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.

  • A Good News Story ... http://www.cryingoverspiltmilk.co.nz/his-gastric-reflux-stopped/

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    Hi Roslyn, Thanks for the updates over the past several months. I am leaving the group as my little boy no longer suffers from gastric reflux and is also no longer dairy intolerant! FYI he was on Neocate from 3 months old and had a combination of formula and my milk until he was 7.5 months. ...

  • Hi. My boy is 6.5 wks. He started screaming at 3 wks. Became unsettled for periods of up to nearly 12hrs without sleep. He's been on formula as my milk never came in. He gets about 100-200 ml breastmilk /dy I pump. He started spilling/vomiting a lot at 4.5wks old.started losec 9 dys ago-frm GP. Saw paediatriciAn 4 dys ago and started amino acid formula to check for CMA. I feel things improved a bit about 4 dys after losec started. Also he seemed great once on th amino acid formula but thn yesterday was his old really bad self - fussed all day 10am-4pm thn really distressed n frantic 4-9pm. He's been ok today.i also started adding karicare thickener 2 dys ago. His first poo day after starting amino acid formula was soft n ok but I thnk he might b constipated with th thickener. He really had to push to get yesterday's out n was very sticky. Anyone else experience this? What do you do? I've heard lactulose and prune juice etc can make reflux/ wind worse. I thought about halving th amt thickener I'm using.also his vomiting better on th new formula I think but still occasional. He vomited Sunday night n mayb brought th losec up- could 1 missed dose like thts make him bad th next day like he was? Any opinions greatly appreciated

  • 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. If you have completed a membership form previously, but never received anything further, please message me (Roslyn Ballantyne at https://www.facebook.com/roslyn.ballantyne.rn ) or comment below. The membership sign-up had been a double opt-in with a confirmation email, but as some people have had trouble with this, I've now changed it to a single opt-in. (I do still need to process applications and add you manually to your Local Support Networks though.)

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    Gastric Reflux Support Network NZ for Parents of Infants & Children Charitable Trust Membership & Confidentiality Agreement Form / Newsletter Admin PageFirst NameLast nameEmailStreet AddressCity/TownAreaPostcodeDo you live in NZ?Country and Area if not NZHome Phone (include area code)Partner's NameE…

  • Hi I'm a bit confused. I filled out th membership form on th cryingspiltmilk main page. Do I need to do anything else? I see there's a forum somewhere else - kiwi health or something? Or do I just post n use this Facebook page? I'm thnking you hav th older site but most people jst use this Facebook page now yeah? Ta :) I hav a 6 wks old beautiful boy who has been in so much pain been breaking my heart but I'm jst getting things in motion now to help I thnk. Saw paediatriciAn few dys ago n hav started losec gaviscon mylanta and amino acid formula with karicare thickener

  • Hiya, I'm starting to introduce solids to my almost 6 month old and just wondering if there are any foods that any of you have found to be better than others and which ones to avoid? TIA. :-)

  • Other information here: http://www.lalecheleague.org.nz/news-a-events/lllnz-conference-2014/312-lllnz-50th-anniversary-conference-2014

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  • Anyone want to help? I know you all have plenty to say. ;-)

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    And just in case you missed the post and the opportunity to help others through.........In five words, no more no less, share some inspirational advice to parents that are struggling with a newborn suffering from colic, reflux and inconsolable crying. If there are enough submissions I will post these on my website and perhaps in my book - Prevent and Remedy Colic, Reflux, Lactose and Dairy Overload Naturally - which is off to the proof readers this week!! http://www.naturalwinding.com/book/

  • A new story: http://www.cryingoverspiltmilk.co.nz/ryans-story-of-reflux-and-christinas-story-of-pnd/ Thank you, Christina.

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    I don’t really know where to begin with my story of Ryan and his reflux, and me with Post Natal Depression. I used to feel very sad thinking of all the precious time that was robbed from us. I loved Ryan from the moment I saw him, and he was a dream baby up until two weeks of age. ...

  • Hi my 7 week old, breastfed baby started showing signs of reflux recently so I went to the GP and was prescribed Gaviscon sachets. I'm having trouble giving it to her, but it seems to be working. She usually goes poos after every feed but since starting the Gaviscon (monday) she has only been once. She strains and cries. Not sure what i safe to give her to help as she is so young? Thanks

  • Hi there My 8 week old boy is formula fed and is now trialing gaviscon for his silent reflux, already I feel like it is making a difference but I am worried about the possible constipation the gaviscon may cause...how do you parents relieve constipation in young babies? I know about the cooled boiled water but are there any other remedies that are worth knowing about? Or tricks that can maybe help avoid constipation?

  • Hi, would you say it's a reflux symptom to bring up small vomits between feeds? Like an hour or so after eating? I keep being told that's normal, but it doesn't feel normal? My baby is only 4 weeks old though, so it's hard to me to tell what's normal and what isn't.

  • Hi, my 10 week old is trialling gaviscon to see if it helps with her (potential) reflux. She isnt a miserable baby, but she does scream if I put her down in the daytime, she has a persistent cough, a husky voice (this developed over the last week), and she spills even hours after a feed. Does this sound like reflux? If so, how do I get her to keep the gaviscon down? It says to give it to her after a feed, but she vomits straight after a feed...also is it worth going dairy free to see if this helps? Finding the spilling and coughing and husky voice quite upsetting, it must be horrible for her :(