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.
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 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 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 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?
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,
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 firstname.lastname@example.org 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.
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Hi Ladies, my 12 week old has silent reflux, was put on neocate with suspected milk intolerance but symptoms never went away untill we suspected reflux was put on gaviscon, helped alot, still wouldnt sleep in the day would wake crying so was put on losec, been on this for three weeks and stil no improvement. And he has started to spill now with every feed. Im wondering if the neocate isn't right for him and considering normal formula. Or would that make things worse?? Any ideas :) Thanks
Did you know that gastro-esophageal reflux disease can present as a behaviour disturbance?
Hi, im after some advice/help. I have a 7 week old son that has been diagnosed with servere reflux and colic.( he also has a upper lip tie and doesnt feed well anyway) We were prescribed infant gavison to help with the reflux but it has blocked him up horrendously. we were told to stop it and have been given a laxative to help clear him out. yesterday the doctor was talking about prescribing him an entensively hydrolysed formula (pepti Junior) and trialing before we can look at the Neocate as she thinks he may have a cows milk allergy. Today she has rung and said there is a new formula out from Karicare. Its called Karicare Plus comfort which is partially hydrolysed. And that i need to pick one and trial it. Im so confused and googling all this info has confused me even more. HELP PLEASE
Hi ladies, is it ok to give a reflux baby infacol wind drops?? Or will it make his reflux worse??? Thanks
The most efficient way to speak to one of the Gastric Reflux Support Network NZ staff is to text a message to 022 585 5935. Include your name, phone numbers or email and a brief explanation of why you are contacting us. We will contact you as soon as possible. Gastric Reflux Support Network NZ for Parents of Infants and Children Charitable Trust (GRSNNZ) appreciates your donations so that we can continue to support families coping with gastric reflux. http://www.givealittle.co.nz/org/GRSNNZ
Can you get samples of Neocate or similar from anywhere?
Does anyone know if there is any kind of parents support page for kids with allergies? Sorry not entirely reflux related but since they often go hand in hand thought id ask here. Thanks :)
The most efficient way to speak to one of the Gastric Reflux Support Network NZ staff is to text a message to 022 585 5935. Include your name, phone numbers or email and a brief explanation of why you are contacting us. We will contact you as soon as possible.
Hi there, I have just today searched for & found your page as I am desperate to find some relief for my 7.5 week old who is in pain & discomfort. My 7 week old was born 4weeks early via c-section & we are seeing a cranio-osteopath for a number of the interventions she needed during & post birth. After the last 2 treatments she has what seems like reflux symptoms, last time (3 weeks ago) was for 6 days, this time we are on day four. She screams for hours after feeds in pain, no holding position really works better than others, we just fluke a good position which may only offer a few minutes relief or she goes into an exhausted pained sleep. She can't sleep on her back in bed during the day (have tried propping it) so I either put her on her tummy (works sometimes) or hold her upright tummy to tummy at varying degrees on me in the ring sling, we need to sleep like that at night sometimes too. She used to wind well & was spilly at times but it didn't seem like an issue. Now she often doesn't burp or spill at all, gets tense & upset instead. Also her saliva gets so thick & it sounds like she's choking & struggling to breathe past it in her throat. I have tried shorter feeds more often but it doesn't really help - and how does this work if she is screaming for 2-3+ hours (more feeding makes it worse) then going to sleep? How will she get enough if every feed is smaller? I don't want to wake her as it all starts again & we both need to recharge too. Any advice much appreciated, I don't know what to do for her & it's so distressing!
http://www.medscape.com/viewarticle/812388?nlid=35583_2047&src=wnl_edit_medn_peds&uac=76049AV&spon=9 :-) - Conclusion is also that it is likely to do no harm either.
Studies vary too widely in products and dosages used to permit definitive conclusions, investigators say.
HAMILTON people - how many of you are out there and reading this post??? I'm just replying to a message regarding our COGS Funding Application for the Hamilton area. As our Trust has just moved from the Hamilton area to the Canterbury area, they want to know how many people we are supporting in Hamilton on a weekly basis. I know how many members we have in Hamilton, but of course we support more via our website and this Facebook page. Please LIKE this post if you are in Hamilton and reading this BUT only if you are in Hamilton. :-) Many thanks for your help. Roslyn National Coordinator Gastric Reflux Support Network NZ for Parents of Infants and Children Charitable Trust
Constipation with infant gaviscon...just wondering if baby's system "gets used to it"?
Sorry but need to vent...my daughter who is now 18months had a pre-op check today for her grommet procedure on Monday, met with another new doctor today who obviously only briefly read her file and noted reflux she then proceeded to check her arms and state how chubby she was and that would make inserting a drip harder and because she is reflux there is a chance the mask could make her sick - she then stated 'obviously she hasn't got bad reflux because she is still quite chubby!' um, well obviously you haven't been her doctor for the last 18months and have no idea of the ordeal the reflux actually has been fir her or our family...this made me wild! Anyone else encountered this attitude??
To my Gastric Reflux Support Network NZ email address "I am interested in buying some of your products for our clients in Manila Philippines.While surfing for some purchases online,I came across that your company stocks some of our required goods and could help provide this items..." LOL what do they want to purchase??? Screaming sounds, vomit, curdled milk, preloved stained carpets... ;-)