Thickened Feeds For Babies
Caring for a baby with reflux can be stressful and exhausting. In your search to find out what you can do to help, you may have heard about thickened feeds.
There are a variety of thickeners available.
For example, there are commercial milk thickeners, rice cereal, ‘cornflour’ (made from corn or wheat) or bean gum.
The idea behind the use of thickened feeds is to make feeds heavier, to try to keep them down in the stomach and not rise back up the oesophagus and out the mouth.
But, do thickened feeds actually help a baby with reflux?
Can they cause any problems?
Here are 5 important facts about thickened feeds:
#1: No Formula Has A Place Treating Reflux In Breastfed Babies
This point may be shocking or surprising to hear.
Formula feeding or mixed feeding your baby?
Anti-reflux (AR) formula is often suggested if your baby has been diagnosed with gastro-oesophageal reflux disease (GORD).
AR formula differs from standard cows’ milk based formula, because it contains added thickener (e.g. some of the lactose is replaced with starch).
Unfortunately, formula companies are well known for making big claims about their products, and AR formula is no different.
There is no reputable scientific evidence that AR formula actually helps babies with reflux.
In addition, many parents find AR formula difficult to make up, as they find it tends to cause clumping.
It’s not recommended to use this type of formula (or any formula) as a treatment for reflux in a breastfed baby.
Some babies with reflux may actually have a cows’ milk protein sensitivity.
This is because reflux can actually be a sign of a cows’ milk protein sensitivity.
In such a situation, AR formula (or even lactose-free formula) will not help, because both they both contain cows’ milk protein.
If a breastfed baby has a cows’ milk protein (or any other food) sensitivity, a dietitian can help plan a diet suitable for a mother.
For a formula fed baby with a cows’ milk protein (or any other food) sensitivity, a paediatrician can help prescribe a suitable formula.
It’s very important to find a medical professional who can correctly diagnose such problems.
Lactose intolerance is often wrongly diagnosed for a range of problems too.
One example is cows’ milk protein sensitivity. Find out more here.
#2: Thickened Feeds Don’t Stop The Reflux
According to Australia’s peak health body, the National Health and Medical Research Council (NHMRC), thickening of feeds “has some benefit in decreasing the amount regurgitated, but is not effective in decreasing the number of episodes of GOR [gastro-oesophageal reflux] or acid exposure, and thus has no real place in the management of complicated GOR.”
In other words, thickeners can reduce how often a baby vomits, but not alter how often his stomach contents rises into his oesophagus.
Less vomiting is worthwhile if it’s deemed to be contributing to a baby not gaining enough weight.
Thickeners are not recommended for babies who are healthy and growing well.
It has been hypothesised that rather than thickening feeds and making them sit in the stomach for longer, it may actually be better to have liquid move through the stomach more quickly.
As a result, this may minimise the possible window for reflux to flow back up again.
#3: Thickened Feeds Cause Practical Problems For Breastfeeding
Obviously, breastmilk which is fed straight from the breast cannot be thickened.
Some breastfeeding mothers may have attempted to add thickener to their expressed breastmilk (EBM).
This doesn’t work since the live enzymes in the EBM breaks down the starches that make up many thickeners.
Adding thickeners to EBM also changes the carbohydrate balance of the EBM.
#4: Some Thickeners May Actually Make A Baby Feel Worse
Unfortunately, some thickeners can actually make a baby feel worse, and have been associated with:
- Colic
- Diarrhoea
- Constipation
- Increased coughing
#5: Thickeners Feeds May Be Dangerous
The NHMRC indicates that feed thickeners have some adverse effects, such as increasing the length of time it takes for feeds to pass through the stomach, and even increasing reflux.
For premature babies, it’s even more important to not add anything to their feeds unless under medical advice.
Some commercial thickeners have been linked to an increased risk of necrotising enterocolitis, a serious and life-threatening condition where tissue in the intestines becomes inflamed and dies.
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It’s important not to give a baby thickened feeds unless advised by a doctor. Since gastro-oesophageal reflux disease can be associated with medical problems, exclusive breastfeeding (i.e. without any thickeners, etc) is advisable whenever medically possible. This is because lack of exclusive breastfeeding carries risks.
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How does this help a mother who has a reflux baby and can’t breastfeed as she has no milk ducts?
It helps her by giving her facts and information to be able to discuss the next action with her healthcare providers. She can choose to feel empowered and in control of the decision making process by knowing information that many don’t – even doctors themselves.
I’m sorry to hear if you’ve had a difficult journey breastfeeding, but all mothers deserve access to factual information so they can make the most informed decisions possible. It’s common for mothers to know more about breastfeeding than their GPs because doctors do not get breastfeeding training in medical school. Nor do they get training on how to support mothers who end up in upsetting situations no matter if they want to breastfeed or formula feed.
