Thickening of infant formula.

Gastro-oesophageal reflux (GOR) is very common in the first year of life. A step-wise approach, firstly promoting conservative strategies, is advisable in uncomplicated cases. Milk thickening is a longstanding practice for the management of GOR. Infant formulas can be thickened at home or industrially with specific thickening agents (rice starch, cornstarch, cereals, locust bean gum) which increase their viscosity, thereby thwarting the passage of gastric content into the oesophagus. The efficacy of milk thickening to reduce typical reflux symptoms, like vomiting and regurgitations, has been largely reported in term-born infants; as a consequence of the lowered nutrient loss, an improved weight gain is frequently noticed. Even so, the effect of thickening practices on reflux features, detected by pH-monitoring or other diagnostic investigations, is still controversial. According to current guidelines, milk thickening is advisable in infants suffering from frequent regurgitations/vomiting and failure to thrive, without further clinical complications. With regard to safety issues, although in vitro researches cast some doubts on the nutritional adequacy of thickened formulas, results from in vivo studies are reassuring. Furthermore, while home-thickened formulas were reported to increase coughing episodes, to require greater sucking efforts and to provide higher caloric contents, current commercial anti- regurgitation formulas seem to be not associated with analogous side effects. Eventually, data from the preterm population are very few and do not support the effectiveness of milk thickening in improving reflux symptoms; moreover, noticeable adverse events, like a higher incidence of necrotizing enterocolitis, have been reported, thus entailing an unfavourable benefit-risk ratio.