Infant reflux, or spitting up, is common in babies as their digestive systems mature. It occurs when stomach contents flow back into the esophagus, often due to an underdeveloped lower esophageal sphincter. While usually harmless and self-resolving, it can cause discomfort. Thickened formula is a dietary adjustment considered to manage these symptoms.
Understanding Thickened Formula
Thickened formula increases feeding viscosity, reducing the backward flow of stomach contents into the esophagus. This makes it more difficult for the formula to be regurgitated. Studies indicate thickened feeds decrease reflux episodes in full-term, formula-fed infants, though their impact on non-regurgitation symptoms like irritability is less clear.
Various types of thickeners are used in infant formulas. Rice starch and corn starch are common choices, often absorbed into the digestive system, and thicken in the stomach when exposed to stomach acid.
Carob bean gum is another thickener, fermented by intestinal flora, which may cause distension or discomfort. Gum-based thickeners, including xanthan, carob bean, guar, and gellan, can differ from starch-based thickeners in taste, texture, and how they affect viscosity over time. Pre-thickened “spit-up” formulas often use rice starch and are designed to thicken further in the stomach, while maintaining nutritional balance.
Preparing and Administering Thickened Formula
When preparing thickened formula, follow instructions to ensure proper consistency and prevent lumps. If using infant cereal as a thickener, pulverize flakes by crushing them or using a blender. This helps prevent nipple clogging.
Prepare thickened formula immediately before feeding, as its consistency can change and thicken over time. If using cold formula, mix the thickener after warming. Shake the bottle to ensure the thickener is well mixed.
Due to its thicker consistency, infants may require a different bottle nipple size for proper flow. Avoid cutting or altering nipples to increase flow, as this can be unsafe and increase the risk of choking or aspiration. Consult a pediatrician or feeding therapist to determine the appropriate nipple size.
Important Considerations and Potential Side Effects
Before introducing thickened formula, consult a pediatrician. This ensures it is appropriate for your infant’s needs and helps rule out other underlying conditions. Thickened feeds are not suitable for all infants and require medical supervision.
Thickened formulas can have side effects. Constipation is a common side effect, as the thicker consistency and larger protein molecules in some formulas can be harder for babies to digest. Other gastrointestinal issues, such as gassiness or loose stools, have also been reported.
Excessive weight gain is possible, as thickened formulas are associated with increased daily weight gain. They may also be linked to gastrointestinal dysmotility or, rarely, necrotizing enterocolitis, especially with certain thickeners in premature infants.
Complementary Strategies for Reflux Management
Beyond thickened formula, several strategies can help manage infant reflux symptoms:
- Keep the baby upright for 20-30 minutes after feeding (e.g., holding over shoulder, using a carrier).
- Burp frequently during and after feedings to release swallowed air.
- Avoid overfeeding; offer smaller, more frequent feeds to reduce stomach contents and decrease reflux.
- Stir formula instead of shaking to minimize air bubbles.