Cochrane for Clinicians

Putting Evidence into Practice

Feed Thickener for Newborn Infants with Gastroesophageal Reflux


Am Fam Physician. 2018 Sep 1;98(5):275-276.

Author disclosure: No relevant financial affiliations.

Clinical Question

Are feed thickeners an effective treatment for the symptoms of gastroesophageal reflux (GER) in formula-fed infants?

Evidence-Based Answer

Feed thickeners decrease the number of reflux episodes in full-term formula-fed infants (mean difference [MD] = −1.97; 95% confidence interval [CI], −2.32 to −1.61). Additionally, full-term formula-fed infants with GER who are given thickeners are more than twice as likely to be asymptomatic compared with infants not receiving thickeners at one to eight weeks of follow-up (number needed to treat [NNT] = 5).1 (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)

Practice Pointers

GER is characterized as reflux of gastric contents into the esophagus caused by lower esophageal sphincter dysfunction. It affects at least 40% of infants.2 Although GER is a normal physiologic process in healthy infants, symptoms of GER—including regurgitation, vomiting, posseting (i.e., milk or formula being regurgitated immediately after feeding), irritability, and disordered sleep—can be distressing to parents and account for frequent office visits, medication use, and subspecialist referral. Thickened infant feeds are thought to prevent symptoms of GER by increasing the “stickiness” of formula in the stomach and preventing retrograde movement of stomach contents into the esophagus. The authors of this review sought to evaluate the effectiveness of feed thickeners in formula-fed infants up to six months of age with GER.1

This Cochrane review included eight randomized controlled trials and 637 participants up to six months of age. Most participants were healthy, formula-fed infants. However, breastfed infants were included, as were preterm infants until their corrected age was six months. Trials including participants with congenital, gastrointestinal tract, or neurologic abnormalities were excluded. Carob bean gum, rice cereal, cornstarch, and alginate feed thickeners were compared with

Author disclosure: No relevant financial affiliations.

The practice recommendations in this activity are available at


show all references

1. Kwok TC, Ojha S, Dorling J. Feed thickener for infants up to six months of age with gastro-oesophageal reflux. Cochrane Database Syst Rev. 2017;(12):CD003211....

2. National Institute for Health and Care Excellence. Gastrooesophageal reflux disease in children and young people: diagnosis and management. NICE guideline (NG1). January 2015. Accessed July 14, 2018.

3. Seach KA, Dharmage SC, Lowe AJ, Dixon JB. Delayed introduction of solid feeding reduces child overweight and obesity at 10 years. Int J Obes (Lond.). 2010;34(10):1475–1479.

4. Huh SY, Rifas-Shiman SL, Taveras EM, Oken EM, Gillman MW. Timing of solid food introduction and risk of obesity in preschool-aged children. Pediatrics. 2011;127(3):e544–e551.

5. Weng SF, Redsell SA, Swift JA, Yang M, Glazebrook CP. Systematic review and meta-analyses of risk factors for childhood overweight identifiable during infancy. Arch Dis Child. 2012;97(12):1019–1026.

6. American Academy of Pediatrics. Infant food and feeding. Accessed July 14, 2018.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at



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