IBCLCs are a great source of support for all mothers, even helping mothers transition from breastmilk if they are diagnosed with cancer, or if they are just ready to move on. They are a great ally, but only a woman herself can decide how she’s going to feel and react to situations.
My 4 wk old baby, although not formally diagnosed with reflux, was bringing up the majority of a regular Nan HA 1 formula. It was suggested he be put on an AR formula but instead of vomiting all the time it gave him the poos. I have been to several clinics and Drs who seem quick to class it as a “maturity” issue and seem to think he will soon outgrow it, although it does not help me now. I don’t want to keep buying different formulas if it’s something in them that are causing the issues. The AR formula stopped the vomiting completely, it’s such a shame it’s now coming out the other end. Any suggestions? Could he have an allergy to cows milk? Could he be sensitive to the thickening agents? What would you do? I’m at a loss, it’s been the most stressful 4 wks of my life!
I have tried many things to keep breastfeeding rather than putting my baby onto thickened formula, but the thickened formula was practically a miracle cure. I am so glad that I didn’t read this before I had a go because my poor baby would have suffered a lot of unnecessary reflux pain.
I appreciate the motivation of wanting to keep people breastfeeding, but I think the most useful thing to achieve that would be explaining how you can thicken breast milk rather than just saying ‘don’t do it’.
I love this reply! This is exactly what I felt here – this article is really useless as it doesn’t address how to help a baby and discourages the only options available to many moms!
I am in the same boat as you and trying the thickened formula as advised by her pediatrician. She was screaming at all feedings before. This article seems it’s written to scare moms out of doing anything besides breastfeeding and has no alternative for babies with reflux!!!
As of now this article reads as a scare tactic in my opinion. I see a lot of claims with little sources. My daughter is almost 8 weeks old and was screaming at every feeding whether it be breast or expressed breast milk from a bottle. She was also crying nearly all day and only quiet when she slept. We thought it was colic when she would cry up to 6 hours in the evening but when it came to during the day and meal time, the doctor said reflux. He suggested thickening with cornflour.
“It has been hypothesised that rather than thickening feeds and making them sit in the stomach for longer, it may actually be better to have liquid move through the stomach more quickly, as this may minimise the possible window for it to reflux back up again. – See more at: https://www.bellybelly.com.au/baby/5-facts-about-thickened-feeds-for-babies/#comment-102811”
“For premature babies, it’s even more important to not add anything to their feeds unless under medical advice. Some commercial thickeners have been linked to an increased risk of necrotising enterocolitis, a serious and life-threatening condition where tissue in the intestines becomes inflamed and dies. – See more at: https://www.bellybelly.com.au/baby/5-facts-about-thickened-feeds-for-babies/#comment-102811”
Where are your sources? The link doesn’t work in the second excerpt.
Curious if there might be another way (if not thickener) of preventing baby from choking on liquid/reflux that comes up through throat/nose causing baby to struggle breathing while trying to swallow the liquid back down? Any tips – because this freaks me out all the time. Also concerns me for aspiration.
Hi Nicole, just wondering if you have had any responses and have any tips/information since you posted this? I have a 12-week old and share your exact feelings – I’ve been freaking out every time he makes choking sounds and it’s been going on for about two weeks now. He has been growing really well (just got back from an appointment with our GP) and is in the 85th percentile for weight but he doesn’t sleep well, which means I don’t either (got very little sleep in the past two weeks…) So I’d appreciate if you have any helpful information to share. Many thanks!
As some one who has never breast fed and never will because I am a guy it’s hard for me to have experience with breastfeeding directly, but I am a physician and a father of children who were breast fed, and who did have GORD and colic, and I think what this article is trying to emphasize is that there is not real substitute for breastfeeding. And while breast feeding is not celebrated as much as it should, in the media or daily culture, it is really the best for babies whether or not they have GORD, ( GERD in the US). So while u may want to relieve your baby of the spit up or perceived pain, as a caring mom, you also want all or many of the other benefits that come with breastfeeding like stronger immune systems, lower chances of obesity and diabetes and increase intestinal health and increase brain function. So as the article said, if your baby is growing and gaining weight there is no need to use formula or to thicken the feed. I think patience is the best treatment for benign infantile GORD. Dr Hannam.
Dear Kelly
Could you please comment on the findings of this Cochrane Review (Dec 2017) which seem to contradict some of what is said in this article? https://www.cochrane.org/CD003211/NEONATAL_feed-thickener-infants-six-months-age-gastro-oesophageal-reflux
“We found that term babies with GOR given feed thickeners had nearly two fewer reflux episodes per day. Babies with GOR were also 2.5 times more likely to have no reflux symptoms if feed thickeners were used. No studies reported information on failure to thrive (i.e. poor growth). We found that babies with GOR given feed thickeners showed an improvement in an important measure of acid reflux obtained from pH study. Reflux index (i.e. percentage of time of acidic reflux of pH < 4) was 5% lower in babies given feed thickeners. No major harms were reported in the eight studies."
Thank you
Isabelle