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.

  • I'm hoping someone here can share their experience with me as I'm at my wits end. My daughter is nearly 11 months old and has had chronic vomiting since she was about 5-6 months old (full feed vomits till there was nothing left, gagging, up to 9 times in 24hrs). After no doctors taking me seriously, and seeing 3 different doctors we finally got a barium swallow test done after taking her to the hospital out of desperation and it showed that she has severe reflux. I have accidentally eliminated gluten which has helped immensely but we still get 2-3 vomits a day. I'm waiting to hear from a paediatric doctor at the hospital for a follow up after the test but I'm just curious if anyone else has experienced this and what eventually helped? Or was it a case of managing it until they grow out of it? She was given liquid omeprazole a week ago but that only made it worse so i stopped giving it to her. Thanks in advance x

  • My sons 3 months, we've been in hospital his whole life but hoping to go home in next couple of days. He has liquad omeprozol via NG, i've heard that you have to pick it up from the pharmacy really reguarly be because once made up it looses it effectiveness quickly. How often do i need to get it made up?

  • This may need adapting a bit for infants and of course remember to think about allergens but some great advice: http://www.drlibby.com/stress/nutrients-herbs-help-children-calm-relaxed/?utm_campaign=December+Newsletter&utm_content=control&utm_medium=email&utm_source=vero&utm_term=Newsletter&vero_conv=365086097

    So often I hear parents exclaim that their children are wired and hyperactive, and it is usually late afternoon when parents are trying to run errands, cook dinner or get home from after-school activities. Quickly, wired children become grizzly and tired. Parents know the difference between when the…

  • can I please be added to the laryngomalacia page

  • My 7 week old has reflux. We went to see the paediatrician yesterday and he gave us Pepti Jr to try. Im dairy free as still partially breast feeding. He also prescribed neocate as a back up. Just wondering on anyone's thoughts about pepti jr as have heard alot of people haven't had any luck on it.

  • Help please. Our 4 month old suffers from silent reflux, he's been on omeprazole for 2 months now. Initially we saw significant improvement (different baby!). Unfortunately, things have really started to plateau (worsen) over the last week. We have had 3 consecutive nights of holding him right throughout the entire night. Any attempt to move him from being held completely upright see's him wake within seconds and start screaming in pain. It's harrowing. We have been advised by our Dr to increase his dose to (20mg) he's currently on (15mg). I'm really concerned as I feel there's going to be nowhere left to go if he doesn't grow out of the reflux soon :( Has anyone switched medicine from omeprazole to something else with good results? Can anyone please recommend a good paediatrician in the Auckland area who specialises in reflux? We're feeling a bit gutted in this household as we thought things were under control but definitely not the case at the moment :(

  • http://faithtap.com/2205/whatsupmoms-blank-space-parody/?v=1
    Just for some fun. We can all relate to parts of this.

    These busy moms take some time out of their schedule and create a parody of Taylor Swift’s "Blank Space" that will have every mom relating to the sleepless nights and the need for caffeine the next day to keep going. All in good fun, these three moms from "WhatsUpMoms" will have you laughing at thei…

  • December 2014 Newsletter - It is on its way out to members.
    If you are on the old Yahoo Mailing List it has been emailed earlier this afternoon, but sometimes gets marked as spam so check your spam/junk folders for it if it hasn't arrived.
    If you are on the new custom emailing list (i.e. not Yahoo), we are sending from a new server...slowly...Currently at 136 of 235. Talking to the webhosts about how we can make this faster next quarter.

    If you should have received one and don't by tomorrow, please contact us.

    If you aren't a member and would like a newsletter, it is easy and free: http://www.reflux.cryingoverspiltmilk.co.nz/grsnnz-membership-confidentiality-agreement-form/

    Gastric Reflux Support Network NZ for Parents of Infants & Children Charitable Trust Membership & Confidentiality Agreement Form / Newsletter Admin Page First Name Last name Email Street Address City/Town Area Postcode Do you live in NZ? Country and Area if not NZ Home Phone (include area code) Part…

  • Help please! Miss 7mths was finally diagnosed with reflux 2wks ago. She was pretty god during the day, no spilling anymore, crying occasionally with what I thought was wind but must have been acid, worst was getting her settled at night, took a couple of hours. We started on Gaviscon and it was great the first few days, except neither Dr nor chemist told me of constipation side effect (still not sure if we have her constipation sorted). So last Friday saw the Dr and got omeprazole, at first it helped but have found I still have to give gaviscon at bedtime breastfeed otherwise she won't settle. Now I am concerned as I just saw on the forum a post about omeprazole in suspension not being as effective and this is what we have. Also saw the comment about giving it with milk so it isn't affected by stomach acid. Chemist told me to give it 1/2hr before her first breastfeed of the day, I usually manage to give it 15-30min prior to feed. Finding I still can't give her a breastfeed or water too close to a sleep otherwise she wakes crying (usually wakes and just chats to herself) after about 30-45min, this is worrying me with this Auckland heat and humidity that she isn't having fluids often enough during the day. Maybe this is still happening due to Omeprazole not working properly?
    Now I don't know what to do. I am not looking for medical advice as such but I don't know if I can believe the advice of the Dr and Chemist who don't seem to be very knowledgeable about reflux. Do I still give it suspension or ask for granules? Suspension with a feed or before? My other 3 kids didn't have reflux and I am feeling very lost

  • Has anyone's baby got worse with their reflux after taking Ompremazole?It seems my wee grand daughter is.Any answers would be grateful.Thank you

  • Hi Moms out there! I am in South Africa and my little girl has just turned 2 years last week!
    She was diagnosed with silent reflux about 7 months ago and is currently on Zantac. I am at wits end.. still wakes up three times a night and just can't deal right now. We feel like zombies since the day she was born. We must sound like terrible parents but the lack of sleep is unbearable and the sleepless nights are relentless. She is now eating only gluten free food but there has been no difference
    . Are there any parents out there experiencing the same thing... i am just so heart broken for my little angel! thank you

  • Time for a cuppa chamomile tea and a gingerbread star...whilst I work.
    What are you doing today?

