Difficulty in Defecation in Infants with Gastroesophageal Reflux Treated with Smaller Volume Feeds Thickened with Rice Cereal

Abstract

We prospectively evaluated the incidence of difficulty in defecation in infants with gastroesophageal reflux who were treated with smaller volume feeds thickened with rice cereal and also assessed the effect of changing the cereal to oatmeal. We evaluated 53 thriving infants with uncomplicated gastroesophageal reflux who were treated with smaller volume feeds thickened with rice cereal. Parents maintained records of bowel movements for 7 days. Rice was substituted by oatmeal cereal in those infants developing difficulty in defecation and another 7 days' record was kept. Of the 53 infants enrolled, 34 (64%) reported no difficulty in defecation, 8 (15%) reported mild difficulty, and 11 (21%) reported severe difficulty in defecation during rice-based feedings. In these symptomatic 19 infants, after rice was substituted by oatmeal cereal, 10 infants (52.6%) reported no symptoms, 6 (31.6%) had mild symptoms, and 3 (15.8%) continued to have severe symptoms. We conclude that difficulty in defecation is common during treatment of infants with gastroesophageal reflux with smaller volume feeds thickened with rice cereal. Substitution of rice with oatmeal cereal results in partial or complete resolution of symptoms in most of these infants.

Xanthan- and Rice Cereal-Based Thickeners in Infants: A Multidisciplinary Single-Center Experience

“…However, improvement in per os tolerance or discontinuation based on parents decision cannot be excluded. Mascarenhas et al ( 18 ) have reported a rate of constipation of only 20% in infants receiving rice cereal for thickening. Our data show a decrease in the use milk thickener over the first year of life.…”

The Effect of Additives for Reflux or Dysphagia Management on Osmolality in Ready‐to‐Feed Preterm Formula: Practice Implications

“…It is known that there is high variability in feed‐thickening practices, and consequences of thickeners are numerous and may include NEC, hypernatremia, malabsorption of nutrients, constipation, dehydration, delayed GI transit, fatigue from nipple extraction, difficulty extracting liquid, decreased oral intake, or prolonged transition of oral feeding in the presence of oropharyngeal dysphagia . In addition, each 1 tsp/oz rice cereal or oatmeal adds 5 kcal/oz, and this increased energy density alters metabolism, which can lead to excessive body fat deposits …”

“…It is known that there is high variability in feed-thickening practices, and consequences of thickeners are numerous and may include NEC, hypernatremia, malabsorption of nutrients, constipation, dehydration, delayed GI transit, fatigue from nipple extraction, difficulty extracting liquid, decreased oral intake, or prolonged transition of oral feeding in the presence of oropharyngeal dysphagia. 1,6,19,[22][23][24][25][26][27][28][29][30][31][34][35][36][37][38] In addition, each 1 tsp/oz rice cereal or oatmeal adds 5 kcal/oz, and this increased energy density alters metabolism, which can lead to excessive body fat deposits. 19,39 Thickeners are frequently used to treat dysphagia with the assumption that thickening decreases the flow rate, thus increasing oropharyngeal transit time to improve airway protection and oromotor control.…”

Comparison of direct effects of rice‐thickened formula vs routine feeds on symptoms and gastroesophageal reflux indices: A crossover cohort study

“…Moreover, thickening human milk is ineffective in reducing gastroesophageal reflux because the amylase in human milk will break down rice starch. 15,16 As the deprescription limits or end-use of added rice formula is not clear, other concerns of use are reported instances of excessive weight gain, irritability from rice intolerance or maldigestion, constipation, and necrotizing enterocolitis (NEC) in premature infants; [17][18][19][20][21][22] arsenic exposure has also been reported. 6,23 However, some reported benefits have been reductions in regurgitation and emesis, along with choke-gag-cough symptoms.…”