Rice Cereal Thickening for Infant Formula
Add up to 1 tablespoon of dry rice cereal per 1 ounce of formula for infants with gastroesophageal reflux disease (GERD). 1
Recommended Dosing
The American Academy of Pediatrics recognizes adding up to 1 tablespoon of dry rice cereal per 1 oz of formula as a reasonable management strategy for otherwise healthy full-term infants with GER or GERD. 1
This is the maximum recommended amount—you can start with less and titrate up based on symptom response. 2
Critical Caloric Considerations
Be aware that thickening 20 kcal/oz formula with 1 tablespoon rice cereal per ounce increases the energy density to 34 kcal/oz—a 70% increase in calories. 1
This significant caloric increase can lead to excessive weight gain with long-term use, so monitor growth parameters closely. 1
Consider commercially available anti-regurgitant formulas as an alternative, which contain processed rice, corn, or potato starch without the excessive caloric density. 1
Important Safety Restrictions
Never use thickened feedings in preterm infants born before 37 weeks gestation, particularly those currently hospitalized or discharged within the past 30 days, due to the association with necrotizing enterocolitis. 1
The FDA specifically warned against using commercial thickening agents like SimplyThick in this vulnerable population. 1
Practical Implementation Details
Thickened feedings decrease visible regurgitation but do not reduce the actual number of reflux episodes. 1
In one study, 24% of formula-fed infants had complete resolution of GERD symptoms after 2 weeks using protein hydrolysate formula thickened with 1 tablespoon rice cereal per ounce, combined with avoiding overfeeding and environmental tobacco smoke. 1
Common Side Effects and Solutions
Approximately 21% of infants develop severe difficulty with defecation when using rice cereal thickening. 3
If constipation occurs, substitute oatmeal cereal for rice cereal at the same concentration—this resolves symptoms partially or completely in most infants (84% showed improvement). 3
When to Use This Intervention
Reserve thickened feedings for infants with documented GERD symptoms, not "happy spitters" who are growing well without complications. 1
Always try this conservative approach before considering pharmacologic therapy with acid suppressants. 2
If no improvement occurs after 2 weeks, consider switching to an extensively hydrolyzed protein formula, as milk protein allergy can mimic GERD. 2