  • Help! How long does omeprazole take to kick in? I thought I saw on here someone say that they had to use gaviscon till it started working but the pharmacist told me it should work straight away. Yesterday was miss 7mths 2nd day of omeprazole and no gaviscon and we had a terrible night last night, she was hard to settle and didn't sleep well. At 2am I gave her gaviscon and she slept about 3-4hrs which was blast nights longest stretch. Just wondering if the omeprazole isn't working at its full potential yet. Thanks heaps

  • Does anyone have a child with laryngeophyrangeal reflux? My son was diagnosed a few months ago and has been on treatment with amazing results (thank goodness). Im just wondering if there is anything else I can do for him, and also if there is an average age they grow out of it. He is 20 months now. Thankyou

  • Gastric Reflux Support Network's page has got much busier and there are more posts to the page.
    Thanks to everyone who keeps on answering. I can't keep up, but it is wonderful to see everyone coming here for support.
    Roslyn, National Coordinator.

  • Has anyone used goats formula on their wee one with a dairy allergy? Am starting my twins on it today as one has dairy allergy and am exhausted from breast feeding so going to do a couple of bottle feeds per day

  • Hello. I read on the website that it recommends the NUK brown rubber teat pacifier. Does anyone know why in particular and where to purchase? Thanks.

  • A question on giving up dairy for relux please...

    Do you need to go 100% dairy free or does cutting back help? I drink ALOT of milk (ill go through nearly 4 litres a week, bit excessive). Can I still have milk in tea/a small amount of cheese etc, or do i need to go 100 % cold turkey?

    My daughter is 2.5 weeks old and is doing alot of regurgitating, back arching/night crying, has acid smelling breath, gets frequent hiccups, coughs and gags alot and cries every time I lay her down. Shall I book a GP visit ASAP? What is usually the first treatment they try?

    Many thanks :)

  • http://www.cryingoverspiltmilk.co.nz/new-baby-on-the-way-taking-probiotics/ - New story from one of our Kiwi Health, Pregnancy and Parenting Forum users. Nice to have positive stories.

    Well I thought I would update you all on our baby. She was born on 24th August, the day before her due date and on my birthday. I was taking 3 x 2 caps of Probiotics per day in the last month of pregnancy which can seem excessive, but as I can’t overdose on them and I only get one chance...

  • Are there any breastfeeding Mums out there? My little girl is about to turn 7mths and has finally been diagnosed with silent reflux (alot of people dismissed me when I suggested it months ago). We have started on Gaviscon sachets nearly 48hrs ago and she is much better especially at settling in the evening. She is usually OK at night so haven't given her the powder when she wakes at night yet. Any tips on how to use at night? I have been mixing it up and syringing it into her mouth. Packet says not to make up in advance but I wondered if I could for nighttime so I don't have to make it up when she wakes. Thanks

  • Anyone else dealing with older children with reflux would love to hear from you my Miss 11 year old seems to be having a relapse . So after nearly 4 years losec free in this household we have it back.

  • There have been some new posts - sorry I haven't had a chance to pop on over and answer. Can anyone share their experiences? Remember, no medical advice. :-)

  • As per my post yesterday, our membership form and newsletter archive for members is now available again.

    Please consider joining Gastric Reflux Support Network NZ for Parents of Infants and Children Charitable Trust for access to our Newsletters and Private Local and National Support Networks: http://www.reflux.cryingoverspiltmilk.co.nz/grsnnz-membership-confidentiality-agreement-form/ Membership is free, and this gives you opportunities to discuss gastric reflux related issues with others in a safe and confidential setting.

    Thanks to one of our amazing webhosts http://www.webmad.co.nz/ for the smooth change-over.

    Gastric Reflux Support Network NZ for Parents of Infants & Children Charitable Trust Membership & Confidentiality Agreement Form / Newsletter Admin Page First Name Last name Email Street Address City/Town Area Postcode Do you live in NZ? Country and Area if not NZ Home Phone (include area code) Part…

  • The website our membership form is on and where are newsletters are archived is down for maintenance until late tomorrow evening - Monday at the latest.

    If you were wanting to complete a membership form, please do check back as we would love to meet you. I'll post an update when it is available again.

    http://www.cryingoverspiltmilk.co.nz is available as usual although it the server it is on is changing tomorrow evening also - hopefully there will be no disruption.

    For infant and child gastric reflux support in New Zealand: Phone/Text 022 585 5935 Phone 0800 380 517 Contact GRSNNZ via email form GRSNNZ has brochures available which explain what Gastric Reflux is, a few simple tricks, the support GRSNNZ offers and our contact details. If you are Health...

  • A question please -my daughter has twin girls aged 3 weeks.They were premature born at 35 weeks 3 days.One of them is fine breastfed and sleep.However the other one grunts and groans,pulls her legs up and sometimes cries after each feed.She does not settle well at all.Could this be reflux or what.I know it's early days but my daughter is exhausted!!Any suggestions would be great.Thanks