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As parents, we all want our infant to be happy, comfortable and healthy. It can be extremely difficult to watch our child suffer from the discomfort caused by reflux. Not to mention the sleepless nights both parent and child will often have to endure.
In this article, I will highlight the most important information about infant reflux including the symptoms, causes, and potential treatments options. Besides, I will mention the differences between gastro-oesophageal reflux (GOR) and gastro-oesophageal reflux disease (GORD), just to make sure that you're well-informed when it comes to identifying them.
What Is Infant Reflux?
source: anatomy medicine
Acid reflux is the term used to describe what happens when your baby ends up spitting up whatever they've swallowed. This is due to the stomach contents (i.e. milk and acid) coming back into the gullet or the mouth.
In some cases, it's completely natural for your baby to have reflux. In fact, the good news is that it usually passes by the time your baby reaches a year old.
Most babies have a small degree of reflux because the muscular valve which is meant to store any consumed food (i.e. milk, vegetables, and fruit) is yet to be fully developed. In other words, when your baby's stomach is full, milk and food can inevitably come back up. When and if your little one brings up a very small quantity of the two, then that is called posseting. This informal term is usually used to describe what happens when babies burp, which results in the unfortunate spitting up over the shoulder. Usually, this is not a cause for worry.
4 Causes of Infant Reflux
Positioning can affect your baby's reflux. The good part about it is that it's such a simple, low-cost treatment which can be tried by parents, way before there is any need to think of expensive treatment options such as medication. Thus, if your baby is suffering from infant reflux, try maintaining horizontal positions which may help reduce acid reflux.
Needless to say, when your baby's belly is full, milk can come back up the way it went in. This is due to a couple of reasons, and an evident one is the size of your baby's stomach. As a newborn, your baby's stomach is not much bigger than a hazelnut. And so, you've guessed it; even a little food can turn into too much when it comes to a newborn baby.
The good news, however, is that there is going to be a continuous improvement in the growth of your baby’s stomach, ranging from the stomach having the size of a walnut to the size of a large egg by day 10.
Possibly the best thing to know is that a staggering 90% of babies who have acid reflux get better on their own before the end of their first year of life.
Using a slow flow bottle may help to prevent overfeeding at some point.
3. Food intolerance to foods such as garlic, tomato, onions, chocolate, etc.
Much like anything that comes with being a new parent, there is a trial and error period. It's a no-brainer that some babies are more sensitive than others and that there is no one-size-fits solution. Unfortunately, your doctor is often unable to tell you exactly what not to feed your baby or what is causing the discomfort. You will just need to be observant when trying new foods out for your infant.
4. Eating too much before bedtime
Again, this is very similar to adults. If you choose to feed your baby before bed, you might end up having a restless and upset little one for obvious reasons. Eating excessively before bed might not allow digestion to take place, resulting in pain and involuntary vomiting. Instead of hurrying your little one to bed right away, try burping your child and waiting at least half an hour which gives just enough time for proper digestion to take place.
How to Tell If Your Infant Has Reflux?
1. Persistent coughing, hiccups or gagging
source: baby kitted
According to research, the terms wet burp or wet hiccup are used to describe the reaction a baby might have when eating (i.e. spitting up liquid when they burp or hiccup).
2. Frequent vomiting and irritability during feeding
As a parent, you might already be aware that your little one can often spit up his feeds or be irritable. It could be a short passing phase though which is not a cause for worry. However, you should note that infants suffering from reflux may start screaming and crying in a distressed andprolonger manner during feeding. This is usually due to the abdominal discomfort and is a sign of reflux.
3. Disturbed sleep
It will not come as a surprise that infants with reflux can experience discomfort or irritation, which in turn, will not let your little one go to sleep or stay asleep for long. This will more than likely mean that you won’t go to sleep either! One trick to overcome that problem is trying is to feed your baby way before bedtime, so as to allow for any food to fully settle.
4. Difficulty swallowing, or pain when swallowing
Because of pain and emotional distress, your infant may refuse to eat, which will only cause you further worry. This pain might be due to the irritation that occurs when food comes back up the oesophagus.
5. Poor weight loss or gain
Due to the constant vomiting, weight loss or failure to gain weight may be inevitable.
