Review question

We reviewed the evidence for the effect of feed thickener on gastro-oesophageal reflux (GOR) in babies up to six months of age.

Background

Gastro-oesophageal reflux is a common condition in babies. It occurs when the stomach contents (milk feeds and acid) come back up into the gullet or mouth. While this normally improves as babies grow older, it can sometimes become troublesome and treatment may be needed. Thickening the milk feeds is a simple method that is commonly used to treat GOR. However, it is unclear if using feed thickeners improves GOR.

Study characteristics

We examined the research published up to 22 November 2016. We found 8 clinical trials recruiting 637 babies up to 6 months of age who presented with symptoms of GOR. The recruited babies were mainly ‘healthy’ term babies (i.e. babies born within three weeks of the due date) who were bottle feeding. Three of the studies were funded by a pharmaceutical company, hence the quality of the evidence presented must be interpreted with caution.

Key results

We found that term babies with GOR given feed thickeners had nearly two fewer reflux episodes per day. Babies with GOR were also 2.5 times more likely to have no reflux symptoms if feed thickeners were used. No studies reported information on failure to thrive (i.e. poor growth). We found that babies with GOR given feed thickeners showed an improvement in an important measure of acid reflux obtained from pH study. Reflux index (i.e. percentage of time of acidic reflux of pH < 4) was 5% lower in babies given feed thickeners. No major harms were reported in the eight studies.

Quality of evidence

Due to study design limitations, we are moderately confident in the evidence for the reduction of two reflux episodes per day. Hence, feed thickeners can be useful in term babies who are bottle feeding and have troublesome GOR.

We rated the quality of the evidence for the other outcomes as low due to the small number of studies with small numbers of babies recruited. Further research is needed to determine which type of feed thickener is better and whether feed thickeners are useful in babies with GOR who are breastfeeding or preterm.