LES pressure may transiently decrease spontaneously (inappropriate relaxation), which is the most common cause of reflux, or after exposure to cigarette smoke and caffeine (in beverages or breast milk). The esophagus is normally at a negative pressure, whereas the stomach is at a positive pressure. The pressure in the LES has to exceed that pressure gradient to prevent reflux.
“Instead of staying nice and tightly closed, a baby’s muscle is not as developed [as it is in adults], so liquid and food can sneak past,” Burgert says. Some symptoms of cows’ milk protein allergy can be similar to reflux symptoms, especially in babies who have eczema or asthma, or a family history of eczema or asthma. See other NICE guidance for details of our guidance on food allergy.
For instance, feeding smaller amounts more frequently will be suggested along with changes to their feeding position, such as sitting them in a more upright position during feeds and immediately afterwards. Every two weeks, stop the treatment to see if your baby’s reflux is getting better (NICE 2015b) . If your baby is still having problems after a couple of months of having an antacid, go back to your doctor (Rosen et al 2018) . In the meantime, if you’re formula feeding, you could try giving your baby his daily allowance in smaller, more frequent feeds.
Learn the symptoms and causes of bloating to feel more healthy. these causes include bloating, gas, colitis, endometriosis, food poisoning, GERD, IBS (irritable bowel syndrome), ovarian cysts, abdominal adhesions, diverticulitis, Crohn’s disease, ulcerative colitis, gallbladder disease, liver disease, and cancers. Recent studies indicate that between 2% to 8 % of children 3 to 17 years of age experience GERD symptoms (detailed later). Infants with GER generally have no symptoms other than the obvious reflux of fluid out the mouth.
Some anatomic causes of reflux also may have to be corrected surgically. For infants with gastroesophageal reflux, the only necessary treatment is to reassure caregivers that the symptoms are normal and will be outgrown. Infants with GERD require treatment, typically beginning with conservative measures.
In most cases, a doctor diagnoses reflux by reviewing your baby’s symptoms and medical history. If the symptoms do not get better with feeding changes and anti-reflux medicines, your baby may need testing. Breastfeed! Reflux is less common in breastfed babies.
Also, don’t give your infant caffeinated beverages, orange juice, or other citrus juices. On occasion, surgery (open Nissan fundoplication or ONF) may be needed for babies with severe reflux. If you are considering this procedure, make sure to talk to a pediatric surgeon who has performed many of these procedures and can tell you what you can expect with the surgery. Just as adults can develop heartburn and reflux if they are feeling anxious, babies who are anxious or overstimulated may also spit up more. Make feeding time more enjoyable by eliminating loud noises and distractions and dimming the lights.
- Sometimes babies may have signs of reflux, but will not bring up milk or be sick.
- Signs and symptoms of GER or GERD in infants and children are overlap.
- In babies, this problem happens because the digestive tract is still growing.
GERD and pyloric stenosis If your baby projectile vomits in the first few weeks of life, keep an eye out for symptoms of pyloric stenosis, since it can sometimes be confused with GERD in infants. In addition to forceful vomiting at feedings, symptoms of pyloric stenosis include blood in the vomit, constant hunger, dehydration and constipation. While rare, the condition does require diagnosis and treatment from a doctor.
Keep feeds small and frequent. Most babies with reflux like to feed often and this is actually good for them as this causes less pressure on the stomach muscle than a large sudden intake of food. Babies suffering silent reflux typically experience discomfort 60-90 minutes after feeding, at which time the stomach’s contents usually move into the intestines for absorption. Instead, the weak muscle at the top of the stomach allows some food to be squeezed upwards into the oesophagus. In a small number of babies, reflux might be associated with a more serious problem, such as gastro-oesophageal reflux disease (GORD).
Most infants gain weight well, however a small percentage fail to thrive due to feeding difficulties (or excessive vomiting). Feeding issues are very common in babies and children of all ages with reflux. Babies and children may suddenly start crying while feeding or after the feed without any other obvious cause for the crying, or they may grimace or make a screwed up face like they tasted something bad. The options for treating gastro-oesophageal reflux disease are improving all the time, with new medicines and surgical options being discovered alongside a better understanding of why a child develops gastro-oesophageal reflux disease. Medications may also be suggested – some form a barrier on top of the stomach contents to reduce the risk of them flowing backwards, while others damp down acid production in the stomach.
If GERD is severe, treatment may include medication or surgery. The surgery to correct reflux is called fundoplication. Some reflux children have huge weight gains, particularly if they feed frequently for comfort. Most babies with reflux gain weight well; however, some babies do
If your child is taking reflux medications, keep in mind that dosages generally need to be monitored and adjusted frequently as baby grows. Although recent research does not support recommendations to keep baby in a semi-upright position (30° elevation), this remains a common recommendation. Positioning at a 60° elevation in an infant seat or swing has been found to increase reflux compared with the prone (tummy down) position [Carroll 2002, Secker 2002]. As always, watch your baby and follow his cues to determine what works best to ease the reflux symptoms. Aim for frequent breastfeeding, whenever baby cues to feed.
with positions to find the best one that will allow your baby to remain fairly upright during feeding. Some mothers report success by having their baby face their breast while straddling their leg. Others prefer to stand up while feeding their baby in a modified twin-style hold. Reflux usually doesn’t need any specific treatment but the feeding suggestions above might be helpful. In severe cases, a GP or gastroenterologist can prescribe medicines that might help with pain and discomfort (Tighe et al, 2014) .