One acid reflux treatment that is often effective and recommended by pediatricians is formula thickening to help keep the formula in the stomach rather than refluxing into the esophagus and more. In some cases a swallow study may be done to determine the best thickeness for your infant. The pros and cons are listed below as well as some general information on types of thickeners that can be used. Bear in mind that if your infant aspirates or weight gain is a concern, the best option is a gel thickener. Keep reading for the basics of thickening formula for reflux.
PROS & CONS OF THICKENING
- Milk/formula may stay down better and reduce overall amount of acid reflux or choking
- May eliminate the need for medication
- Added calories for weight gain (if thickening with cereal)
- May reduce lung complications for infants who aspirate
- Can help reduce chronic congestion and vomiting
- Might can make the choking and aspiration worse (swallow study can reduce this chance)
- The baby may reduce formula/breast milk intake
- Can decrease formula intake enough that dehydration becomes an issue
- Often the baby still needs acid reflux medication
- Can cause constipation (rice cereal)
Breast feeding and thickening
Requires pumping and feeding with a bottle
Rice cereal will not thicken breast milk (contains an enzyme that will break down the rice starch)
To thicken breast milk either oatmeal or a gel thickeners is needed
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 one teaspoon to one tablespoon of cereal should be added for every ounce of liquid. 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 OR 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:
Please read the current FDA warning regardin the use of Simpy Thick for infants:
Gelmix is a Carob Bean Gum AKA Locust Bean Gum and has a very little (if any) chance of an allergic reaction. to purchase or read
gel that is also based on xanthan gum to purchase or read
Thick It or Thicken Up:
Powder thickener based on corn starch and maltodextrin, 15 calories per tablespoon http://www.thickitretail.com/
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 barium swallow) 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.
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.