Thickened Formula for the Treatment of Gastroesophageal Reflux in Infants
Loren Murphy, PGY-2
March, 2012
Gastroesophageal reflux (GER) is a common problem in infants and regurgitation is the most
common complaint that parents have. Conservative measures are appropriate for the treatment of
uncomplicated infantile reflux. Traditionally this includes “reflux precautions”, reassurance and
anticipatory guidance. Reflux precautions include thickened feeds, elevation of the head of the bed and
maintaining an upright position for 20-30 minutes after feeding. Prone positioning is no longer
recommended due to the increased risk of Sudden Infant Death Syndrome (SIDS) when sleeping in that
position. An extensive review of the literature was completed to answer the question do thickened
feeds decrease the episodes of reflux in infants diagnosed with GER. The Cochrane database, PubMed,
and TRIP database were searched using the key words “Gastroesophageal Reflux”, “thicken*” and
“infant formula”. Despite the extensive search, only 5 relevant articles were found. Each article was
individually appraised based on design, validity, results, applicability and limitations. All articles
attempted to answer the study question. However, many of the studies were limited. The literature
shows that thickened feeds does have an impact on the number of regurgitation episodes per day.
There is no evidence to suggest that thickened feeds affect the reflux index (the percentage of time the
esophageal pH is less than four) or the number of reflux episodes, both acidic and non-acidic, per day. In
infants with uncomplicated GER, the benefit of decreasing regurgitation episodes is cosmetic. Therefore,
thickened feeds should be reserved for specific clinical scenarios, for example failure to thrive, and not
routinely used for the treatment of infantile GER. There is little evidence to support or refute its use.
References:

Horvath, Andrea, Piotr Dziechciarz, and Hania Szajewska. "The Effect of Thickened-Feed
Interventions on Gastroesophageal Reflux in Infants: Systematic Review and Meta-analysis of
Randomized Controlled Trials." Pediatrics 122.6 (2008): 1268-277. Print.

Huang RC, Forbes D, Davies MW. Feed thickener for newborn infants with gastro-oesophageal
reflux. Cochrane Database of Systematic Reviews 2002, Issue 3.

Wenzl, T. G., S. Schneider, F. Scheele, J. Silny, G. Heimann, and H. Skopnik. "Effects of Thickened
Feeding on Gastroesophageal Reflux in Infants: A Placebo-Controlled Crossover Study Using
Intraluminal Impedance." Pediatrics 111.4 (2003): E355-359. Print

Hegar, Badriul, Rastra Rantos, Agus Firmansyah, Jean De Schepper, and Yvan Vandenplas.
"Natural Evolution of Infantile Regurgitation Versus the Efficacy of Thickened Formula." Journal
of Pediatric Gastroenterology and Nutrition 47.1 (2008): 26-30. Print

Vanderhoof, J. A., J. R. Moran, C. L. Harris, K. L. Merkel, and S. R. Orenstein. "Efficacy of a Prethickened Infant Formula: A Multicenter, Double-Blind, Randomized, Placebo-Controlled Parallel
Group Trial in 104 Infants with Symptomatic Gastroesophageal Reflux." Clinical Pediatrics 42.6
(2003): 483-95. Print