Does Thickened Formula Help Reflux?

It's a timeless recommendation for the spitting baby: put cereal in the bottle and hope to God that things improve. And as a tummy doc in America's largest children's hospital, I can attest to the fact that most parents have tried this by the time they reach my clinic. Few, however, report glowing results. But that's just me and my simple observation. But is there any evidence of the effectiveness (or ineffectiveness) of cereal to the baby with reflux? A group of Polish pediatricians performed what we in the business call a 'meta-analysis'. Essentially what they did was to take all of the research on thickened formula done in recent years and put it together into something of a survey of surveys. And here's what they found:

• Cereal added to formula slightly reduces the daily number of spitting episodes in infancy.
• Reflux measured using pH probes (a tool for measuring reflux) show little changes when formula is supplemented with cereal.
• When thickening works, it appears to work well: added cereal appears to increase the number of children with total resolution of their spitting when compared to unsupplemented babies.
• There isn't enough information to tell if one thickening agent is better than another.

Bottom line: Adding cereal to your baby's bottle is unlikely to fix their reflux. But as I tell my patients, however, it's worth a shot at 1 teaspoon per ounce of formula (any more than that they'll suck like the dickens to get the formula from the nipple and swallow lots of air). If the results aren't impressive during the first 2-3 days, let it go. The hassle and added calories aren't worth something that isn't helping. I'll also add that constipation is a major consequence to cereal supplementation. In this case, recent studies have shown that oatmeal may be a better option.