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/nutilis%20powder%20jan%202015.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.”

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