Formula Thickening Basics
Sometimes it is recommended that parents thicken their babies formula to help with acid reflux. The idea is that adding weight to the formula, or making it thicker, will prevent it from splashing around in the stomach and can help keep it down. This is a somewhat controversial practice and evidence as to whether thickening actually helps to control acid reflux is lacking. The pros and cons are listed below as well as some general information on types of thickeners that can be used.
Should I thicken or not?
Pros:
Milk/formula may stay down better and reduce overall amount of acid reflux or choking
Possibility for not needing medication if the thickened bottles stay down and prevent the refluxing
Added calories for weight gain
May be necessary in instances where the baby is aspirating the reflux in order to prevent aspiration and potential lung complications like asthma and pneumonia.
Can help reduce chronic congestion and vomiting
Cons:
Milk may still come back up, no matter how thick you make it and can make the choking and possible aspiration worse because it is thicker
The baby may increase caloric intake overall, but reduce the amount of formula/breastmilk
(which contains all the nutrients necessary for the first year of life).
Can decrease intake enough that dehydration becomes an issue
Early introduction of solids may possibly increase the risk of developing allergies
If breastfeeding, thickening means giving up feeding from the breast (would require pumping and feeding with a bottle to add in the thickener)
Often, even when the amount of spit-up is reduced, the baby still needs acid reflux medication, indicating that thickening is not preventing the reflux, but just preventing it from coming all the way out (reducing vomiting).
Cereal Thickening
Rice or oatmeal, single grain cereal are the two main cereal thickeners. When thickening with cereal, always introduce it slowly in case of a reaction. Each bottle needs to be thickened just prior to feeding, as it will continue to thicken if it sits. Generally, it is recommended that between one teaspoon and one tablespoon of cereal should be added for every ounce of formula. It is often trial and error to see what works best and how much to add for your infant. Some babies may react poorly to rice cereal because it tends to be constipating, so adding oatmeal instead may work better for some. When choosing a cereal for an infant with suspected allergy or milk/soy protein intolerance be sure to use Beechnut, Earth’s Best or Healthy Times as Gerber brands of baby cereals contain soy ingredients and may be contaminated with dairy.
Gel/Powder Thickening
Tasteless gel thickeners can be used in place of cereal to thicken liquids such as formula, juice and Pedialyte. Options for gel and pwder thickeners include:
Simply Thick:
calorie-free gel thickener with xanthan gum base http://www.simplythick.com/
Hydra-Aide:
gel that is also based on xanthan gum to purchase or read
Homemade gel thickener:
see recipe below
Thick It or Thicken Up:
Powder thickener based on corn starch and maltodextrin, 15 calories per tablespoon http://www.thickitretail.com/
Other Notes on Thickening
You may need to use a different nipple size for thicker formula, and it may take a few tries to get the best flow. Usually the y-cut nipples work better for cereal thickening. If thickening with gel or powder, you can often just go up a nipple size or two.
Generally it is recommended to start with the minimum amount of thickener and then work up to the thickness that works best for your baby. If you make the formula too thick, your infant will struggle to swallow and may begin choking.
In some babies, particularly when aspiration is an issue, thickening with cereal can cause lung infections due to the cereal particles getting lodged in the lungs during aspiration.
Swallow evaluations (see diagnostic testing) are very helpful in determining what thickness may be needed for your baby.
If thickening with cereal, it is helpful to run the dry cereal through a blender or food processor to produce a finer, more powder-like texture prior to thickening.
Thickened bottles take longer to heat than unthickened bottles.
Constipation (which makes reflux symptoms much worse) is a common side-effect of thickening with rice cereal.
Rice cereal will not thicken breastmilk. The milk contains an enzyme that will break down the rice starch, so if you need to thicken breastmilk you will need to use either oatmeal or one of the gel thickeners.
One undesirable effect of thickening can be excess gas. When the formula gets shaken, air gets trapped in it. If you are using a gel thickener, making batches ahead and allowing time in the refrigerator before feeding can help to reduce the gas as the air surfaces. Mylicon drops added to the formula is also a good option to help minimize the gas.
Homemade Gel Thickener Recipe
As always discuss thickening with your pediatrician before trying it. This is a hypoallergenic and tasteless type of thickener. Xanthan gum is derived from corn, so if your baby has a confirmed corn allergy, this thickener may not be recommended. It does not add extra calories to the formula.
This recipe will make 64 ounces for about $5 and contains no preservatives. It is best to make 16 ounce batches at a time to maintain freshness, and it must be stored in the refrigerator. One tablespoon will thicken 4 ounces of formula to a nectar consistency, and two tablespoons will thicken it to a honey consistency.
Ingredients
3 teaspoons of xanthan gum
8 ounces of water
Directions
Place the xanthan gum and water in a container that you can cover and use for vigorous shaking or use a hand mixer if you’d prefer. Shake the mixture like crazy. You will see clumps of the xanthan gum in the water - place it into the fridge and allow it to sit for about 8 hours while they dissolve
Repeat shaking every hour or two until there are no clumps and your mixture is consistent. This will produce a batch of gel thickener that you can mix into any drink. Depending on how thick you need the fluid will determine how much of the gel to use.
* Xanthan gum can be purchased at many stores or online at http://www.barryfarm.com/thickeners.htm
**Each 4oz. bag should make 128 ounces of thickener.
