Babies 0-12 Months | Your Baby's Wellbeing

Infant Acid Reflux

A Burning issue
Infant acid reflux defined

Infant acid reflux, also known as gastroesophageal reflux or GER, is a painful condition that affects more than half of all babies in the first few months of life. GER occurs when there is a backward flow of stomach contents into the oesophagus and out the mouth, resulting in spitting up or vomiting.

Although very stressful for both parent and baby, GER is common in healthy infants. Normally peaking between 1 and 4 months of age, reflux usually resolves on its own by the time the infant is between 6 and 12 months old.

If GER goes undiagnosed, parents are sometimes led to believe that their parenting skills are faulty because baby is overly fussy and niggly most of the time, when in actual fact the poor little thing has acid reflux.

In contrast to the more commonly occurring reflux (GER), the rarer condition of gastroesophageal reflux disease (or GERD) is far more serious.  Affecting approximately 1 in 300 infants, GERD causes further complications such as failure to thrive, slower growth rate, aversions to food, inflammation of the oesophagus, pneumonia, chronic sinusitis and other complications.

What’s up, baby?
Signs and symptoms of infant reflux

Experiencing regular bouts of GER is very common, and is an almost expected part of babyhood. Only a small percentage of infants with GER will experience severe symptoms.

Common symptoms include:

• Spitting up or regurgitation
• Vomiting
• Prolonged coughing
• Wet burps and hiccups
• Excessive drooling
• Sour, bad breath
• Poor feeding habits and diminished appetite
• Fussiness after eating
• Restlessness during sleep
• General irritability and colicky behaviour
• Frequent crying
• Choking or gagging
• Wheezing and asthma-like symptoms
• Frequent colds and respiratory infections
• Eroded dental enamel
• Blood in the stools

More concerning symptoms include:

• Poor growth due to constant vomiting
• Substantial pain, resulting in refusal to feed
• Marked irritability
• Breathing complications
• Persistent projectile vomiting
• Vomit that is green, yellow or resembles coffee grounds
• Blood loss

Generally, GER is easily treated. Should an infant display serious symptoms, however, the best route is to seek immediate medical advice.

What goes down…might come back up
Causes of reflux

In normal cases, food travels down the oesophagus, upon which the muscles in the tube contract downwards , pushing the food down into the stomach. Once the food has been swallowed and has entered the stomach, a band of muscle known as the lower esophageal sphincter (the LES) closes like a one-way valve, trapping the stomach contents and acids and preventing these from refluxing back into the oesophagus. If the LES fails to close (due to the fact that this mechanism is not yet fully developed), these stomach acids flow back into the oesophagus, irritating and burning the tube lining on its way back up.

The degree of regurgitation depends on the severity of this reflux action. If the swallowed food and stomach acids reflux only partially up the oesophagus, the baby will still experience pain but won’t spit up or vomit. This can be worse for the baby and his parents, because reflux isn’t immediately apparent so can go undiagnosed.

As the reflux becomes more severe, the baby will then regurgitate first a little, and then a lot. When the refluxed stomach contents enter the back of the infant’s throat, the baby could experience gagging, choking, sore throat, coughing and eroded dental enamel. Sometimes, the gastric contents are aspirated into the lungs, causing respiratory infections and asthma-like symptoms.

First line of defense
Breastfeeding and GER

GER can’t be prevented per se, as the condition is a result of baby’s still-developing bodily systems. That being said, research has shown that breastfed babies have fewer and less severe reflux episodes than babies who are formula-fed.

There are several reasons why breastfeeding helps minimise the symptoms of reflux:

• Breastmilk is easier to digest than formula
• Breastmilk is less likely to be refluxed into the oesophagus
• Breastmilk is emptied twice as fast from the stomach
• Breastfed babies eat smaller meals more often, so will spit up less

Yet more proof that breast will always be best!

There are a few things that breastfeeding mothers can do to prevent reflux episodes:

• Identify the breastfeeding position that minimises forceful letdowns as much as possible
• Allow your baby to drain the first breast before switching sides
• Avoid overfeeding
• Modify your diet for a while to see if it makes a difference – some babies are intolerant to various foodstuffs, including wheat, eggs and soy

Down with acid!
Dealing with GER

Living with a baby who is suffering from GER is stressful, exhausting and very taxing for the rest of the family.  However, there are things that can be done to lessen the discomfort and complications caused by reflux.  Although what works for one baby may not work for another, the following treatments and lifestyle changes should go a long way to improve symptoms:

Changes in feeding routine and positioning

• Continue breastfeeding (see our notes on breastfeeding, above)
• Make feedings as calm and peaceful as possible
• Maintain skin-to-skin contact
• Nurse or feed your baby when he’s sleepy
• Keep him in a semi-upright position during feedings and try to keep him in this position for about 15 minutes afterwards
• Feed your baby smaller amounts, more frequently
• Burp him often
• Offering a dummy after feeds, which may help prevent him from overfeeding and spitting up
• After feedings, hold your baby upright or prop him up at a 45° angle for at least half an hour
• Elevate the head of his cot

Medical treatment

• Various medications are available to assist with treating the symptoms of GER, such as acid blockers, proton-pump inhibitors, antacids and those that assist in improving coordination of the gastrointestinal tract.  Speak to your doctor about your options
• The homeopathic ColicCalm is very effective in controlling reflux and managing discomfort
• Although surgery to correct problems associated with GERD is very rare, various procedures are available for those little sausages unlucky enough to have such a severe case of reflux

Look after yourself

We understand how overwhelming it can be to have to care for a baby with GER. Make sure that you get enough sleep, eat well, keep in touch with friends and family and take advantage of those who offer to look after your baby while you enjoy some time-out. Your baby needs you to be a tough cookie, so do all you can to care for yourself too. And just remember that this, too, shall pass!

References
www.keepkidshealthy.com
www.medscape.com
www.webmd.com
www.netdoctor.co.uk
www.medicinenet.com
www.askdrsears.com
www.coliccalm.com
www.niddk.nih.gov