The Short Answer
For babies diagnosed with painful reflux (GERD), the best option is a pre-thickened Anti-Reflux (A.R.) formula. These specialized milks are engineered to get heavy in the stomach so they stay down.
HiPP Anti-Reflux is our top choice because it uses natural locust bean gum to thicken the milk without heavy metals.
If you prefer a US brand, Enfamil A.R. and Similac For Spit-Up both use added rice starch to reduce spit-up by over 50%.
Why This Matters
Almost all babies spit up, but it only becomes a problem when it impacts their health. When simple spit-up turns into painful reflux, weight loss, or persistent crying, your pediatrician might diagnose Gastroesophageal Reflux Disease (GERD).
For decades, the standard medical advice was to manually add a teaspoon of rice cereal to a standard bottle. This DIY thickening is now widely discouraged by pediatricians. It causes babies to consume too many empty calories and creates a severe choking hazard.
Instead, companies created pre-thickened formulas to solve the problem safely. These are designed to be thin in the bottle so they flow easily, but they thicken instantly when they hit stomach acid.
While highly effective, the thickening ingredients themselves introduce new concerns for health-conscious parents. Safest Formula Brands
What's Actually In Anti-Reflux Formula
- Rice Starch — The primary thickener in American AR formulas like Enfamil and Similac. It makes the formula heavy, but heavy reliance on rice products raises valid concerns about arsenic exposure in infants. Arsenic In Baby Formula
- Locust Bean Gum — Also known as carob bean gum, this is the preferred thickener in European formulas like HiPP. It's a natural, plant-based fiber that effectively thickens milk without the heavy metal risks associated with rice. European Vs American Formula
- Hydrolyzed Proteins — Sometimes reflux isn't a mechanical issue, but an allergic reaction. Hypoallergenic formulas use proteins that are already broken down, allowing the stomach to digest and empty faster. Best Formula Gassy Babies
- Corn Syrup Solids — Often used in specialized formulas to replace lactose and ease digestion. While effective for sensitive tummies, it's a highly processed sugar that many parents prefer to avoid. Is Corn Syrup Formula Bad
- Palm Oil — Found in Enfamil A.R., palm olein oil can react with calcium in the gut to create "soap-like" compounds. This causes harder stools and constipation, which is a terrible side effect for babies already struggling with digestion. Palm Oil Formula Bad
What to Look For
Green Flags:
- Pre-thickened formulations — Commercially mixed AR formulas are clinically balanced and safer than DIY rice cereal methods.
- Locust bean gum — A natural, plant-based alternative to heavy metal-prone rice starch.
- Partially hydrolyzed proteins — Because they are easier to digest, they speed up stomach emptying before milk can travel back up.
Red Flags:
- DIY added rice cereal — Do not add cereal to a bottle yourself, as it increases choking risks.
- Palm oil — It exacerbates constipation, which is already a common side effect of thickened formulas.
- Corn syrup as the first ingredient — Often used in US spit-up formulas as a cheap, highly processed carbohydrate source. Corn Syrup Baby Formula
The Best Options
If your pediatrician recommends an anti-reflux formula, you have to weigh the ingredients against the relief it provides. Here are the top contenders.
| Brand | Product | Verdict | Why |
|---|---|---|---|
| HiPP | Anti-Reflux (AR) | ✅ | Thickens with natural locust bean gum instead of rice starch. |
| Enfamil | Nutramigen | ✅ | The best choice if your baby's reflux is caused by a milk protein allergy. |
| Similac | For Spit-Up | ⚠️ | Palm oil-free, but relies heavily on corn syrup and rice starch. |
| Enfamil | A.R. | ⚠️ | Clinically effective, but contains palm oil which can cause constipation. |
The Bottom Line
1. Get a real diagnosis. Spit-up is a laundry problem; GERD is a medical problem. Don't switch to a thickened formula unless your baby is in pain or failing to gain weight.
2. Skip the DIY rice cereal. Adding cereal to a bottle is an outdated, dangerous practice. Use a commercially mixed AR formula instead.
3. Watch for constipation. Thickened formulas are notorious for causing hard stools. If using Enfamil A.R., be prepared to manage constipation, or switch to a palm oil-free option like Similac.
FAQ
Is Similac or Enfamil better for reflux?
It depends on your baby's specific needs. Enfamil A.R. is thicker and widely recommended, but it contains palm oil which can cause constipation. Similac For Spit-Up has no palm oil, making it easier on the bowels, but it relies heavily on corn syrup solids. Similac Vs Enfamil Comparison
Why is there rice starch in reflux formula?
Rice starch is used to make the formula heavier. It goes down smooth but thickens upon contact with stomach acid, physically preventing the milk from traveling back up the esophagus.
Can I just use a gentle formula instead?
Yes, sometimes. If your baby's reflux is mild, formulas with partially hydrolyzed proteins (like Bobbie Gentle or Gerber Good Start) can speed up digestion so the stomach empties before spit-up occurs. Easiest Digest Formula