Quality statement 3: Formula‑fed infants – stepped‑care approach

Quality statement

Formula‑fed infants with frequent regurgitation associated with marked distress have their symptoms managed using a stepped‑care approach.

Rationale

A stepped‑care approach enables parents and carers of formula‑fed infants to try a sequence of easy modifications to the feeding practice that can help them manage frequent regurgitation with marked distress.

Quality measures

Structure

Evidence of local arrangements to ensure that formula‑fed infants with frequent regurgitation associated with marked distress have their symptoms managed using a stepped‑care approach.

Data source: Local data collection.

Process

a) Proportion of formula‑fed infants with frequent regurgitation associated with marked distress that have their feeding history reviewed.

Numerator – number in the denominator who have their feeding history reviewed.

Denominator – number of formula‑fed infants presenting with frequent regurgitation associated with marked distress.

Data source: Local data collection.

b) Proportion of formula‑fed infants with frequent regurgitation associated with marked distress that had excessive feed volumes reduced.

Numerator – number in the denominator whose excessive feed volumes were reduced.

Denominator – number of formula‑fed infants presenting with frequent regurgitation associated with marked distress who receive excessive feed volumes.

Data source: Local data collection.

a) Proportion of formula‑fed infants with frequent regurgitation associated with marked distress who received a trial of smaller and more frequent feeds.

Numerator – number in the denominator who received a trial of smaller and more frequent feeds.

Denominator – number of formula‑fed infants presenting with frequent regurgitation associated with marked distress receiving appropriate total daily amount of milk.

Data source: Local data collection.

b) Proportion of formula‑fed infants with frequent regurgitation associated with marked distress given a trial of thickened formula.

Numerator – number in the denominator given a trial of thickened formula.

Denominator – number of formula‑fed infants with frequent regurgitation associated with marked distress receiving appropriate total daily amount of milk and receiving trial of small and frequent feeds.

Data source: Local data collection.

Outcome

Infants with frequent regurgitation associated with marked distress presenting in healthcare settings.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (community care providers, secondary care and specialised women's trusts) ensure that healthcare professionals offer a stepped‑care approach to managing frequent regurgitation associated with marked distress for formula‑fed infants.

Healthcare professionals (health visitors, midwives, paediatric nurses or GPs) use a stepped‑care approach to manage frequent regurgitation associated with marked distress for formula‑fed infants.

Commissioners (clinical commissioning groups, local authorities, NHS England) ensure that the services they commission use a stepped-care approach to managing frequent regurgitation associated with marked distress for formula‑fed infants.

Parents and carers of formula‑fed babies with reflux (regurgitating, bringing up or vomiting feeds) who are very distressed, for example, if they cry inconsolably and seem to be in pain, are told about small changes they can make to feeding that are likely to improve their baby's symptoms, such as reducing the amount or frequency of feeds.

Source guidance

Gastro-oesophageal reflux disease in children and young people (2015) NICE guideline NG1, recommendations 1.2.3

Definitions of terms used in this quality statement

Stepped-care approach

In formula‑fed infants with frequent regurgitation associated with marked distress, use the following stepped‑care approach:

  • review the feeding history, then

  • reduce the feed volumes only if excessive for the infant's weight, then

  • offer a trial of smaller, more frequent feeds (while maintaining an appropriate total daily amount of milk) unless the feeds are already small and frequent, then

  • offer a trial of thickened formula (for example, containing rice starch, cornstarch, locust bean gum or carob bean gum).

[Gastro-oesophageal reflux disease in children and young people (2015) NICE guideline NG1, recommendation 1.2.3]