How does Infant Reflux Diagnosed?
If you’ve ever been “lucky” enough to have a doctor’s appointment, then you will know that the first step any doctor will take is a verbal consultation. In the case of infant reflux, this will include wanting to know as much as possible about potential symptoms, their perseverance (i.e. for how long your baby has been feeling a certain way), and how severe they are, in your opinion.
Afterward, a physical exam will take place. If the doctor determines that your baby is healthy, happy, and growing as expected, then further testing won't be a priority or necessity. However, if there is any cause for concern, your doctor might recommend the following:
1. Lab tests
Blood and urine sample are usually required to either identify or rule out possible causes of recurring vomiting and poor weight gain.
In many cases, doctors make use of X-Ray images, as they are highly capable in determining abnormalities in the digestive system. These images are considered to be a safe procedure that uses radiation to obtain a clear picture of the upper GI tract.
This is used to detect pyloric stenosis, which is a condition blocking food from entering the baby's small intestine.
4. Oesophageal pH Monitoring
source: med scape
Meant to measure the acidity in the baby's
5. Upper Endoscopy
This is a more invasive procedure, as it involves having a special tube inserted through your baby’s mouth and into to
Reflux in Breastfed Babies
According to studies, acid reflux is far less common in breastfed babies, meaning that breastfed babies show fewer and less severe reflux episodes.
It appears that there is considerable evidence backing up this claim, as it's been proven that human milk is less irritating than its artificial counterpart. Additionally, human milk is highly nutritious and is sometimes prescribed as an efficient and quick method of treating gastroesophageal reflux.
This is because breastmilk is packed with immune factors, not solely antibodies, but other nutrients which protect from bacteria and viruses. Breast milk forms a protective barrier which protects your baby from microorganisms designed to infect and invade the body.
If breastfeed baby persist with reflux issue, Sarah Channa provides some guidance on how to handle them well.
Another important thing any parent should also take into account is environmental factors. Since our bodies are sponges to outside factors (i.e. tobacco, alcohol, caffeine), it’s important to try to eliminate, as much as possible, any such potential risk factors.
Lastly, when it comes to infant reflux, many studies point to the fact that up to half of all gastro-oesophageal issues might relate to allergies caused by cow's milk protein, which is the synthetic stuff found in artificial milk.
If you have twin babies, check out NW London Twins in-depth guide on twins with reflux diagnosis.
5 Treatments for Infant Reflux
So what can you, as a mom or dad, do in order to treat infant reflux, in a more natural way?
1. Calm and relaxed environment
The reality is that much like adults, infants thrive in a more relaxed environment. This means that babies will prefer not to be stressed by any external factor (e.g. loud noises, distractions). In the same way, any internal changes to the body (i.e. due to caffeine, tobacco) can have a negative impact on infant reflux.
2. Burp your baby more often
source: Styles at Life - Learn how to burp baby here
Additionally, try burping babies as often as possible, as this may help with reflux symptoms. This also means avoiding big meals before bedtime and giving smaller but more frequent feedings. If for some reasons breastfeeding is not an option, don't guilt-trip yourself, just try to switch the type of formula you usually use, just in case this may be a contributing factor. Alternatively, watch out for air gulping by double-checking the bottle and the bottle nipple (i.e. try different sizes).
3. Thicken formula or breastmilk
You may also choose to thicken the formula or breast milk, but try to do it as gradually as possible. For example, your doctor may advise adding cereal to thicken the formula. It has not yet been proven that this treatment is effective. However, it doesn't hurt to try, as many doctors suggest giving it a go before resorting to using medication.
4. Lay your baby on the left
Additionally, studies have revealed that lying on the left side and on their tummy might improve acid reflux. However, note that placing the infant in the belly-down position should only be done when the child is awake and heavily monitored. This is due to SIDS, which is increased by babies sleeping in this prone position.
Last but not least, positioning plays a vital role. According to extensive research, reflux is at its worst when babies lie flat on their back. Try to avoid compressing your baby’s abdomen by having tight nappies or letting them stay in bent positions. Also, dressing your little one in loose clothing can help alleviate pain or discomfort.
Nonetheless, as mentioned earlier, there is no right or wrong answer. Each baby has their needs and personalities, thus what may work for one might fail for another. Experiment to find what works best for your baby.
