Infant Reflux and GERD
A small number of babies who tend to spit up a lot are also experiencing what is called Gastroesophageal Reflux Disease (GERD). These babies tend to not only spit up frequently but also tend to be fussy and poor sleepers. Reflux is most common in premature babies due to their immature gastrointestinal systems, but can also occur in full-term babies.
What are the symptoms of reflux?
Babies with reflux tend to spit up frequently after and between meals, and may vomit and show discomfort when spitting up. Reflux-related spit-up is usually relatively clear and may contain some white chunks.
Many of the babies will also gag or choke on the spit-up, burp a lot, hiccup a lot, and even have bad breath due to the semi-digested acidic foods coming back into their esophagus and mouth.
In more severe cases, the reflux may cause severe crying after and between feedings, poor weight gain ('failure to thrive'), and refusal of food or breast. These babies may also spit up bile (green/yellow fluid) or blood, develop chronic sinus or ear infection problems, and even develop breathing problems. If you think your baby might have reflux, you should contact a medical professional immediately.
How can our doctor treat reflux with medication?
Most cases of reflux goes untreated because current medical practice indicates that treatment should only be pursued if the spitting up is accompanied by weight loss or poor weight gain, choking on spit-up, or other medical complications.
Your doctor may also perform one or more tests to help them determine whether your baby has reflux, such as a 24-hour pH probe, during which a tube is stuck down your baby's throat and the doctor measures the amount of acid in the esophagus. If your baby is in the small group that ends up getting treated, there are a variety of reflux medicals that your doctor may decide to use, such as:
1. Antacids: There are many antacids containing aluminum hydroxide and magnesium hydroxide, and they temporarily neutralize stomach acids. They do not reduce the amount of acid that the stomach produces, and they also do not last for very long. These drugs include Maalox, Mylanta, Milk of Magnesium, and Gaviscon.
2. Histamine blockers: These are drugs that can block acid production in the stomach, including Zantac, Pepcid, and Tagamet.
3. Cytoprotective agents: These are drugs that typically coat the esophagus or stomach lining with a thick protective layer, and they include Carafate and Cytotec.
4. Proton pump inhibitors: These are drugs that completely shut down acid production in the stomach. These include Prilosec, Prevacid, Zegerid, and Nexium.
5. Prokinetics (mobility aids): These are drugs that help move food through the stomach faster, reducing the chance that any food will remain in the upper stomach and lower esophagus for an extended period of time. These drugs include Reglan, Motilium, and Urecholine.
How can parents treat reflux?
For babies who do not have severe enough reflux to warrant medical treatment, your doctor might recommend trying several at-home methods that can help relieve the symptoms of reflux in your baby. Here are some helpful hints that can help your baby (and you!). It is important that you always consult a doctor before beginning any treatment (see our full disclaimer here):
1. Keep your baby upright for at least 30 minutes after he or she eats. This means do not put your baby down for a nap, do not lay them down, do not sit them up (this can put a lot of pressure on the stomach), do not put them in their car seat, and do not recline them in a bouncer!
Try holding your baby on your shoulder and sitting on the couch or gently walking them around the house. You can also use a baby carrier that keeps them upright, such as the Infantino, Baby Bjorn or Onya carrier. Also try not to do any activities for 30 minutes, and to keep them peaceful and relaxed. The more time you allow gravity to work its magic, the less likely it is that your baby will spit-up after feeding.
2. Avoid tight clothing that puts pressure on the tummy.
3. If possible, breastfeeding (rather than formula feeding) the baby can reduce the chance of reflux. Mother's breast milk acts as a natural antacid.
4. Some babies respond well to having their breast milk or formula thickened with rice or oatmeal cereal. Thickened foods tend to settle better in the stomach (because they're heavier) and also tend to have more calories (which can help with weight gain). Always consult with your child's pediatrician before considering this approach.
5. Try to have smaller and more frequent feeds throughout the day, rather than only feeding your baby when you know they are hungry. This can help your baby slow down their eating, and help keep them from over-filling their stomach.
6. There is some evidence that, if you are breastfeeding, it may help your baby if you eliminate certain foods from your diet. Some mothers find it helpful when they remove dairy products (milk, cheese, ice cream, butter), caffeine (coffee, tea), fatty foods, citrus foods (oranges, lemon), and spicy foods. There are some great books to help guide you through this process.
7. Always burp your baby during and after meals. Stop after every 5-10 minutes of feeding to burp your baby, and also burp at the end of the feeding. This can help rid the stomach of air bubbles that can act to push semi-digested foods back up into the esophagus.
8. Try giving your baby a pacifier. For 0-3 months, we suggest the Philips Avent Soothie Pacifier, and for babies over 3 months we suggest orthodontic pacifiers, like the Philips Avent Freeflow. Pacifiers can help increase your baby's saliva production. Saliva is alkaline and can help reduce some of the acid build-up that can occur in the esophagus.
9. Try infant massage! This can be a fun and relaxing bonding experience for mother and baby, and there are some infant massage techniques that have been found to be particularly effective in lessening the symptoms of reflux.