food allergies.

Problems with Neocate became apparent when the father of a 10-year-old boy in Mississippi found himself the target of an investigation by Child Protective Services in late 2017. His son, born with cerebral palsy and suffering from multiple medical issues, had been fed Necoate most of his life.

As reported in the Jackson Clarion Register, doctors had discovered that the child suffered from bone fractures that could not be explained. Suspecting that the boy had been abused, they filed a report with CPS as required by law. It was not until the boy’s adult sister told their father about an advertisement by a local litigation attorney who was investigating Neocate-related injuries that the connection was made.

It was in April of 2017 that researchers published a study in the journal Bone, which discovered the link between Neocate and bone disorders, specifically HPP. The good news is that when children were given phosphate supplements or changed over to a different formula, their symptoms improved. Since then, Nutricia has changed the product by adding a form of phosphate to Neocate that is more soluble and therefore more easily processed and absorbed during the digestive process.

The role of phosphorus in bone development and maintenance was established in 2002 after a study was published in the Journal of the American College of Nutrition. Researchers found that phosphorus is necessary for the function of calcium; they are in fact “co-dependent.” Additionally, more than 50 percent of bone make-up consists of phosphorus.

Parents with children who must subsist on elemental formulas should be aware of signs of HPP. In addition to bone fractures and pain, these symptoms can include tremors or seizures, respiratory distress, mental confusion and overall weakness. While phosphorus supplements can reverse HPP, it is important to consult with a physician before making any changes to the child’s diet if they have special needs.

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K.J. McElrath is a former history and social studies teacher who has long maintained a keen interest in legal and social issues. In addition to writing for The Ring of Fire, he is the author of two published novels: Tamanous Cooley, a darkly comic environmental twist on Dante's Inferno, and The Missionary's Wife, a story of the conflict between human nature and fundamentalist religious dogma. When not engaged in journalistic or literary pursuits, K.J. works as an entertainer and film composer.