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Date: | Wed, 16 May 2007 09:48:26 +1000 |
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> Can someone (maybe one if the good doctors) help me understand why my
> online
> friend has been 'prescribed' rice cereal added to the supplemental bottle
> for her premie daughter (now two months old and 4 pounds or so, original
> due
> date was 4th week of May). I do not understand this.
> Karyn-grace Clarke, IBCLC, LLLL
Hi Karyn-grace
The information I've pasted below comes from
<http://www.kellymom.com/babyconcerns/reflux.html>.
Kelly notes "that rice cereal will not effectively thicken breastmilk due to
the amylase". While rice cereal will not thicken breastmilk effectively
there is one thickener that will thicken breastmilk but I have not heard of
it being recommended for reflux episodes but it is used for babies that
aspirate. There are still lots of doctors in US & Australia recommending
rice cereal for reflux either with or without the use of medication. The
youngest baby I've heard of the doctor suggesting rice cereal was three
weeks old.
Very few doctors seem to be aware that managing the breastfeeding can make a
substantial difference to the vomiting. Many mothers find it very hard to
get medical support while they look into food intolerances/allergies while
they are breastfeeding, since many medical professionals view it as either
unnecessary or too hard for the mother (even if the mother states it's what
she wants to do).
There are at least a few studies about looking at the efficacy of thickening
feeds for reflux. I need to pull them out for another reason in the next
few weeks and I'm happy to send the references to you if you'd like.
This came across my desk recently.
Starch thickening of human milk is ineffective in reducing the
gastroesophageal reflux in preterm infants: A crossover study using
intraluminal impedance" by Corvaglia and colleagues and comes from the
Journal of Pediatrics Feb. 2006 vol. 148 no. 2 pp. 265-8
Regards
Suzie Heaton
Australia
From <http://www.kellymom.com/babyconcerns/reflux.html>
"What about thickened feeds?
Baby cereal, added to thicken breastmilk or formula, has been used as a
treatment for GER for many years, but its use is controversial.
Does it work? Thickened feeds can reduce spitting up, but studies have not
shown a decrease in reflux index scores (i.e., the "silent reflux" is still
present). Per Donna Secker, MS, RD in Gastroesophageal Reflux Disease , "The
effect of thickened feedings may be more cosmetic (decreased regurgitation
and increased postprandial sleeping) than beneficial." Thickened feeds have
been associated with increased coughing after feedings, and may also
decrease gastric emptying time and increase reflux episodes and aspiration.
Note that rice cereal will not effectively thicken breastmilk due to the
amylase (an enzyme that digests carbohydrates) naturally present in the
breastmilk.
Is it healthy for baby? If you do thicken feeds, monitor baby's intake since
baby may take in less milk overall and thus decrease overall nutrient
intake. There are a number of reasons to avoid introducing cereal and other
solids early. There is evidence that the introduction of rice or
gluten-containing cereals before 3 months of age increases baby's risk for
type I diabetes. In addition, babies with GERD are more likely to need all
their defenses against allergies, respiratory infections and ear
infections - but studies show that early introduction of solids increases
baby's risk for all of these conditions."
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