If your baby spits up frequently chances are it is a case of infant reflux. Infant reflux is the regurgitation of milk and stomach acid by a baby, which can cause the baby pain and which causes distress to both the infant and parents. More than half of all babies experience reflux in the first 3 months of life. Only a small number of infants have problems due to gastroesophageal reflux.
Usually reflux in infants is due to a poorly coordinated gastrointestinal tract where the esophageal valve or muscle at the upper end of the stomach allows feedings to "reflux" or come back up. Many infants with the condition are otherwise healthy; however, some infants can have problems affecting their nerves, brain or muscles. Most infants will out-grow the condition between eight months and eighteen months old.
The most common infant reflux symptoms are:
• frequently spitting up
• persistent cough.
• refusing to eat
• choking or gagging when feeding
• frequent crying and fussiness
• regurgitation and re-swallowing.
• Poor growth
• Breathing problems
• Recurrent pneumonia
Usually, a family physician can make a diagnosis based on a parent's description of the symptoms, especially if the problem occurs regularly and causes discomfort. Occasionally, further tests are recommended. They may include:
Barium swallow or upper GI series. This is a special X-ray test that uses barium to highlight the esophagus, stomach and upper part of the small intestine. This test may identify any obstructions or narrowing in these areas.
pH probe. During the test, the patient is asked to swallow a long, thin tube with a probe at the tip that will stay in the esophagus for 24 hours. The tip is positioned, usually at the lower part of the esophagus, and measures levels of stomach acids. It also helps determine if breathing problems are the result of reflux.
Upper GI endoscopy. This is done using an endoscope (a thin, flexible, lighted tube and camera) that allows the doctor to look directly inside the esophagus, stomach and upper part of the small intestine.
Overfeeding can aggravate reflux, and your health care provider may suggest a different feeding schedule. For example, smaller volume with more frequent feedings can help decrease the chances of reflux.
If a food allergy is suspected your health care provider may ask you to change the baby's formula (or modify the mother's diet if the baby is breastfed). If a child is not growing well, feedings with higher calorie content or tube feedings may be recommended.
If your child is uncomfortable, or has difficulty sleeping, eating or growing, the doctor may suggest a medication. Different types of medicine can be used to treat reflux by decreasing the acid in the stomach. Although these medications will help protect your child's esophagus from damage due to reflux, the medicines are unlikely to completely cure the spitting up.
Very rarely do infants have severe gastroesophageal reflux that prevents them from growing or that causes breathing problems. It is rare for infants to require surgery for reflux. If surgery is necessary, your baby's doctor or nurse can discuss treatment options with you.
The following lifestyle changes will help the majority of infants with reflux, and include:
• Breast feeding: Reflux is milder in babies that breast feed.
• Feed smaller amounts: It is better to feed your infant small amounts more frequently than giving a large amount and overfilling the stomach. Reflux is always worse with overfeeding.
• Burp often: You should try to burp your child frequently during each feeding.
• Thicken feedings: add 1-2 teaspoons of Rice cereal to each ounce of formula to thicken it up. Stop if you don't notice any improvement in 3-5 days.
• Positioning: Elevate the head of the baby's crib or bassinet. Hold the baby upright for 30 minutes after a feeding. Also avoid putting pressure on their abdomen after meals.
For babies who have severe infant reflux or GERD, more aggressive treatment may be recommended. These treatments my include medications, alternative feeding methods or even surgery. Very rarely do infants have severe gastroesophageal reflux that prevents them from growing or that causes breathing problems. It is rare for infants to require surgery for gastroesophageal reflux. If surgery is necessary, your baby's doctor or nurse can discuss treatment options with you. Please refer to Infant Reflux Treatments and Drugs
Most babies with infant reflux do not benefit from changing their formula. Unless the spitting up is accompanied by vomiting, diarrhea, allergies, or weight loss, it is very unlikely that it will improve with formula changes.
If your child improves with thickened feedings, then you could consider changing to Enfamil AR (added rice) which is thicker than most formulas.
Protect your clothing, carpets, furniture, etc. Use bibs or towels to protect things from getting stained and don't feed your infant when you are dressed up or on the new couch.
Be Patient! Most infant reflux cases improve with time.
Infant Reflux References
By Mortin - Copyright 2009
Last modification 31/12/2009