Arsenic recently has been reported to be present in rice. The reports have raised concern in the press and in the literature that exposure to high levels may increase the risk of bladder and lung cancer. It also is noted that the potential effect on the developing brain is unknown.

In response to these concerns, the Food and Drug Administration (FDA) has convened an advisory group to conduct a risk assessment and update recommendations regarding acceptable levels of arsenic in drinking water and in our diets. Currently, the recommendation from the FDA and the Academy is that children eat a wide variety of foods, including other grains such as oats, wheat and barley, which will decrease their exposure to arsenic from rice.

Infants and older children who require thickened feeds due to special needs including dysphagia or gastroesophageal reflux may be exposed to rice cereal frequently and in relatively large quantities over a prolonged period of time. Infants born prematurely (10%-15% of all births), young infants with neurologic impairment and infants with disabilities are particularly predisposed to dysphagia and benefit from thickening in their feedings to facilitate swallowing safely.

In response to this concern, the Academy has convened a group with representation from the Committee on Nutrition, the Section on Gastroenterology, Hepatology and Nutrition, the Council on Environmental Health and the Department of Federal Affairs to address the issue related to the exposure to arsenic in rice.

Until more data regarding arsenic are available, interim advice is needed regarding alternatives to rice cereal as a thickening agent for use in feedings for infants and older children. Following review of current evidence and deliberation, the group reached a consensus that oatmeal be used as the preferred thickener instead of rice cereal. As oats are not a member of the same family of grains as wheat, this should not increase risk of celiac disease in an at-risk population. Although there can be cross contamination of oats either in the field or in mills that prepare the grains, this potential risk can be minimized by using products that are labeled as gluten free. In older children, cornstarch or gum-based thickeners would be suitable alternatives.

Use of food-based thickeners presents challenges in determining the best viscosity for the infant, maintaining consistent viscosity and nipple selection. Alteration of the consistency of commercial infant oatmeal products may be helpful in attaining a satisfactory viscosity, and the family may need to be advised to exert care in maintaining the desired suspension. Consultation with feeding specialists who can provide specialized assessment often is needed.

This interim advice will be revisited after the FDA report is complete and periodically as more data become available. The AAP Department of Federal Affairs also will be in close communication with the FDA to ensure the agency is aware of the potential exposure of very young and fragile infants.

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