Monday, October 26, 2015

Thickened feeds may help infant GERD but may also cause excess weight gain

- Jennifer Middleton, MD, MPH

Thickening infant feeds with rice cereal is not a new practice; my mother has told me more than once that doing so "cured" my belly woes as an infant, and she frequently recommends the same to new mothers whose babies are struggling with frequent spit-ups and fussiness. As discussed in an article in the current issue of AFP, thickening feeds is one of many remedies often tried for symptomatic gastroesophageal reflux disease (GERD) in infants prior to treating with medication, but this common remedy can be associated with excess weight gain.

This finding comes from a 2008 systematic review, cited by the AFP authorsThe included studies also demonstrated mixed results regarding the efficacy of thickening feeds, and the systematic review authors, citing a 2002 guideline, assert that "thickening agents and infant diets containing thickening agents should be used only for selected infants with failure to thrive caused by excessive nutrient losses associated with regurgitation and used only in conjunction with appropriate medical treatment and supervision."

Although the connection between excess weight gain from thickening agents in formula and weight later in life has not been studied, another 2008 systematic review did find that overweight children tend to remain overweight into adulthood. This study, recently featured in the Journal of Family Practice, included 13 studies dating back to 2001 deemed to be of high quality and looking at children's weights as far back as 1 year of age; one study also included birth weights in its cohort. Although there was significant variability in study findings, in general, children with BMIs greater than the 85th percentile were at least twice as likely to be overweight as adults. It's perhaps not an impossible stretch that minimizing infants' excess calories may benefit them later in life, especially since even what our mothers ate while pregnant can affect our risk for obesity. 

There are several other conservative measures to recommend first for infants with GERD. If you'd like to read more, there's also an AFP article from 2009 on infant formula as well as an AFP by Topic on nutrition.

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