From what I have seen, both with my own kids and with many other babies whose adoptive mothers are supplementing their milk supply with formula, I think it is a very important issue that is often overlooked.  I found the flavor was a VERY big issue in the feeding problems my daughter, Julia, had when she was placed with me at six months old.  None of the professionals that had worked with her had thought about the flavor issue, when they decided to give vile tasting Pregestimil to a CDH baby, with a small stomach and overactive gag reflex.  They had put in a gastrostomy, and had been pumping the formula in through a tube, while they kept trying to get her take more of it by mouth, through a fast flowing premie nipple.  After I found something she liked (SMA, and also some goat milk), a bottle nipple that she could suck on without getting a large gulp, and making her feedings as nurturing as possible, she started gaining weight rapidly, without a drop going in through the tube.   I had a great time pulling the dumb thing out!  The way it sputtered when the tube first cleared the hole reminded me of opening a bottle of champagne, which I felt was fitting!  (I should also say that I have NOTHING against gastrostomies, in children who really need it.  Julia didn't need it!)

I have also needed to use Nutramigen with three of my boys, partly because I am very allergic to soy and couldn't use soy formula in the Lact-Aid or SNS so, when they had trouble with milk based formulas, that was the next logical choice.  My second and third sons both did OK on a combination of Nutramigen and breastmilk, but started refusing to take the Nutramigen by about six months old, which is a common time for babies to start being more picky about the taste of things.  Some babies who have been on one of these formulas since they were tiny will continue to take it, but I can't think of one I have ever seen who would start taking it at more than six months old.  However, although most younger babies will take it, my fifth child, Joseph, absolutely refused to suck on either a bottle or my breast with the Lact-Aid, that tasted of Nutramigen, from the time I picked him up at 15 days old.  Since milk based formulas didn't work with him and I felt like it was essential for me to be able to supplement my milk supply at the breast, I ended up using nothing but homemade formula based on fresh goat's milk with Joseph, which he did very well on.  

I think this is just one example of the need to try to consider what an infant with feeding problems is experiencing, before moving on to looking for more complicated explanations.  Trying to put ourselves in the place of the child can be very illuminating!

Darillyn
 
"Food Flavors Make Big Impression on Infants

Infant Formula, Mother's Diet Imprint Lifelong Food Habits on Newborns

Doesn't this make you want to eat this stuff?

"Most babies get milk-based infant formulas like Enfamil or Similac,
which are often described as being "sour and cereal-like." But for
babies with milk or protein intolerance or allergy, or with colic,
there are hydrolyzed protein-based formulas like Alimentum,
Pregestimil, and Nutramigen - which have a bitter and sour taste,
unpleasant smell, and horrible aftertaste, explains Mennella.""

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