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Infant reflux occurs when the contents of a baby’s stomach move back up into the esophagus, the tube that connects the mouth to the stomach. This is also known as gastroesophageal reflux (GER). It is common and happens several times a day in healthy infants, but it usually decreases as the baby gets older.
GERD, or gastroesophageal reflux disease, is a more severe and long-lasting form of reflux that can cause problems with feeding or last for more than 12 to 14 months. However, as long as a baby is growing well and healthy, reflux is not usually a cause for concern. It is rare for infant reflux to continue beyond 18 months, and symptoms such as weight loss or delayed growth may indicate a medical issue such as an allergy, blockage in the digestive system, or GERD.
While infant reflux is common and usually not a cause for concern, GERD is a more serious form that can cause health problems. It is important to seek medical attention if a baby’s symptoms prevent them from feeding or if they experience weight loss or delayed growth, as this may indicate an underlying medical issue.
Symptoms
Stomach acid rarely reaches levels high enough to cause symptoms like irritation of the throat or esophagus, so infant reflux usually causes no concern. Symptoms of infant reflux include:
- Projective vomiting or spitting forcefully
- Crying for more than three hours each day without a medical reason is referred to as “colic.”
- Infant does not gain weight.
- Vomits a yellow or green liquid.
- Vomits up what appears to be coffee grounds or blood.
- Refuses to eat or problem swallowing
- Blood in the stool
- Wheezing or difficulty breathing
- Persistent coughing
- Becomes irritated after eating
- Weakness
It is recommended that you seek medical attention if the infant is experiencing some of the symptoms that could be signs of serious conditions, such as GERD or digestive system obstructions. These conditions are treatable.
Causes
During infancy, the lower esophageal sphincter (LES), which is the muscular ring separating the esophagus and stomach, is not yet fully developed. As a result, it may not be able to prevent the backward flow of stomach contents into the esophagus. However, as the LES matures, it should open when the baby swallows and stay closed at other times, ensuring that stomach contents stay in the stomach.
Babies commonly experience reflux due to certain unavoidable factors such as spending most of their time lying down and being fed a mostly liquid diet.
Infant reflux may occasionally be brought on by serious conditions like:
- GERD: The esophageal lining is irritated and damaged by the reflux’s high acid content. Younger infants frequently have GERD as well. It’s common among 4-month-olds. Nevertheless, only 10% of infants still have GERD by their first birthday.
- Food intolerance: The most frequent cause is a protein found in cow’s milk.
- Pyloric stenosis: Pyloric stenosis results in the valve thickening and enlarging beyond what is normal. Consequently, food is trapped in the stomach by the thickened valve, preventing it from passing into the small intestine. As part of digestion, a muscle valve allows food to exit the stomach and enter the small intestine.
- Eosinophilic esophagitis: Eosinophil a type of white blood cell. The lining of the esophagus gets damaged by a buildup of a certain type of white blood cell.
- Sandifer syndrome: As a result, the head tilts and rotates irregularly and exhibits motions resembling convulsions. It’s an uncommon side effect of GERD.
Risk factors
Infant reflux is common. But some things make it more likely that a baby will experience infant reflux. These include:
- Premature birth
- Cystic fibrosis
- Cerebral palsy (Conditions of the nervous system)
- History of surgery of the esophagus
Diagnosis
A healthcare provider can identify GERD by a variety of tests. To make a diagnosis, they will occasionally request multiple tests. Typical tests include.
- Physical examination: The healthcare provider will conduct an assessment and ask about the infant’s symptoms. If the infant is growing normally and is healthy, then no further testing will be needed. However, if the symptoms do not improve with feeding changes and reflux medications, the infant may require further testing.
- Imaging test:
- Ultrasound: Pyloric stenosis can be found using this imaging test.
- X-rays: These scans can identify issues with the digestive system, like a blockage. Before the test, the infant will be given barium, a bottle of a contrast liquid.
- Laboratory tests: Recurring vomiting and poor weight gain can be investigated through blood and urine tests to identify or eliminate potential causes.
- Esophageal pH monitoring: To measure the acidity levels in a baby’s esophagus, a thin tube will be inserted through the nose or mouth and into the esophagus, and it will be attached to a device that monitors acidity. The baby may need to stay in the hospital while being monitored. The tube will measure the amount of acid or liquid in the esophagus and will be attached to a monitor that records the measurements. This process will take 24 hours, during which the baby will wear the device while in the hospital.
- Upper endoscopy: An endoscopy is a medical procedure that involves using a tube with a camera and light to examine the inside of a baby’s esophagus, stomach, and upper small intestine. The doctor may also take tissue samples for analysis during the procedure. General anesthesia is typically used for infants and children undergoing endoscopy.
Treatment
Making simple adjustments to a baby’s feeding routine may assist some babies’ infant reflux until it goes away on its own. If feeding adjustments are insufficient, a healthcare may suggest medications.
- Lifestyle changes: Feeding changes can be made to alleviate reflux or GERD symptoms in infants. These include adding rice cereal to the baby’s milk or formula, adjusting the nipple size if the mixture becomes too thick, and burping the baby after every 1-2 ounces of formula or nursing from each breast. It is important to avoid overfeeding and to hold the baby upright for 30 minutes after feedings. If the baby is using formula, and a doctor suspects a milk protein sensitivity, switching to a different formula may be recommended but should only be done after consulting with a doctor.
- Medications: Usually, children with simple reflux are not treated with reflux medications. However, a healthcare provider might advise taking an acid-blocking drug for a few weeks or months. Cimetidine (Tagamet HB), famotidine (Pepcid AC), and omeprazole magnesium (Prilosec) are examples of drugs that prevent the production of acid.
Healthcare provider may prescribe an acid-blocking medication if the infant have poor weight gain, refuses to eat, have an inflamed esophagus, or has chronic asthma.
Healthcare provider will frequently recommend a medication as a trial and will discuss any potential side effects. Without a prescription, parent’s should not administer any medications to their infant.
- Surgery: The infant might require surgery in rare situations. Only if the infant has trouble gaining sufficient weight or is having breathing difficulties due to reflux. The LES, which is located between the stomach and the esophagus, is tightened during the procedure. By doing this, acid is kept from rising back into the esophagus.
