GERD in Infants - Causes, Symptoms, Complications, Diagnosis, and Treatment

What Is GERD in Infants?

GERD in infants is very common as they generally intake liquid food and spend most of their time lying down. GERD, a reflux disease, causes repeated gastroesophageal reflux (GER) symptoms that are worrisome and may lead to medical complications.

GER and GERD diagnoses are based on a combination of history and physical examination. They are commonly seen in infants and usually resolve spontaneously by the time the baby reaches 12 months old.

It is a normal physiological process that occurs throughout the day in infants. The occurrence of this reflux is less common in children and adolescents.

What Causes GERD in Infants?

In the case of infants, the muscle present between the esophagus and the stomach, known as the lower esophageal sphincter (LES), is not completely developed. When LES is not completely developed, it allows the contents present in the stomach to flow back into the esophagus. As the baby develops, LES will mature. The LES opens when the baby swallows and will be closed at other times.

However, some factors contribute to reflux in infants, and these cannot be avoided. Some factors are:

• The infants spend most of their time sleeping during the first six months. During this period, they will not have a fully developed esophagus and lower esophageal sphincter.

• At this stage, the babies are more dependent on liquid food.

• Babies arching their backs can also be a symptom of GERD in infants. This is done to relieve the pain and discomfort caused by the backwash of the food and acid in the esophagus.

These factors may cause the stomach contents to flow back up through the esophagus and reach the mouth. However, as the infant grows, eats more solids, and spends more time in upright positions, the gastroesophageal reflux disease symptoms in the child gradually reduce on their own. Infants have a definite possibility of developing GERD if they have the following health conditions:

• Premature birth.

• Cystic fibrosis.

• Cerebral palsy.

• History of previous surgery for esophageal atresia.

• Hiatal hernia.

What Are the Symptoms of GERD in Infants?

Infant gastroesophageal reflux disease commonly causes regurgitation (stomach contents coming out through the esophagus either into the throat or mouth) or spitting up in infants.

Apart from this, it can also affect the infant's life by causing:

• Choking, gagging, or problems with swallowing.

• Irritability because of regurgitation.

• The baby might refuse to eat or swallow, leading to loss of appetite.

• The baby spits up green or yellow fluid.

• Abnormal movement of the neck and the chin.

• Poor weight gain.

• Wet burps and hiccups.

• Coughing and wheezing.

• Vomiting.

How to Diagnose GERD in Infants?

The doctors attempt to review your infant's symptoms and medical history. If your doctor suspects GER or GERD, they may suggest lifestyle modifications to help alleviate this condition. However, if the symptoms are severe, your doctor might recommend some tests to rule out GERD.

The tests for diagnosing GERD include:

1. Upper gastrointestinal (GI) endoscopy:

It is a procedure in which a flexible tube with a camera is inserted to check the lining of the upper GI tract, including the esophagus, stomach, and duodenum. Sometimes, a doctor might take a small piece of tissue for a biopsy.

2. Esophageal pH monitoring:

Esophageal pH monitoring is done to detect acid reflux in the esophagus. Your doctor might suggest this test to detect non-acid reflux. The doctor inserts one end of a flexible catheter into the esophagus through the infant's nose. The catheter is connected to a monitor to diagnose the GERD condition. This test can help the doctor detect problems related to sleeping, eating, and other types of esophageal reflux. It can also provide an idea about the effectiveness of GERD medicines.

3. Upper GI series:

It is a procedure in which a doctor uses barium to visualize the upper GI tract with X-rays. It is used primarily to detect anatomic problems of the esophagus and upper GI tract to determine why symptoms worsen.

What Is the Treatment of GERD in Infants?

The infants do not require treatment, as the condition typically resolves independently by the time they turn 12 months old. Some treatment methods include:

• The doctor may recommend certain diet modifications, depending on the age and symptoms experienced by your infant.

• They will ask you to hold your baby upright for 15 to 20 minutes after feeding.

• You should avoid exposing the infant to passive smoking.

• Based on the severity of the condition of your infant, a doctor might suggest some medications.

• Surgery is usually not recommended and is an option only when your infant is unresponsive to all other treatment modalities.

What Are the Most Recommended Diet Modifications That Can Improve GERD in Infants?

If you suspect GERD signs in your baby, you should avoid making any lifestyle modifications without consulting your doctor.

Depending on the age and symptoms of the infants, a doctor will suggest changes in your baby's diet plan, such as,

• Frequent breastfeeding of your infant and avoiding overfeeding.

• Adding cereals or stored breast milk to the formula to make it thicker.

• Removing cow's milk from the diet, as many infants are allergic to the protein in cow's milk and may exhibit signs similar to GERD.

• Additional calorie intake is needed if your baby is showing poor weight gain.

One must follow the doctor's diet guidance plan, as it will suggest a balanced diet essential for your baby's growth and development.

What Are the Associated Complications of GERD in Infants?

The infant with GERD might develop some complications, either concerning the esophagus or some outside esophagus, if appropriate treatment is not given in time; the commonly known complications are:

• Esophagitis (inflammation of the esophagus).

• Poor weight gain.

• Complications outside the esophagus include cough, pneumonia, wheezing, or laryngitis.

What Are the Risk Factors Related to GERD?

Some common risk factors are

• Infant reflux.

• Premature birth.

• Lung issues like cystic fibrosis.

• This condition can affect the nervous system.

• Prior surgery on the esophagus.

When to Consult the Doctor?

The doctor should be called if:

• The baby either loses weight or fails to gain weight.

• There is blood in the vomit.

• The baby has breathing issues.

• The patient is seen to be in pain.

• The baby continues to cry and cannot be calmed.

• The baby is dehydrated.

• The vomiting gets worse.

• The baby has a very high fever.

Conclusion

Infant gastroesophageal reflux disease is commonly reported in breastfeeding infants. Some studies support that its occurrence in infants might be due to spending long hours lying while sleeping and consuming more liquid food. Various research studies are being conducted to detect the reason for its increased prevalence in infants compared to adolescents and children. If you notice frequent gagging or spitting up in your infant, it is advisable to seek the help of your pediatrician at the earliest to get it sorted.

Key Takeaway From iCliniq

• GERD in infants is a condition in which there is a backflow of acid from the stomach to the infant’s esophagus.

• This condition may resolve on its own as the infant grows and develops.

• For more information, you can consult a pediatrician at iCliniq.