I hear this question all of the time: What is the best formula for a baby with acid reflux? It certainly is an important question because we know diet can be an important part of a reflux treatment plan. Whether or not your baby has acid reflux, it is still very confusing to walk up and down the infant formula aisle of the store and see the variety of infant formulas available, all making nutritional claims and more.
I am not sure if this is the proper term for it, but I know a lot of parents who have switched from one formula to another hoping that a change of diet will magically "fix" the reflux. This is often referred to as "formula hopping". In essence, it is an attempt to fix the reflux by changing the diet. Unfortunately, it often leads to trying several formulas over the course of weeks or months with mixed results.
I am concerned when I hear a parent has tired several formulas without consulting the doctor. It is very important to discuss the formula options and any changes to the reflux treatment plan, including diet with the doctor. The doctors are very familiar with the different types of formulas and can assist you in making decisions and evaluating each option.
Fixing Reflux with Formula
We know adults with reflux experience better digestion and fewer symptoms when they avoid foods that trigger heartburn. So it makes sense that we would look at the formula options for an infant to see if there is any benefit of one formula over another. I think the idea of "fixing" the reflux through diet has some basis in fact since a baby with a true allergy or intolerance such as Milk Soy Protein Intolerance (MSPI) will often show rapid improvement when the diet is changed. But here is the tricky part: Milk Soy Protein Intolerance and reflux have very similar characteristics namely crying and fussing. It might seem that changing the diet has "fixed" the reflux while in fact there was an underlying and maybe undiagnosed intolerance that was actually to blame. We often hear stories about how a baby suddenly stopped crying and slept for hours and hours after a formula change. Well, doesn’t that sound like a dream come true? Send hubby out to the 24 hours super store right away But wait; wouldn’t all of the doctors just change the baby’s diet if that was the most effective reflux treatment? In reality, diet is often an important part of a reflux treatment plan however; diet is rarely the treatment plan. I think it is more realistic to look at changing formula as a means to increase digestive comfort and decrease reflux symptoms.
Milk Based Formula
Milk based formula is by far the most common type of infant formula available for all babies. The options are endless from what one doctor described as the fancy "boutique" brands to the generic store brand. There is no significant benefit from one to another and they are all FDA approved. Most of the time, the doctor will recommend a milk based formula for a baby with or without reflux. If your baby with reflux does not have allergies or intolerances, a milk based formula may be just fine.
Soy Based Formula
The American Academy of Pediatrics Nutrition Committee believes soy formula is useful for an infant on a vegan diet. While there have been some studies looking at the effect of a soy formula diet on colic, research has not found a link between soy formula and decreased crying from colic. Further, soy formula may inhibit the absorption of minerals. So the bottom line is, skip the soy formula if you are changing your baby’s diet due to reflux.
I always through AR formula was short for Acid Reflux Formula but it really stands for Anti Regurgitation Formula. AR formula contains a thickener and may be recommended for a baby with excess spit up and vomiting from reflux. There is some evidence that thickened formula reduces the amount of spit up. However, thickener does not reduce the acid.
Partially Hydrolyzed Formula
There is some evidence that a partially hydrolyzed formula reduces colic symptoms such as fussing and crying. In some cases, a trial of a partially hydrolyzed formula is useful after positioning and other home care techniques have been tried.
Extensively Hydrolyzed Formula or Amino Acid Formula
An extensively hydrolyzed formula or an amino acid formula may be recommended by the doctor as part of a reflux treatment plan. The new NASPGHAN (North American Society for Pediatric Gastroenterology, Hepatology and Nutrition) guidelines support the use of a 2-4 week trial of this type of formula for "bothersome regurgitation and vomiting".
If your baby with reflux is happily drinking her formula and growing, there is no need to change the way you are feeding her. You already have enough to worry about. However, if your baby is crying, resists feedings and has frequent spit up or vomiting, it might be worthwhile to discuss your baby’s diet with the doctor. After reviewing the treatment plan, the doctor may recommend a short term trial of another formula. Be patient and stick with the new formula for a week or two. Then report back to the doctor for further instructions. And remember, some babies spit up and fuss no matter what formula they are on. At some point, you and the doctor may decide that the formula is "good enough" and search for other treatments to decrease the symptoms.