Thickening Agents

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, Well Child Provider, Doctor or Specialist before introduction.

NB: With babies who get pain from reflux as well as vomit, it may be important to control the pain and acid first before considering the use of thickeners or thickened formulas. Studies have shown that although thickeners and thickened formula may reduce the number of episodes they prolong the length of time of the remaining episodes as thickened fluid does not drain as well from the oesophagus. It is these prolonged reflux episodes, when they contain acid that can do the most damage.

However, with the move away from prescribing for GORD by many Health Professionals unless there appears to be significant pain, severe complications, growth issues or difficulties feeding it may be appropriate to discuss thickeners with your Health Professional (doctor, Well Child Provider or dietician).

Thickener
Ingredients
Thickening Ability
Formula
Breastfeeds
KCAL/G
Comments
Cornflour Maize or wheat starch. Use maize cornflour for infants under one year of age. Must be cooked. One level teaspoon per 100 ml of water. Boil then simmer for two minutes. Cool and prepare formula using thickened water. Not suitable. ? absorbed Not recommended for preterm infants.
Karicare Aptamil Food Thickener
Pregelatinised maize starch, maltodextrin, locust bean gum. -Thickens instantly.-Can be added directly to feeds. Add to formula feed (1 – 3 teaspoons per 100 ml). Prepare gel and feed before, during or after feeds (1 – 2 teaspoons per 20 – 30 ml breast milk or water). 3.6 Provides additional calories for babies with poor weight gain.
Nutilis Modified maize starch. Thickens over a few minutes, but does not continue to thicken. Remains thickened in the stomach but not as thick as when first mixed. 1 – 1.5 scoops per 100 ml. 3.6 Not recommended for children under 3 years.  “…to be used under strict medical supervision.”[i]
Resource Thicken Up Pregelatinised waxy maize starch 3.3 Smoother but use in neonates not well documented. NB high sodium content (9.6mmol Na per 100 g).
Carobel (Cow and Gate)Not available in New Zealand. Carob bean flour, calcium lactate. -Requires several minutes to thicken.-Can be added directly to feeds. Add to formula feed (0.5% – 1%) Prepare gel and feed before or during the feed 1 – 1½ scoops (1.8 – 2.7g) per 100 ml water). May increase stool bulk.

 

These thickeners are all currently available here in NZ (as indicated) through your local pharmacy and maybe some supermarkets. Please note though that pharmacies do not always keep such products in stock, and so you may need to ask that they get them in for you (usually takes 2-3 days).  There has been some problems with the supply of Karicare Aptamil Food Thickener late 2014.  Phone Nutricia if you have problems obtaining this.

Also, you may like to try:

· AR formula – dairy based formula with natural thickener added. Available through most supermarkets.

· Thickening feeds with rice cereal (baby rice).  Please check the ingredients as some brands of rice cereals, contain milk products. You can experiment a bit with the consistency, but usually 1 tsp of rice per 30-50 ml of formula is adequate. Some parents in countries other than New Zealand have been advised to use different cereals such as oatmeal because rice cereal may cause constipation. This is not recommended in NZ as it contains gluten – the early introduction of this may increase the risk of gluten intolerance developing.

· It also pays to remember when using thickened feeds that you may need to use teats with larger holes (medium/fast flow), and it is also best to mix Karicare food thickener and AR formula with cold liquid (heat bottles after mixing).

· For very smooth results, Karicare Aptamil Food Thickener may also be boiled into the water that you make up your formula with. Mix 20 teaspoons of Karicare Aptamil Food Thickener with 1 litre of cold water in a pot on the stove. Bring to the boil, stir frequently. Once boiling point is reached, remove from the heat and allow to cool. When cool re-measure the thickened water and add the appropriate number of scoops of formula powder. An electric mixer is ideal for mixing the formula powder into the thickened water. The amount of Karicare Aptamil Food Thickener in the recipe can be varied to suit, however, do remember that the mixture thickens the most as it cools.  (Don’t use an electric mixer for formulas that should be mixed gently e.g. Elecare, Neocate as their amino acids are easily bruised.)

