About Reflux in Babies
The disease causes of reflux in babies are due to various factors:
- The muscles in the lower esophageal sphincter (LES) aren’t fully developed, making it easier for stomach contents to flow back into the esophagus. This can cause inflammation and irritation.
- Babies also have a shorter esophagus, weaker and underdeveloped muscles in the upper and lower sphincters, and a less sharp angle where the esophagus meets the stomach, all of which make acid reflux more likely.
The non-modifiable risk factors for reflux in babies cannot be changed or controlled. These include:
- Underdeveloped esophageal sphincter muscles at birth
- Spending a lot of time on their backs, especially before they learn to roll over
- Mostly liquid diet, which is easier to regurgitate than solid food
The modifiable risk factors for reflux in babies can be influenced or changed. These include:
- Feeding position: When a baby is lying flat or in a horizontal position while feeding, it becomes easier for the stomach contents to flow back into the esophagus. Keeping the baby upright during and after feedings for about 20 to 30 minutes can reduce reflux.
- Feeding amount: Overfeeding can increase the likelihood of reflux, so smaller, more frequent feedings may help.
- Burping: Regularly burping the baby during and after feedings can help release air and reduce reflux.
- Modify sleeping position: Avoid putting the baby to sleep right after feeding, and always place babies on their backs to sleep. Elevating the head of the bed by using blocks or wedges can help prevent acid from flowing back into the esophagus during sleep. It is recommended to raise the head between 6 and 8 inches off the bed.
- Diet: The foods a baby eats can also play a role in acid reflux. Making changes to their diet, such as avoiding certain foods, may help reduce the chances of acid reflux. If breastfeeding, changes to the mother's diet may also be beneficial.
These changes can help manage reflux symptoms in babies. However, it is always recommended you check with a healthcare professional for personalized advice and before making significant adjustments.
In the early stages of reflux in babies, the most common symptoms include:
- Spitting up: Babies may frequently spit up or regurgitate milk after feeding.
- Irritability: Babies with reflux may be fussy, irritable, or difficult to soothe.
- Poor appetite: Reflux can cause babies to have a decreased appetite or refuse to eat.
As reflux progresses or becomes more severe in babies, other common symptoms that may occur include:
- Arching of the back during or after eating
- Colic, which is excessive crying lasting for more than 3 hours a day with no medical cause
- Coughing
- Gagging or trouble swallowing
- Poor weight gain or weight loss
- Wheezing or trouble breathing
- Forceful or frequent vomiting
It's important to note that not all infants with reflux will experience all of these symptoms. If you suspect your baby has reflux, it's best to consult with a healthcare professional for an accurate diagnosis and appropriate management.
To diagnose reflux in babies, doctors commonly perform the following examinations, tests, and procedures:
- Medical history: The doctor will gather information about the infant’s diet, feeding patterns, and symptoms. In many cases, the doctor may not recommend further testing or procedures.
If more information is needed to confirm a diagnosis, the doctor may recommend additional examinations, tests or procedures to performed by a pediatric gastroenterologist (doctor who specializes in digestive diseases in children). Examples include:
- Upper endoscopy: This test uses a thin tube with a camera attached to enable the doctor to view the baby’s digestive tract. If needed, the doctor can take a small sample of tissue from the digestive tract for analysis under a microscope.
- Upper GI series: This test uses a contrast liquid called barium to visualize the shape of the baby's upper gastrointestinal tract. X-rays are taken as the barium passes through the esophagus and stomach.
- Esophageal pH and impedance monitoring: A thin flexible tube is inserted through the baby's nose into the stomach to measure the amount of acid or liquid in the esophagus. The tube is connected to a monitor that records the measurements over a 24-hour period.
Other examinations, tests, or procedures may be recommended based on initial findings or individual factors.
The goals of treatment for reflux in babies are to relieve symptoms and improve the baby's quality of life. Here are the recommended treatments and how they work to achieve these goals:
- Non-medication treatments: These include lifestyle modifications that aim to reduce the frequency and severity of reflux episodes. Examples of changes include:
- Keeping the baby upright for 30 minutes after feeding.
- Burping the baby frequently during feeding.
- If bottle feeding, holding the bottle at an angle that reduces air swallowing.
- Avoiding overfeeding.
- Offering smaller but more frequent feedings.
- Modifying the mother's diet (if breastfeeding) to exclude certain foods that may trigger reflux symptoms.
- Medications: In some cases, healthcare providers may prescribe gastroesophageal reflux disease (GERD) medications like H2 blockers or proton pump inhibitors (PPIs). These medications help reduce the amount of acid produced in the stomach, thereby decreasing acid reflux. Prokinetic agents may also be recommended to improve movement in the small intestine, allowing faster emptying of stomach contents.
- Therapeutic procedures: In certain situations, healthcare providers may suggest therapeutic procedures like anti-reflux surgery for babies with severe reflux symptoms that do not respond to other treatments. This procedure aims to strengthen the lower esophageal sphincter and prevent acid from flowing back into the esophagus.
It's important to consult with a healthcare professional before starting any medications or making significant changes to your baby's treatment plan. They can provide personalized advice based on your baby's specific needs.
Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Side effects can occur. Check with your health care professional or read the information provided with your medication for Side effect information.