At what age can infants start Enfamil (infant formula) AR (anti-regurgitation)?

When to Begin Enfamil AR for Infants

Enfamil AR (anti-regurgitation) formula can be safely introduced to full-term infants from birth, but is specifically designed for infants with regurgitation issues and should be used when these symptoms are present rather than as a routine formula.

Understanding Enfamil AR

Enfamil AR is a specialized formula containing added rice starch that thickens in the stomach to help reduce regurgitation (spit-up) in infants. It's important to understand when this formula is appropriate to use.

Appropriate Age for Introduction

• Enfamil AR is formulated for full-term infants experiencing frequent regurgitation
• It can be introduced from birth for full-term infants with symptoms
• Important safety note: Thickened formulas should NOT be used in premature infants due to potential association with necrotizing enterocolitis 1

When to Consider Enfamil AR

Enfamil AR should be considered when:

1. Your infant has frequent regurgitation or "spit-ups" (occurring more than 5 times per day)
2. The infant is otherwise healthy and growing well (what pediatricians often call "happy spitters")
3. Simple feeding modifications haven't resolved the issue

Clinical Evidence for Thickened Formulas

Research shows that thickened anti-regurgitation formulas can:

• Decrease observed regurgitation episodes 1
• Reduce esophageal acid exposure time 2
• Improve gastrointestinal symptom scores in infants with regurgitation 3
• Make infants 1.6-1.8 times more likely to have zero spit-up episodes compared to standard formula 4

Algorithm for Decision-Making

1. First, determine if regurgitation is the issue:

   • Is your infant spitting up frequently (more than 5 times daily)?
   • Is the infant otherwise growing well and not showing signs of distress?

2. Rule out other conditions:

   • Cow's milk protein allergy can mimic GERD symptoms 1
   • If other symptoms present (excessive crying, apparent pain, poor weight gain), consult pediatrician

3. Try simple feeding modifications first:

   • Avoid overfeeding
   • Ensure proper positioning during and after feeds
   • More frequent, smaller volume feedings

4. If regurgitation persists despite these measures, Enfamil AR may be appropriate

Important Considerations

• Nutritional adequacy: Enfamil AR provides complete nutrition for infants and supports normal growth 4

• Stool changes: Expect potential changes in stool consistency and color when using thickened formulas 5, 4

  • May have firmer stools than breast-fed infants
  • May have more yellow stools

• Caloric density: Be aware that adding rice cereal to regular formula increases caloric density (thickening a 20-kcal/oz formula with 1 tablespoon rice cereal per ounce increases energy density to 34 kcal/oz) 1. Commercially available AR formulas like Enfamil AR are formulated to provide appropriate calories without this issue.

• Premature infants: The FDA has warned against using certain thickening agents in premature infants (born before 37 weeks) due to risk of necrotizing enterocolitis 1

Conclusion

Enfamil AR can be introduced from birth for full-term infants with regurgitation issues, but should be used specifically to address this problem rather than as a routine formula choice. Always consult with your pediatrician before switching formula types, especially if your infant has other symptoms beyond simple regurgitation.