Gastroesophageal Reflux in Infants

Gastroesophageal Reflux in Infants

Gastroesophageal reflux in infants is a condition that causes a baby to spit up breast milk, formula, or food shortly after a feeding. Infants may also spit up stomach juices and saliva.

Reflux is common among babies younger than 2 years, and it usually gets better with age. Most babies stop having reflux by age 12–14 months.

Vomiting and poor feeding that lasts longer than 12–14 months may be symptoms of a more severe type of reflux called gastroesophageal reflux disease (GERD). This condition may require the care of a specialist (pediatric gastroenterologist).

What are the causes?

This condition is caused by the muscle between the esophagus and the stomach (lower esophageal sphincter, or LES) not closing completely because it is not completely developed. When the LES does not close completely, food and stomach acid may back up into the esophagus.

What are the signs or symptoms?

If your baby’s condition is mild, spitting up may be the only symptom. If your baby’s condition is severe, symptoms may include:

• Crying.
• Coughing after feeding.
• Wheezing.
• Frequent hiccuping or burping.
• Severe spitting up.
• Spitting up after every feeding or hours after eating.
• Frequently turning away from the breast or bottle while feeding.
• Weight loss.
• Irritability.

How is this diagnosed?

This condition may be diagnosed based on:

• Your baby’s symptoms.
• A physical exam.

If your baby is growing normally and gaining weight, tests may not be needed. If your baby has severe reflux or if your provider wants to rule out GERD, your baby may have the following tests done:

• X-ray or ultrasound of the esophagus and stomach.
• Measuring the amount of acid in the esophagus.
• Looking into the esophagus with a flexible scope.
• Checking the pH level to measure the acid level in the esophagus.

How is this treated?

Usually, no treatment is needed for this condition as long as your baby is gaining weight normally. In some cases, your baby may need treatment to relieve symptoms until he or she grows out of the problem. Treatment may include:

• Changing your baby’s diet or the way you feed your baby.
• Raising (elevating) the head of your baby’s crib.
• Medicines that lower or block the production of stomach acid.

If your baby’s symptoms do not improve with these treatments, he or she may be referred to a pediatric specialist. In severe cases, surgery on the esophagus may be needed.

Follow these instructions at home:

Feeding your baby

• Do notfeed your baby more than he or she needs. Feeding your baby too much can make reflux worse.
• Feed your baby more frequently, and give him or her less food at each feeding.
• While feeding your baby:
  • Keep him or her in a completely upright position. Do notfeed your baby when he or she is lying flat.
  • Burp your baby often. This may help prevent reflux.
• When starting a new milk, formula, or food, monitor your baby for changes in symptoms. Some babies are sensitive to certain kinds of milk products or foods.
  • If you are breastfeeding, talk with your health care provider about changes in your own diet that may help your baby. This may include eliminating dairy products, eggs, or other items from your diet for several weeks to see if your baby’s symptoms improve.
  • If you are feeding your baby formula, talk with your health care provider about types of formula that may help with reflux.
• After feeding your baby:
  • If your baby wants to play, encourage quiet play rather than play that requires a lot of movement or energy.
  • Do notsqueeze, bounce, or rock your baby.
  • Keep your baby in an upright position. Do this for 30 minutes after feeding.

General instructions

• Give your baby over-the-counter and prescriptions only as told by your baby’s health care provider.
• If directed, raise the head of your baby’s crib. Ask your baby’s health care provider how to do this safely.
• For sleeping, place your baby flat on his or her back. Do notput your baby on a pillow.
• When changing diapers, avoid pushing your baby’s legs up against his or her stomach. Make sure diapers fit loosely.
• Keep all follow-up visits as told by your baby’s health care provider. This is important.

Get help right away if:

• Your baby’s reflux gets worse.
• Your baby’s vomit looks green.
• Your baby’s spit-up is pink, brown, or bloody.
• Your baby vomits forcefully.
• Your baby develops breathing difficulties.
• Your baby seems to be in pain.
• You baby is losing weight.

Summary

• Gastroesophageal reflux in infants is a condition that causes a baby to spit up breast milk, formula, or food shortly after a feeding.
• This condition is caused by the muscle between the esophagus and the stomach (lower esophageal sphincter, or LES) not closing completely because it is not completely developed.
• In some cases, your baby may need treatment to relieve symptoms until he or she grows out of the problem.
• If directed, raise (elevate) the head of your baby’s crib. Ask your baby’s health care provider how to do this safely.
• Get help right away if your baby’s reflux gets worse.