GRSNNZ & Crying Over Spilt Milk are funded by NZ Lottery Grant Board.

Please be aware that Breastfeeding is best for all infants especially those with Gastric Reflux.  Artificial milk/formula, AR (thickened) or standard will not cure reflux.  If you are considering Artificial Feeding please contact your Midwife, Plunket nurse, Doctor, or Specialist before introduction.

 Caution!
Infant Gaviscon Powder also acts as a thickener and cannot be used in conjunction with any AR formula or other thickening product.

 
What is AR formula
 
AR stands for AntiRegurgitation

What do the manufacturers use as thickeners? 
 
Some manufacturers use:
 
Pre – Cooked corn starch 
 
Carob Bean
Carob bean flour is not broken down by the enzymes in the mouth or the gastric acid and so retains its thickening properties. It is a soluble dietary fibre and adds volume to the bowel motions.
 
Rice flour
Rice flour is not as common in NZ/Australian manufactured AR formulas.
 
What are casein and whey?
 
Whey and casein are the two main types of protein found in milk. Breast milk is whey predominant and cow’s milk is casein predominant. AR formulas (including Karicare AR and S26 AR) are casein predominant as the casein protein helps to increase the viscosity of the feed in the stomach.
Whey is watery and bluish in colour. Whey is digested more quickly than casein.
 
Breast milk
Breast milk is whey dominant and has the perfect blend of fats that are easily digested.  Although breast-feeding a baby with Gastric Reflux can be stressful and time consuming it is nature’s complete, perfect food.  GRSNNZ has a story on breastfeeding if you need to know that your concerns are understood and shared.
 
How does AR formula work?
 
AR formula has a thickener: cornstarch, carob bean, or rice flour. The thickening agents differ in their action; some thicken in the infant’s stomach, others are already thick and maintain the consistency of the feed all the way to the stomach. The theory behind all is that the thicker stomach contents are harder to regurgitate and there is a reduction in the symptoms of reflux.
Some thickened formulas such as Karicare AR lower the fat content of the formula to enhance gastric emptying and reduce the likelihood of regurgitation – digestion and absorption of nutrients is not compromised.
Although breast milk is a thinner consistency it is very easily digested and the absorption process commences immediately. 
 
Can AR formula contribute to constipation? 
 
Generally if formula is made correctly according to manufacturer’s instructions constipation is not likely. The infant may take some time to adjust to a new feeding type and stools will differ in consistency to a fully breastfed baby. Some infants suffering from gastric reflux have a problem with gut motility and this can lead to constipation as well as reflux symptoms. If your baby has problems with constipation this needs to be addressed by your GP, specialist or midwife. 
 
Do I need different feeding equipment when using AR formula?
 
Yes
Ordinary plastic, glass, feeding bottles of any brand are fine.
AR formula is thicker in consistency and baby may find it hard work to get the feed fast enough and may object to the slow flow or fall asleep trying.  To solve this problem parents have recommended a variable flow teat, which has a slow, medium, and fast setting.  Avent have a variable flow teat if you have chosen to use a wider neck style of bottle.  If you have chosen to use a narrow neck bottle, NUK Anti–colic Cereal teats would be very helpful. NUK have a medic Pro range of teats - some come with the Anti – colic valve which keeps the air flow consistent between the inside and outside of the bottle and prevents large amounts of air being gulped down and encourages uninterrupted feeding.  In turn this constant flow prevents the teat being sucked flat during feeding.  NUK also have teats for Cleft lip, jaw and palate.  
Karicare recommend the use of a medium or fast flow teat for Karicare AR.
 
How do I mix AR formula?

• Follow the manufacturer’s instructions.

• It is not recommended to make any formula in advance for food safety reasons.

• Water should first be boiled and allowed to cool.  Refrigerate if desired. To save time you can have a supply of bottles filled with the correct amount of cooled boiled water. The bottle for a feed can then be heated to feeding temperature and the formula powder added just before feeding.

• Wyeth who makes S26 AR offers a water temp indicator strip, (on a magnetic card that attaches to the fridge when you’re not using it) which is wrapped around the outside of the bottle of water and indicates when the water is the right temperature. Water thermometers can also be purchased – try your local pharmacy or baby shop.

• Do not add powder if the water is not the correct temperature or it will not disperse properly and could become lumpy and set before the feed can commence.

• Add the exact amount of powder to water.

• Apply cap and shake well.

• If warming formula before feeding, take care not to over heat, or premature thickening will occur.  Discard any remaining formula after the feed.

• AR formula will start to thicken straight away.

DISCLAIMER: This information on AR artificial feeding is provided for general information only and is not a substitute for professional medical advice. GRSNNZ are not responsible or liable for any diagnosis or action made by a user based on the content of this Fact sheet.  GRSNNZ does not endorse any commercial product or manufacturer mentioned in this fact sheet. Always consult your own doctor if you are in any way concerned about your child’s health.
 
Reference and appreciation to:
Karen, GRSNNZ member, Nurse and mother of twins,
http://www.clinicalevidence.com/ceweb/conditions/chd/03 10/0310_i10.jsp   
Wyeth Nutrition - Health professional information
Tara Chaplow, NZ Registered Dietician, Nutricia Advisory Service
Composition of formulas from the Karicare site - Page no longer available on website.
Bottle Babies – A NZ guide to guilt – free bottle feeding by Adelia Ferguson
Nutrition food services Royal Children’s Hospital. Formula Composition Table
Shalimar School of Natural Therapies Physiology and Anatomy course content
Breastfeeding the Baby with Reflux - (L015 - $6) from La Leche League.  Contact at admin@lalecheleague.org.nz or LLLNZ, PO box is 50780, Porirua 5240, Ph/Fax: 04 471 0690
 
Written by Jennifer Howard, National Coordinator © Crying Over Spilt Milk Gastric Reflux Support Network New Zealand for Parents of Infants and Children Charitable Trust July 2004. Revised by Roslyn (Roz) Ballantyne (RN), Regional Coordinator and Jennifer Howard, National Coordinator June and August 2005.
 
This page may be printed for the personal use of families, as long as the copyright and source (i.e. Crying Over Spilt Milk’s URL) is also printed. It may not be copied to other websites or publications without permission.
 
www.cryingoverspiltmilk.co.nz
 

Page last modified 01-Nov-2007 by Roz (Website Manager, Crying Over Spilt Milk).