Baby

Joys of Reflux

refluxAre you constantly walking around with a burping towel? Is a muslin cloth your latest accessory? Do you smell like sour milk? Reflux, vomiting, possetting, regurgitation, spit up, call it what you like, it is messy and drives you nuts…
 
Gastroesophageal Reflux (GER) or more commonly known as reflux, occurs when the stomach contents reflux, or back up, into the oesophagus during or after a meal. The oesophagus is the tube that connects the mouth to the stomach. A ring of muscle at the bottom of the oesophagus opens and closes to allow food to enter the stomach. This ring of muscle is called the lower oesophageal sphincter (LES). The LES normally opens to release gas after meals. With infants, when the LES opens, stomach contents often reflux into the oesophagus and out the mouth, resulting in regurgitation and vomiting. GER can also occur when babies cough, cry, or strain.
 
More than half of all babies experience reflux in the first 3 months of life. Symptoms usually peak around four months and begin to subside around seven or eight months when baby begins to sit upright and eat more solid foods. For some it can last until the child is one or two years old.
 

Symptoms to look out for include:

  • Excessive spitting up or vomiting
  • Sudden or inconsolable crying, irritable and fussy feeding
  • Arching of back during or after feeding
  • Vomiting hours after a feed
  • Erratic feeding patterns, fussy eater or comfort feeding
  • Failure to gain adequate weight
  • Poor sleep habits
  • Gagging or choking
  • Frequent burping or hiccuping
  • Difficult or noisy swallowing
  • Excessive drooling
Other signs of reflux which may not seem related but actually are include:
  • Chronic coughing
  • Asthma symptoms
  • Frequent ear infections
  • Sore throat
  • Chest infections
It is important to know that not all reflux babies require medication. Some babies are happy spitters and it doesn’t seem to bother them. If your baby is content, gaining weight and doesn’t seem to be in any pain when vomiting, then you can assume that your baby is a -happy spitter . In this case your baby doesn’t require any medication.
 
There are a few things that you can start doing right away to alleviate some of the discomfort associated with reflux.
  • Keep your child upright for at least 30mins after a feed. Let gravity help keep the milk in. Formula fed babies may need to be kept upright longer as it takes longer to digest than breast milk
  • Elevate the head of the cot or pram to a 30 ° angle so that baby isn’t lying completely flat on the mattress
  • Try smaller and frequent meals
  • Avoid tight elastic clothing around baby’s waist and keep nappy loose around waist
  • Burp baby frequently during feeds
  • Don’t smoke around baby, nicotine stimulates gastric acid production
  • Breastfeeding mother’s should eliminate caffeine from their diet as this is a known contributor to reflux
If your baby seems to be in a lot of pain and the reflux is severe enough to affect his or her weight gain and sleeping patterns then it is advisable to contact your doctor.
Medication will only help reduce the pain and discomfort that your baby might be experiencing, it won’t actually stop the milk from coming up. There are various options to help alleviate the burn of reflux.
 
 

Medication

Antacid medications are used to neutralize the acid in the stomach and whilst they work well the effects are short lived. If you can get your hands on Gaviscon for infants this is a popular antacid and can be added to baby’s bottle or given to breastfed babies after a feed. Gaviscon Infant has been known to cause constipation so it is best to seek the advice of your healthcare practitioner.
 
Zantac is an H2 Blocker which means that it reduces the amount of acid that the stomach produces by blocking one important producer of acid called histamine 2. It is generally well-tolerated with no side effects. You will need a prescription for this medication.
 
Losec MUPS is the most common and preferred medication for many doctors. It is a proton pump inhibitor which controls or prevents the production of acid in the stomach and therefore helps relieve the burn. You will also require a prescription for Losec or its generic equivalent.
 
For those who are bottle-feeding you can try thickening the formula which might help keep more of the milk in. Formulas are available which already have thickeners added, they are labeled as AR (Anti-Reflux) formula. Bear in mind that with a thickened formula you might have to change to a teat with a faster flow.
 
 

Further Tests

If your baby does not improve after investigating all these options then you need to have your baby reassessed by a specialist who may suggest further tests. A pH probe might be requested to measure the acid levels in the lower oesophagus. This test can also diagnose -silent reflux’, which is when a baby has all the reflux symptoms without the vomiting.
 
An endoscopy is another test for reflux, this is where a thin tube with a camera on the end is inserted through the mouth and down the oesophagus. The doctor examines the food pipe and stomach for damage and other problems (hiatial hernia, narrowing etc) and may also take a biopsy of tissue for testing. A light general anaesthetic is required for an endoscopy.
 
Barium swallow is when a mixture of barium and water is given to a baby to drink whilst being x-rayed. Should the baby struggle to drink from a bottle then a syringe can be used to administer the mixture.  The white, chalky substance shows up on an x-ray and you can see the movement of fluid through the digestive tract. This test can rule out other conditions, other than a weak lower oesophageal sphincter (LES).
 
The good news is that almost all babies do eventually grow out of it. For some it might be overnight and for others it might be a gradual process. Assuming your baby does not have a severe case of reflux, the best thing you can do is invest in a great washing machine and tumble dryer for all your milk-stained clothes.

 

-Don’t pray for lighter burdens, but rather for stronger backs

 

 – Lucy Ann Monastursky

 

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