AR Formula

AR Thickened Artificial Milk For Infants with Gastric Reflux

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 fiber 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
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 Coordinat 2001 – 2013, GRSNNZ for © Crying Over Spilt Milk Gastric Reflux Support Network New Zealand for Parents of Infants and Children Charitable Trust July 2004. Revised by Roslyn Ballantyne (RN), National Coordinator and Jennifer Howard, National Coordinator 2001 – 2013, GRSNNZ 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.

  • http://www.pinkymckay.com/how-can-i-get-my-baby-to-sleep-more-than-45-minutes/

      “I’m after some advice on how to get my baby to sleep longer than 45 minutes during the day. it seems to be a common topic with many mummies and i wondered whether you had already blogged this and if so if you could point me in the right direction to find it. Alternatively if you havent, do you th…

  • http://www.treasures.co.nz/Explore-your-stage/Article/?contentId=1784920 These won't work if your child is unwell or in pain, but are otherwise good tips.

    Sleeping through the night At this age and stage research by Dr Marc Weissbluth indicates that hunger is no longer why your baby is waking at night if they are a healthy weight and continuing to gain weight we can teach them to sleep from 7pm-7am. Your baby needs to be eating a healthy diet of carbo…

  • Hi everyone, It has been pointed out that new posts to the page by non-admin don't show up in your newsfeed. I don't want to repost them, but if you want to pop on over and share your experiences there are a few new posts from October.

  • Please do not advertise on our page. This is for sharing our experiences about Infant Reflux/GOR/GORD. If you would like us to link to your organisation or your page, please message the page. The GRSNNZ Committee will make the decision once you have provided us with information on the Governance of the Organisation, Source of your Information or your relevant NZ Health or Nutrition Qualification etc. Grumble over...

  • https://www.healthed.govt.nz/system/files/resource-files/HE2309.pdf Cool pictures, lovely mothers. Not saying that women who choose to bottle feed aren't wonderful mothers too, but this is neat promotion.

  • Hi there. Posting from the UK. Wanted to share our story to gain some more insight. We've had a really tough time. My first baby is 8 + weeks now and we've had no end of issues. She was tongue tied..snipped...but latch still a problem. She is mostly breastfed but using nipple shields. Occasional top up when i can't tolerate feeding her. She feeds or wants to feed constantly. Thought it was hunger but no different after a bottle of formula. Anyway...a friend mentioned she could have silent reflux...symptoms are constant feeding hand sucking...back arching fussing through feeds like she wants it but doesn't too. Struggles to sleep although sooo tired. Falls asleep on boob but wakes immediately after. Hiccups a lot. Sneezes a lot. Crys after feeds...weight has been slow to gain tho. Prescribed infant gaviscon...any experiences of this and is it likely to make her constipated if mostly breastfed?! Worried it feels like trial and error at her expense. She's so unsettled and we are really struggling....opinions welcome :)

  • The Cards are now available in an app for Android and Apple devices: http://allright.org.nz/our-projects/tiny-adventures/

    Our Pack of Tiny Adventures was developed to help parents to enjoy quick, fun and affordable activities with their children. It was developed in partnership with SKIP (Strategies with Kids Information for Parents) gives parents easy ways to connect with their kids - even if they only have a few min…

  • My 12 week old baby has reflux, currently on 5mg of losec in the morning novelac reflux formula, she also suffers with painful wind, lately she has been choking on her vomit, not sure if I should change to novo lac colic formula instead, we have tried soy and goats to which she spewed up a lot more than the ar formula, please help with suggestions , it is hugely stressful for our family

  • Cn u get formula made for babies with reflux on script?

  • I'm getting the September Newsletter ready. Is there anything anyone wants to contribute? Please let me know: https://www.facebook.com/roslyn.ballantyne.rn

  • Hi there are there any formulas that you can get on prescription or financial assistance? Pretty sure my 8 week old isn't coping with his formula that he's on. He has reflux and on ranitidine but now he has green mucousy poo so im thinking he might need some different formula? But I see specialist formulas are expensive!!

  • Hi, my 5 month old has started solids and we have been ok'd to feed these before milk as otherwise he spills most of it. He takes losec granules, which was have been giving with pear 30mins before a milk feed. Can we now just give these with his solids with milk following half an hour+ later? Or not due to the higher volume of food in his stomach so it wouldn't be digested by the time he has his milk. Thanks

  • Hi. We've used the karicare thickener in our boys bottles on top of losec and neocate to control his reflux. Now he's 4 months old I was looking at using watties rice cereal to thicken his bottles before moving to solids at 6 months. Looking to find anyone who thickens with rice cereal. Advice? Thank you

  • Argh! I don't know if I'm doing the right thing for my wee girl. We discovered her reflux early 8 days old and has been on goats milk formula for 3 months. Did it help? Hard to say but she was happy enough. We were reffered to the hosp dietician by our plunket nurse and on Thursday started neocate. Its made things worse and she seems in pain.. her poops are slimy green. We gave her a few gaviscon feeds with it to help her tum cos she seems to have a sore tummy a lot. So its Sunday, we've been on it three days but I am continually second guessing myself. Should we have seen a change in her by now. Is it normal to take a few days for the tummy to get used to it? I hate putting her through all this esp if it doesn't end up working... sometimes I just want to throw it in and put her back on goats milk... would love some advice from others on neocate or just any advice/encouragement please and thank you :)

  • Hi mums I have recently taken my daughter off losec on advise from a paed to see how she went. We didn't notice the symptoms coming back and also started solids around same time with it going great. She's had a cough and cold but is over it except this nagging cough which is day and night until she eventually throws up. My question is could the cough actually be the reflux and should I start losec again.