Clinical inquiries. Should we change formula for a formula-fed infant with persistent spitting up, but with adequate weight gain?

We found no controlled trials evaluating the efficacy of changing formulas in the management of uncomplicated regurgitation. However, the evidence suggests that no benefit can be expected from changing formulas, including the discontinuation of iron-fortified formulas. 1,2 Additionally, changing formulas leads many mothers to believe that their child has a disease or illness. 3 Although controlled trials of infants with gastroesophageal reflux disease (GERD) show that formula thickening (eg, with rice cereal) decreases spitting-up, 4 and expert consensus panels recommend formula thickening (along with parental reassurance) as first-line therapy in the management of uncomplicated regurgitaion, 5 one could question whether these outcomes in infants with GERD would hold for infants with uncomplicated regurgitation. Flat-prone positioning and avoiding the seated position is beneficial in infants with GERD, but the association of prone positioning with sudden infant death syndrome limits this intervention. 5 (Grade of recommendation: D, based on a synthesis of information from controlled trials performed in other patient populations, retrospective surveys, physiologic evidence, and consensus expert opinion.)