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NICE stepwise recommendations on infant regurgitation

Download our free patient support material and aSTAR stepped care approach infographic for managing infant regurgitation.

Functional gastrointestinal issues are common in infancy1. For example, around 30% of infants below one year of age will experience regurgitation1. This can be a distressing and confusing time for parents, who may not be confident in what to change or adapt to help their baby keep down their feed.

For first-line management of breast-fed infants who present with frequent regurgitation and marked distress, NICE recommends a breastfeeding assessment is carried out by a person with appropriate expertise or training.

For formula-fed infants NICE have developed a stepped-care approach:

  1. Review the feeding history
  2. Reduce the feed volumes only if excessive for the infant’s weight
  3. Offer a trial of smaller, more frequent feeds – while maintaining the advised daily intake of milk (unless the feeds are already small and frequent)
  4. Offer a trial of a thickened formula (that contains rich starch, cornstarch, locust bean gum or carob bean gum)

Aptamil anti-reflux is a food for special medical purposes for the dietary management of frequent reflux and regurgitation, which is a suitable thickened formula for step four of the NICE process.

It’s a nutritionally complete*, thickened formula, which is suitable from birth and is specially formulated with carob bean gum. The carob bean gum helps to thicken the formula on mixing and remains thick upon contact with stomach contents3, helping the feed stay down4-6.

*Suitable as the sole source of nutrition from birth to 6 months and as part of a weaning diet from 6 months to 1 year.

IMPORTANT NOTICE: Breastfeeding is best. Aptamil Anti-Reflux is a food for special medical purposes for the dietary management of frequent reflux and regurgitation. It should only be used under medical supervision, after full consideration of the feeding options available including breastfeeding. Suitable for use as the sole source of nutrition for infants from birth and as part of a balanced diet from 6-12 months. This product should not be used in combination with antacids or other thickeners and is not suitable for premature infants. Refer to label for details.

  1. Vandenplas Y et al. Prevalence and Health Outcomes of Functional Gastrointestinal Symptoms in Infants From Birth to 12 Months of Age. J Pediatr Gastroenterol Nutr 2015;61(5):531-537.
  2. Nice. Gastro-Oesophageal Reflux Disease: Recognition, Diagnosis and Management in Children and Young People. January 2015. Available At: www.nice.org.uk/guidance/ng1 (Accessed April 2016).
  3. Danone Research (Data on file).
  4. Wenzl TG et al. Effects of Thickened Feeding on Gastroesophageal Reflux in Infants: A Placebo-Controlled Crossover Study Using Intraluminal Impedance. J Paediatr 2003;111:E355–E359.
  5. Vandenplas Y et al. A Clinical Trial with An “Anti-Regurgitation” Formula, Eur J Pediatr 1994;153:419–423.
  6. Borrelli O et al. Use of A New Thickened Formula for Treatment of Symptomatic Gastrooesophageal Reflux in Infants. Ital J Gastroenterol Hepatol 1997;29:237–242

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