Last one, I promise. Also from Medscape today.
Anna Swisher
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Caution Urged in Use of Thickened Infant Formulas for GERD Prevention
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CHICAGO (Reuters Health) Jan 25 - Thickened infant formula has received
attention in the pediatrics community for its potential to decrease
gastroesophageal reflux. However, this therapy, which is not effective for
all infants, has some significant drawbacks, nutritional specialists
announced here at the American Society for Parenteral and Enteral
Nutrition's 25th Clinical Conference.
Rice cereal, the most common thickening agent, proportionately increases the
amount of carbohydrates and decreases the amount of protein and minerals
contained in infant formula. If too much cereal is added, infants "may gain
weight quite well but they may not grow as well in length," said Jacqueline
Jones Wessel, a neonatal nutritionist at Children's Hospital in Cincinnati.
The nutritional implications of thickening raised a number of questions this
week during a conference workshop on the diagnosis and treatment of
gastroesophageal reflux. Though this therapy has been around for years,
nutritionists have only recently begun to emphasize the impact it can have
on an infant's diet.
A common problem is the addition of more and more rice cereal to the infant
formula until it visibly thickens. Though appropriate doses range from about
1 teaspoon to 2 tablespoons per ounce of formula, parents have been known to
add considerably more.
Wessel said that this is a particular concern with pumped breast milk, as
rice cereal often fails to thicken it no matter how much is added. In
addition, bottle nipples must be slit in order to enable the thickened
formula to pass through, raising the risk that babies will take in too much
formula and gag, cough or choke.
While thickening is considered part of the first line treatment for reflux
disease in infants, Dr. Colin Rudolph, professor and chief of pediatric
gastroenterology and nutrition at the Medical College of Wisconsin in
Milwaukee, suggested that increasing the formula's caloric density might be
just as effective. "If you increase caloric density, you'll decrease the
amount of distention in the stomach and get less of these episodes of
transient lower esophageal sphincter relaxation."
The neonatal intensive care unit where Wessel works has chosen not to use
thickened feeds. With pre-term infants, it is even more likely that the
decreased amounts of protein in thickened formula will negatively affect
growth, she said. "Our judgment has been that nutrition is so important
while they're in the NICU that there are other things we can typically do to
avoid the complications of reflux."
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