5. Using Prescription Medicine for Infant Reflux
If all the above advice has failed, your doctor may end up prescribing medication for your baby. This isn’t usually a necessary step, but in some more severe cases it may be recommended:
- Alginates – a salt of alginic acid, this medication forms a protective barrier over the inside of your baby’s stomach, stopping foodfromtraveling up and distressing theoesophagus, which would ultimately result in vomiting or spitting up
- Proton pump inhibitors (PPIs) and H2-receptor antagonists – this form of medication is meant to help reduce the stomach’s acidity level, and this is done so that the stomach contents don't cause more discomfort and pain to the oesophagus.
Just remember, some medication could prevent absorption of calcium and iron. Therefore they should only be used in extreme situations, and under the advice of your doctor. Moreover, if your child is prescribed reflux medications, keep in mind that dosages need to be monitored and adjusted, as the baby grows.
Surgery for Infants
Surgery aiming to reduce infant reflux is usually a last option for babies who have not benefited from any holistic treatment or medication. A doctor may conclude that surgery is the best course of action if, for example, your baby or child experience heartburn (i.e. chest or stomach burn), or in other more extreme cases, when there is a narrowing of theoesophagus. Additionally, babies who suffer from any lung infection or a chronic cough might require surgery, if advised by your doctor.
The most common type of anti-reflux surgery is called fundoplication. This procedure is only used in severe cases (e.g. reflux causing breathing problems, or negatively influencing growth), and it usually takes 2 to 3 hours.
During the surgery, the baby is usually put under general anesthesia, meaning that no pain will be felt during it. A gastrostomy tube (otherwise called a g-tube) would be inserted by the doctor, should your child have swallowing or feeding problems. This tube helps with feeding and releases air from your child's stomach
Another type of surgery, called pyloroplasty, may also be considered as an option. This procedure is meant to widen the opening between the stomach and small intestine so that the stomach can digest and process food easier.
5 Preventive Measures of Baby Reflux
Before thinking of the worst scenarios, note that there are alternative treatments (like the ones mentioned above). If your baby has not even had this issue, there are some preventative measures which if followed, can ensure that he will not suffer from reflux.
1. Avoiding Overfeeding
This means trying to provide smaller and more frequent meals, while not letting your baby get really hungry before you feed him, not even during Baby-Led weaning process
Feed your baby in an upright position, and try to hold your baby upright for 20 minutes to 30 minutes after each feed. Alternatively, try raising your baby’s head, even holding him or her in your arms while feeding.
3. Burping your baby
If you are unable to breastfeed and thus use a bottle, try burping him every two minutes or three minutes during feeds, making sure that you're using the right size nipple to avoid air bubbles from forming.
4. Thicken milk
As mentioned above, despite there being little to no evidence suggesting that this will work, many doctors recommend adding cereal to make your baby's milk thicker. This is done because thicker milk can help your baby not to spit food right back up. However, you should always check with your doctor before trying this approach.
Loosen your baby's diapers to avoid putting pressure on the tummy, especially during feeding!
To sum up, there are a variety of reasons for which your baby might suffer from infant reflux, and there are many variations of the condition (i.e. gastro-oesophageal reflux, gastroesophageal reflux disease, or silent reflux).
One of the symptoms that parents should look out for is frequent and recurrent vomiting. As we’ve mentioned earlier, reflux can sometimes be a temporary problem, one that is likely to fix itself over time. However if your baby is more than posseting (meaning bringing up small quantities of milk) after a meal, it may still be worth consulting with your doctor.
Persistent coughing during and after eating, or alternatively signs of heartburn, gas or abdominal spasms can be a good indication of acid reflux. However, if problems do persist, they can appear in the form of food refusal or decreased rate of growth.
For any worried parents, there any many preventative measures which can be adopted. Alternatively, doctors may suggest using medication, and in certain extreme cases, surgery will be recommended to stop the onset of more serious respiratory or digestive problems.
All in all, your doctor is the best option in determining the right course of action, and you can trust that all avenues will be investigated before resorting to medication or surgery.
You are welcome to share your experience with infant reflux in the comments below. Do you have any additional tips to add?