Please consider checking with your doctor, well child provider or dietician before including these in your baby’s diet especially if they are under the age of six months (and check under the comments column for any age restrictions).

REFERENCES
[i] http://www.nutriciaclinical.co.nz/admin/documentlibrary/nutilisnz.pdf

ACKNOWLEDGEMENTS:
Tara Chaplow, Babytimes Dietician
Neonatal and Infant Nutrition Handbook, Second edition.

© Gastric Reflux Association for the Support of Parents/babies (GRASP) and Crying Over Spilt Milk Gastric Reflux Support Network New Zealand for Parents of Infants and Children Charitable Trust (GRSNNZ) 2004. (Some content originally prepared by a Nutricia Dietician). Used and edited by GRSNNZ with permission.  Last updated January 2015.

Page may be printed or reproduced for personal use of families, as long as copyright and Crying Over Spilt Milk‘s URL are included. It may not be copied to other websites or publications without permission and acknowledgement. This information (unedited) was also provided (by GRASP) to health professionals in New Zealand to use ” to continue to support and inform families with babies/children with Gastro-oesophageal Reflux.”

  • Gastric Reflux Support Network NZ shared their photo.

    Get in fast...there isn't long to go.

    If you are a Health Professional or other agency, please click http://www.cryingoverspiltmilk.co.nz/request-awareness-week-poster/ to request your National Infant and Child Gastric Reflux Awareness Week Poster(s). Posters are funded by NZ Lottery Grant Board and Community Post have donated envelopes. A preview of the Posters is available on the request form.

  • Gastric Reflux Support Network NZ shared a link.

    Linkage provides a variety of services to help people navigate their way through the government, health and social service systems to find solutions that best meet their most urgent needs.

  • Hi everyone, there is a new question about Pepti Junior and reflux on the page - have a look if you have any experience. No advice please, just share experiences.

  • Has anyone found that Pepti-Junior formula triggers silent reflux? I can't see how this is possible but my toddler's silent reflux has been rearing it's ugly head for the past four months and after slowly eliminating anything that might possibly be a trigger, the only other thing left is his formula, which was prescribed around the time when everything went pear shaped again. He has recently turned two but isn't teething (I've had a good look and a feel). He was prescribed Pepti-Junior because he is dairy free so am hesitant to remove it from his diet. Has anyone else found that their little one reacted to Pepti-Junior? Thank you :-)

  • Please don't be afraid to ask for help or support. If you can't afford private help there are other options.

  • This year the National Infant Gastric Reflux Awareness Week has been renamed to include Children – National Infant and Child Gastric Reflux Awareness Week

    Gastric Reflux in Infants is common and normal due to immaturity of the sphincter at the top of the stomach. The baby may be a bit unsettled and may have periods of crying. Crying in a normal infant with Gastric Reflux will usually peak in the second month and settle around three to four months.[1] They may have short bouts of painful crying associated with a spill, but this crying is not prolonged. Spilling may also disturb sleep. Gastric Reflux does not need to be treated with conventional medication.

    Gastro-Oesophageal Reflux Disease (GORD) is relatively rare and occurs when Gastric Reflux causes some sort of complication usually including pain. The predominant symptom may be a high-pitched pained scream although this is not always the case. Some babies may have feeding difficulties, not grow well or have problems with sleep.[2] GORD can be managed in a variety of ways including diet, upright positioning, parenting techniques and as a last resort medications. Not all cases of GORD will need medical treatment.

    The bottom line is you need to take your baby to a doctor for a proper diagnosis if you think they may have gastric reflux and it is a problem.

    The Gastric Reflux Support Network NZ for Parents of Infants and Children Charitable Trust acknowledges the impact that coping with Gastric Reflux can have on families and hopes that by promoting Awareness that although Gastric Reflux is common, it is normal to feel overwhelmed when faced by all that Infant Gastric Reflux includes. Please don’t feel that you are alone because you aren’t. There are many other parents who understand.

