Crying Over Spilt Milk Thickening Agents for Reflux

THICKENER	INGREDIENTS	THICKENING ABILITY	FORMULA	BREASTFEEDS	KCAL/G	COMMENTS
Cornflour	Maize or wheat starch. Use maize cornflour for infants under one year of age.	Must be cooked.	One level teaspoon per 100ml of water. Boil then simmer for two minutes. Cool and prepare formula using thickened water.	Not suitable.	? absorbed	Not recommended for preterm infants.
Karicare Food Thickener	Pregelatinised maize starch, maltodextrin, locust bean gum.	-Thickens instantly. -Can be added directly to feeds.	Add to formula feed (1 – 3 teaspoons per 100ml).	Prepare gel and feed before, during or after feeds (1 – 2 teaspoons per 20 – 30ml breast milk or water).	3.6	Provides additional calories for babies with poor weight gain.
Nutilis	Modified maize starch.	Thickens over a few minutes, but does not continue to thicken. Remains thickened in the stomach but not as thick as when first mixed.	1 - 1.5 scoops per 100ml.		3.6	Not recommended under 12 months.
Resource Thicken Up	Pregelatinised waxy maize starch				3.3	Smoother but use in neonates not well documented. NB high sodium content (9.6mmol Na per 100g).
Carobel (Cow and Gate) *Not available in New Zealand.*	Carob bean flour, calcium lactate.	-Requires several minutes to thicken. -Can be added directly to feeds.	Add to formula feed (0.5% - 1%)	Prepare gel and feed before or during the feed 1 – 1½ scoops (1.8 – 2.7g) per 100ml water).		May increase stool bulk.

These thickeners are all currently available here in NZ (as indicated) through your local pharmacy and maybe some supermarkets. Please note though that pharmacies do not always keep such products in stock, and so you may need to ask that they get them in for you (usually takes 2-3 days).

· AR formulae - dairy based formulae with natural thickener added. Available through most supermarkets. eg Karicare AR, S26 AR.

· Thickening feeds with rice cereal (baby rice). You can experiment a bit with the consistency, but usually 1 tsp of rice per 30-50mls of formula is adequate. Some parents in countries other than New Zealand have been advised to use different cereals such as oatmeal because rice cereal may cause constipation. This is not recommended in NZ as it contains gluten – the early introduction of this may increase the risk of gluten intolerance developing.

· It also pays to remember when using thickened feeds that you may need to use teats with larger holes (medium/fast flow), and it is also best to mix Karicare food thickener and AR formulae with cold liquid (heat bottles after mixing).

· For very smooth results, Karicare food thickener may also be boiled into the water that you make up your formula with. Mix 20 teaspoons of Karicare food thickener with 1 litre of cold water in a pot on the stove. Bring to the boil, stir frequently. Once boiling point is reached, remove from the heat and allow to cool. When cool re-measure the thickened water and add the appropriate number of scoops of formula powder. An electric mixer is ideal for mixing the formula powder into the thickened water. The amount of Karicare food thickener in the recipe can be varied to suit, however, do remember that the mixture thickens the most as it cools.

Please consider checking with your doctor, child health nurse or dietician before including these in your baby's diet especially if they are under the age of six months.

© Gastric Reflux Association for the Support of Parents/babies (GRASP) and Crying Over Spilt Milk Gastric Reflux Support Network New Zealand for Parents of Infants and Children Charitable Trust (GRSNNZ) 2004. (Some content originally prepared by a Nutricia Dietician). Used and edited by GRSNNZ with permission.

Page may be printed or reproduced for personal use of families, as long as copyright and Crying Over Spilt Milk's URL are included. It may not be copied to other websites or publications without permission and acknowledgment. This information (unedited) was also provided (by GRASP) to health professionals in New Zealand to use " to continue to support and inform families with babies/children with Gastro-oesophageal Reflux."

Page last modified 25-Aug-2007 by Roz (Website Manager, Crying Over Spilt Milk).