Infant Reflux: Understanding GERD in Infants

What Is Infant Reflux?

Infant reflux is one of the very common reflux seen in newborns. In this condition, the food (milk) consumed moves back up from the baby's stomach, and the baby starts spitting. This can be seen in healthy infants, which are normal and do not harm the baby. The infant reflux does not cause any harm to the infant need not worry until this reflux is severe and if it causes any problems to the child. The other name of the reflux is gastroesophageal reflux. This reflux occurs five to six times a day in healthy babies, but it is more than that. The infant should be taken to the healthcare provider. This reflux is very common in younger babies and keeps continuing, this reflux may be severe till four months of age and gradually decreases by the time of the first birthday.

What Are the Causes of Infant Reflux?

Normally there is a lower esophageal sphincter that acts as a valve between the stomach and esophagus. This valve prevents the food from going back into the mouth. When we eat food, the sphincter slowly relaxes, opens, and allows food to pass into the stomach. But in a few children, these sphincters are poorly developed and result in such refluxes. The becomes very relaxed and starts open when it is not supposed to be open, causing gastroesophageal reflux.

What Are the Symptoms of Infant Reflux?

The symptoms of infant reflux include:

• Continuous spitting of food, sometimes forceful shooting of foods occurs.

• Very poor weight gain.

• Spits green-yellow fluid.

• Spits blood or blood-like discharge.

• After the feeding is done, arching of the back is seen.

• Gagging.

• Difficulty in swallowing.

• Difficulty in breathing.

• Cough and hiccups are noticed while feeding.

• Very disturbed or discomfort during feeding.

• Begins to spit at the age of six months and above.

What Are the Risk Factors for Infant Reflux?

Risk factors for infant reflux can include:

1. Age: Reflux is more common in infants, particularly in those under the age of one year.

2. Prematurity: Premature infants may be at a higher risk of developing reflux due to the immaturity of their digestive system.

3. Low Birth Weight: Infants with a low birth weight may be more susceptible to reflux.

4. Family History: Having a family history of reflux or gastroesophageal reflux disease (GERD) can increase the likelihood of an infant developing reflux.

5. Maternal Factors: Certain maternal factors, such as smoking during pregnancy or while breastfeeding, can contribute to infant reflux.

6. Overfeeding or Improper Feeding Techniques: Overfeeding, using an improper bottle nipple size, or feeding too quickly can increase the chances of reflux.

7. Certain Medical Conditions: Infants with certain medical conditions, such as neurological disorders or conditions affecting the gastrointestinal tract, may be more prone to reflux.

8. Positioning During Feeding: Feeding a baby in a reclined position or not maintaining an upright position during and after feeding can contribute to reflux.

9. Allergies or Food Intolerances: Some infants with allergies or food intolerances may experience reflux as a result.

What Are the Precautions That Are Taken to Prevent the Symptoms of Infant Reflux?

Some precautions are required to prevent the severity of the symptoms, the precautions are:

• Get proper advice from the doctor about the position of breastfeeding or how to bottle feed the baby.

• Take advice or help from a doctor.

• Once the feeding is done, hold the baby in an upright position as long as one can do it.

• Burp should be done after feeding the baby.

• Babies should not have slept on their sideways; they should sleep flat on the neck.

• Do not change feeding in case breastfeeding is done.

What Are the Complications of Infant Reflux?

Although the condition may be a serious issue, in few children, the condition may cause severe complications such as:

• The reflux causes damage to the esophageal lining and causes ulcers in a few cases.

• Sometimes the valve between the esophagus and the stomach starts getting narrowed, and the condition is called pyloric stenosis.

• Some babies show up with lactose intolerance (lactose, a protein present in the milk) which increases the risk of complications.

• Eosinophilic esophagitis has developed a condition where white blood cells called eosinophils start accumulating in the injured portion of the esophageal lining caused by the acids produced during the reflux.

• Sandifer syndrome is a condition where the abnormal position of the neck resembles seizures. This is a very rare complication of infant reflux.

What Is the Treatment for Infant Reflux in Babies?

The treatment for infant reflux in babies can vary depending on the severity of the symptoms and the underlying causes. Here are some common approaches:

1. Lifestyle and Feeding Modifications: Making changes to the baby's feeding routine and positioning can help manage reflux. This includes feeding smaller, more frequent meals, burping the baby more frequently during feeding, keeping the baby upright for at least 30 minutes after feeding, and avoiding overfeeding.

2. Thickening Feeds: Adding a small amount of rice cereal to breast milk or formula can help thicken the feeds, reducing the likelihood of reflux.

3. Medications: In some cases, doctors may prescribe medications to help reduce acid production in the stomach or to promote faster emptying of the stomach contents. These medications are typically prescribed for severe cases or when other measures have not provided sufficient relief.

4. Dietary Changes: If allergies or sensitivities to certain foods are suspected, a doctor may recommend changes to the mother's diet (if breastfeeding) or to the baby's formula. Elimination diets or hypoallergenic formulas may be suggested to identify and manage food triggers.

5. Elevating the Crib: Placing the baby's crib at a slight incline by raising the head of the mattress can help prevent reflux episodes during sleep.

6. Monitoring and Reassurance: In most cases, infant reflux resolves on its own as the baby's digestive system matures. Regular monitoring of the baby's growth and development, along with reassurance and support for caregivers, is crucial.

Conclusion

Infant reflux is a condition that is seen very commonly in very young babies. The babies throw out or spit milk. This condition may be normal till four months of age and lasts till the baby's first birthday. It is quite normal for the baby to spit four to five times a day but if the baby spits more than that and not gaining weight, immediately seek medical attention.