    Most Infants outgrow Gastric Reflux as their digestive system matures, but a few continue to suffer from this invisible disability into childhood. As they get older a preschooler may develop problems with their behaviour, appear tense or be overenergetic and can’t concentrate, or have difficulty expressing their feelings.[3] School-aged children with gastric reflux are often very self-conscious about being different from other children and want to be normal. They may try to put up with their symptoms and won’t ask for help until the very last moment. They usually do not use their condition to seek attention.[4]

    On http://www.cryingoverspiltmilk.co.nz there is more information on Gastric Reflux, National Infant and Child Gastric Reflux Awareness Week Posters can be ordered and the Gastric Reflux Support Network NZ (GRSNNZ) can be joined free of charge for access to our Newsletters and Private Local and National Support Networks. This gives opportunities to discuss gastric reflux related issues with others in a safe and confidential setting.

    In addition to Crying Over Spilt Milk (www.cryingoverspiltmilk.co.nz), this year GRSNNZ launched a new website Spilt Milk (www.not.cryingoverspiltmilk.co.nz) recognising that many parents are coping with infants who spill and/or are irritable, but do not meet the criteria for gastric reflux.

    References:
    [1]http://purplecrying.info
    [2]http://healthinfo.org.nz/index.htm?toc.htm?12789.htm
    [3] http://www.cryingoverspiltmilk.co.nz/general/copingwithrefluxingtoddlers/
    [4] http://www.cryingoverspiltmilk.co.nz/general/gastricrefluxinschoolagedchildren/
    Excerpts from pages on http://www.cryingoverspiltmilk.co.nz included.

    http://www.cryingoverspiltmilk.co.nz there is more information on Gastric Reflux, National Infant and Child Gastric Reflux Awareness Week Posters can be ordered and the Gastric Reflux Support Network NZ (GRSNNZ) can be joined free of charge for access to our Newsletters and Private Local and National Support Networks. This gives opportunities to discuss gastric reflux related issues with others in a safe and confidential setting. In addition to Crying Over Spilt Milk (www.cryingoverspiltmilk.co.nz), this year GRSNNZ launched a new website Spilt Milk (www.not.cryingoverspiltmilk.co.nz) recognising that many parents are coping with infants who spill and/or are irritable, but do not meet the criteria for gastric reflux. References: [1]http://purplecrying.info [2]http://healthinfo.org.nz/index.htm?toc.htm?12789.htm [3] http://www.cryingoverspiltmilk.co.nz/general/copingwithrefluxingtoddlers/ [4] http://www.cryingoverspiltmilk.co.nz/general/gastricrefluxinschoolagedchildren/ Excerpts from pages on http://www.cryingoverspiltmilk.co.nz included.">

  • Gastric Reflux Support Network NZ created an event.

  • If you are a Health Professional or other agency, please click http://www.cryingoverspiltmilk.co.nz/request-awareness-week-poster/ to request your National Infant and Child Gastric Reflux Awareness Week Poster(s).

    Posters are funded by NZ Lottery Grant Board and Community Post have donated envelopes. A preview of the Posters is available on the request form.

    http://www.cryingoverspiltmilk.co.nz/request-awareness-week-poster/ to request your National Infant and Child Gastric Reflux Awareness Week Poster(s). Posters are funded by NZ Lottery Grant Board and Community Post have donated envelopes. A preview of the Posters is available on the request form.">

  • Gastric Reflux Support Network NZ shared a link.

  • Gastric Reflux Support Network NZ shared Judy Arnold - Infant and child Consultant's photo.

    Tomorrow, Thursday, 10 am-11.30 is Question time. I am looking forward to hearing from you.

  • Has anyone got any dietary tips to help a 9 year old with reflux. She has had a pH probe done which shows high acidity levels, barium meal (waiting on report). She is currently on Rinitadine. She is under a paedatrician - but he is on holiday until June. Not considering taking her off the Rinitadine - but, if I could help by giving her lower acid foods that would be great. She was a happy chucker as a baby. Thank you in advance.

