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 email@example.com 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 there, just wanted to say that this page and your website has been a huge help! It has provided ideas, helping me and my 8 week old son cope with his reflux. He was diagnosed @ 4 weeks old, and has been on gaviscon since. I have also gone dairy free, not sure if it's helping but he's definitely settled over the weeks. Hopefully he 'grows out of it' as the Dr says, grateful for all tips and advice from other parents experiencing the same...'I'm not alone'....this is a photo of our son in his Happy Place, where he goes from crying to smiling straight away!
Hi, Just wondering if you could help me with a question please. I got given Losec Suspension today. Since it's in suspension form and not the granules how long before a feeding should I give it to my baby or can it be given at the same time?
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Hi there. I've been reading your website and Facebook page with interest over the past few months and it's been really helpful. My daughter is coming up 4 months old and her reflux seems to be improving. We tried gaviscon but it didn't make much difference. Main thing for us has been that I cut dairy out of my diet. I now have food with dairy in it but just don't do the core basics like cheese, yoghurt, milk etc and although she still spills often, the associated pain seems to be almost gone. Am hoping she's growing out of it but the dairy still seems to have a bit of an effect. Anyway, in two months time I have to go back to part-time work and will need to start using a formula on those days. I usually used karicare gold with my kids but have no idea what options would be best for my reflux baby. Can you make some suggestions? I'd like to try some out to see how she reacts etc before I go back to work but don't know what brands to try. Thanks.
Hi, I have a wee girl Matilda, 3.5 months, who has been diagnosed with gerd and is currently on Ranitidine and Domperidone. We have tried Losec and gaviscon infant too, and after trying pepti jnr and neocate we are now on elecare formula. Also have done the usual, raise cot, chiro, upright after feeds etc. We don't seem to be making much progress and its really heart-breaking to try all these medications on such a wee person! We do seem to have 3-4 great days when she is happy and contented but then have 3-4 terrible days with constant crying, not much drinking, so much vomit and terribly unsettled, not much sleeping etc; my question is, is this 'normal' ?! Is gerd cyclonic? Thanks, Amanda :)
My four month old son has recently been diagnosed with reflux after his feeding has become worse and worse over the last month. He will cry before and during a feed and constantly turns his head from side to side. It takes alot of coaxing to get him to drink. He has also started waking almost hourly through the night. We have tried gaviscon which gave him terrible constipation and now ranitidine. After reading the dosages on the spilt milk site we realized the dose we were given was far too low so have now been on a high ish dose for a week with little change. How long should it take to see a change? We also have a script for omeprazole so can try that next. Anyone else with a reflux baby also had these sleeping issues? Any tips welcome, we have raised the bed and keep him upright after feeds. Thanks in advance
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Our membership form is now working again. Sorry for the delay. We are looking forward to meeting some new members. http://www.reflux.cryingoverspiltmilk.co.nz/grsnnz.../ Joining Gastric Reflux Support Network NZ for Parents of Infants and Children Charitable Trust gives access to our Newsletters and Private Local and National Support Networks. Membership is free, and this gives you opportunities to discuss gastric reflux related issues with others in a safe and confidential setting.
hi i have a nearly 8 month old girl, she is on ''Kari-care anti reflux AR'' now they say by six months the reflux or spewing up heaps of milk should be fine now. but im scared to put her on normal kari care cause she use to vomit like crazy, what formula should i be going on? thanks :)