In several European countries, including Spain, formulas for infants Anti Reflux or Anti Regurgitation, better known as "AR" are available for purchase in virtually any establishment where they sell infant food.
However, they have special characteristics that do not conform to European Union standards regarding the composition that infant formula should have.
For this reason they should be considered as a medical treatment for specific children and under prescription and medical supervision And not as a choice of milk to choose. The Anti Reflux or Anti Regurgitation (AR) formulas are modified start and continuation formulas by adding a thickening substance, using casein as the main source of protein or decreasing fat concentration.
We already talk in Babies and more recently the difference between regurgitation and gastroesophageal reflux.
Mild or moderate regurgitation during or after feeding It is a common and physiological phenomenon that is solved over the months. In the absence of any other symptoms, no treatment should be performed, much less indicate the diet with these types of formulas.
Only in some children the so-called pathological gastroesophageal reflux occurs in which the milk output is more “violent” and in which the injuries produced by the passage of stomach acid through the esophagus produce pain, feeding difficulties, growth deficit and risk of pulmonary aspiration.
In these cases, a specific diagnosis is necessary to assess the severity of the problem and determine the therapeutic measures to be followed.
The three types of modifications of the AR formulas with respect to infant formula are:
- Addition of thickeners: carob seed meal, rice starch and precooked corn starch have been used. There are studies that conclude that in fact regurgitation decreases, however they increase the residence time of the refluxed material in the esophagus, so those prepared with these thickeners are not indicated in children with esophagitis (that is, those who have gastroesophageal reflux).
- Use of casein as the main source of protein: casein increases rennet density by decreasing regurgitation, but delays gastric emptying.
- Decrease in fat concentration: This modification is based on the hypothesis that a lower concentration of long chain fatty acids may favor better gastric emptying.
The truth is that there is very little information on these three variations and the functioning of the modifications is based more on hypotheses than on real data with babies.
The effects of a diet for months with these types of preparations, what effects they have on mucous membranes and what the allergenic potential of thickeners are unknown.
Given this lack of documentation, the Nutrition Committee of ESPGHAN, since 2002, recommends that this type of preparation with thickeners be used only with infants suffering from growth failure caused by excessive loss of nutrients, along with appropriate medical treatment and under supervision.
In other words, they are indicated in those children who, from vomiting the milk they drink, are not feeding properly and as a result they are not growing what is expected of them. This is a serious problem that needs monitoring.
Therefore, the usual practice of offering the general public the possibility of acquiring these formulas for infants who frequently regurgitates is a misuse and abuse by the companies that market them that should be regulated.
Seven years ago, ESPGHAN wrote the recommendations on AR milks and apparently everything remains the same. Commercial firms pack this type of milk in cans almost identical to those of normal artificial milk. This leads to confusion of parents who believe that it is one more possibility of choice when It is a theoretical medical treatment.
To do the test I asked in a pharmacy near my home about these milks, which were not in the exhibitor, and the pharmacist told me that I had them inside and that if I wanted I would sell them without any problem.
