The management of infant regurgitation

Regurgitation is a frequent manifestation in infants and, in most cases, a self-limiting physiological condition. However, it is a frequent cause of parental anxiety, feeding problems, change of milk formula, and medical referral. Regurgitation is not a reason to stop breastfeeding. A thickened anti-regurgitation formula is indicated in formula-fed infants with frequent, persistent, or troublesome regurgitation. Several agents have been used to thicken infant formula including rice and cornstarch and nondigestible carbohydrates such as carob bean gum, guar gum, and soybean polysaccharides. Data suggest that thickened formula reduces regurgitation, increases weight gain, and may improve reflux-associated symptoms. Clinical efficacy and effect on gastroesophageal reflux are related to different variables such as origin and concentration of thickener, viscosity, kind of protein, hydrolysis, osmolarity, frequency and volume of the meal, gastric accommodation, gastric emptying, and position of the infant. Parental reassurance and dietary guidance for appropriate volume and frequency of feeding remain the cornerstone of the management. Commercial thickened formulas offer a preferable composition with better viscosity, digestibility, and nutritional balance compared to adding thickeners to standard formula. Positional treatment (side sleeping or elevated supine position) cannot be recommended in sleeping infants as there are insufficient data regarding both efficacy and safety. Conclusion: If reassurance and appropriate dietary intake are not sufficient to reassure parents, or in case of poor weight gain due to the regurgitation and infant distress, anti-regurgitation formula should be considered. Commercial thickened formulas reduce regurgitation frequency and severity and parental anxiety and prevent unneeded referral and drug overuse.