  • Hi all...not sure if I am allowed to do this or not, but thought this would be the best place to ask. I've had a few people tell me that I should see a cranial osteopath for my 1yr son who has reflux and is also dairy intolerant. I am in Cambridge. So would like to know if anyone has had any success with this kind of treatment and any recommendations on who to see. Thanks in advance :)

  • Gastric Reflux Support Network NZ shared Hope For The Broken Hearted's photo.

    The Bible say laughter is good medicine. God designed us to laugh because it helps our bodies. Laughter releases endorphins, which are made in the brain and spinal column. Endorphins act as analgesics (diminishing the perception of pain) and as sedatives that calm emotions. If you're feeling sad, stressed, or anxious, watch a comedy for a little while... your brain will feel better and you will feel your spirit lift for awhile.

  • Gastric Reflux Support Network NZ shared Judy Arnold - Infant and child Consultant's photo.

    It is that time again. Friday afternoon, 1.30-2.30 Spread the word.

  • Gastric Reflux Support Network NZ shared Inspiring and Positive Quotes's photo.

    I had to share this one!

    Inspiring and Positive Quotes <3

  • Those walking on a similar path are more likely to understand.

  • Gastric Reflux Support Network NZ shared Inspiring and Positive Quotes's photo.

    Inspiring and Positive Quotes <3

  • Gastric Reflux Support Network NZ shared a page.

  • This is GRSNNZ's new additional website. It has it's own Facebook Page attached to it. We were aware that there was a group of parents who were not getting the support that they needed as although they were stressed by their situation, their babies were not deemed to have gastric reflux. Please let anyone you know who might benefit from support with others about the website and associated social media.

    Welcome to “Spilt Milk”! The aim of this website is to provide information and support for parents or caregivers who are stressed by coping with their infant who spills and/or is irritable. The hope would be that by participating with others with similar challenges and experiences, that a...

  • Hi Roz and team just to let you know we are re branding from Mothers Matter to PND Canterbury and the new website went live last week http://www.pndcanterbury.co.nz. There is a page on support for Canterbury. If there are any Mums/Dads with any questions please get in touch supportgroup@pndcanterbury.co.nz or call me on 021 131 4352 Sonya. :) I to had a reflux baby through to about 3 years so I really do get it.

    Postnatal Depression Family/Whanau NZ Trust. Our mission: To support the wellness of mothers and their familes who are suffering from postnatal depression (PND) and other related mental illnesses.

  • Jess McBrearty :)

  • My daughter was discharged from hospital last Monday, but is still very unwell. I processed all the membership forms last week (except for one that has since come in) and have finally come up for air.
    I've just turned on the phone and cleared the messages, but I only have one. I know there was at least one other from 27 February, but the phone hasn't saved it. Please phone back! I would love to talk to you.

  • The GRSNNZ 0800 number and cell phone is currently not being answered or messages cleared. I haven't had a chance to change the message on it either.
    I know there is a message there from last week I haven't cleared too.
    My daughter has been in hospital since Monday and we had several visits last week. I'll attend to the messages hopefully next week.

  • My 4 week old baby is on Ompreazole granules and we are going to start weaning him off in a few weeks to see how we go. I am considering starting him on probiotics to help this process. Can I give probiotics to a 4 week old or do I take them and he gets the benefit through my breastmilk? If I give it to him how do I administer it and what brand is best?

  • Alisha is now 3 1/2 months old, she is around 5 kg. We have had heaps of trouble with her. Put her on various medications and changes in my diet, then onto Neocate Formula with Losec Capsules. She has pretty much improved 100% from where she was a couple of months ago.

    My question is, what quantity of formula does your baby drink and roughly how long inbetween? I've been trying to give her three hours inbetween each feeding which she can manage totally fine. But when food is offered she hardly drinks much in a sitting. I can usually get 100ml of formula into her over an hour, sometimes takes me longer.

    Is this normal for a reflux baby??