Reflux in babies

It's not unusual for babies to bring up small amounts of milk soon after you have fed them. It needn't spoil the precious moments when you feed your baby.

So let's look at this relatively minor feeding problem and understand why it happens. And, importantly, we'll look at how you can try to stop it from happening quite so often, and perhaps reduce your laundry a little!

What is reflux in babies?

Reflux is also known as "posseting."  This is simply when your baby brings up what they have just swallowed. It can consist of a mixture of their food (milk) and stomach acid.  Reflux is very common in babies:

• About half of all babies will have some reflux during the first three months of their lives. Thankfully  this causes a problem for only a very few[1]
• By  about 10 months 55% of cases are resolved¹

Reflux is different from being sick (or vomiting).  If your baby vomits, it's usually because they have an infection in their tummy, such as gastroenteritis. One normal reaction that can happen during an infection is for your baby's muscles to contract forcefully and food is brought up. As you will see, this is a very different type of action and cause compared to reflux or posseting.

Why does reflux happen?

There are two reasons that can influence reflux in your little one:

• At the bottom of baby's food pipe is a ring of muscle called a sphincter, which is not yet fully developed. As a result, it may not always be strong enough to keep the food down in place in their tummy[2]
• Your baby's oesophagus (or food pipe) is shorter, narrower and not fully matured[1] since, like the rest of their body; it hasn't yet grown very much. So, food hasn't got far to travel in order to pop out of their stomach and into their oesophagus and mouth

Together these two factors mean that milk (or food) and stomach acid can more easily spill out into the oesophagus.

It's comforting to know that reflux happens to just about every baby at some point. Usually only a teaspoon or so of liquid comes out. However in a few cases reflux can be associated with what is known as GORD or Gastro Oesophageal Reflux Disease.

GORD in babies - what to look out for

If your baby continually brings up their food after you've fed them, it's possible they may have GORD.

What is GORD?

GORD is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. So GORD is more than the simple posseting we've already looked at.

GORD can manifest itself in different ways. In some people, reflux causes the symptoms of heartburn or an acidic taste in the back of the mouth. In others it may lead to problems such as inflammation of the oesophagus (oesophagitis).

What causes GORD?

This is usually due to the sphincter muscle, mentioned above, becoming weak or relaxed when it shouldn't be.  If this happens, the acidic contents of the baby’s stomach can frequently move up into their oesophagus.   Unlike our stomach lining, the lining of the oesophagus in both babies and adults is not designed to withstand the effect of acid very well. Therefore, if the liquid that comes out of the stomach and into the oesophagus contains a lot of stomach acid, your baby may feel pain. This can be similar to the pain of heartburn.

GORD is seen more commonly in premature and low birth weight babies. It can also be present in babies who are allergic to cow's milk or suffer from a nerve or muscle disorder like cerebral palsy.²

Recognising GORD in babies

Here are some typical signs of GORD:  

If your baby: ^{1, 2}

• Brings up their food frequently. This can be soon after feeding or as much as two hours after their feed (but possibly due to vomiting rather than reflux if it's this much later)
• Arches their back when you are feeding them or after you have fed them
• Refuses a feed, even though they are OK with sucking a dummy or their comforter, if they have one
• Has difficulty getting to sleep
• Cries frequently or is irritable                                         
• Has bad breath
• Coughs and/or has breathing problems

When should you consult a GP?

You may want to consider seeing your GP if your baby displays any of the signs above. However, should you see any of the following, in addition to the above; it is advisable to get your baby checked straight away:[3]

• If regurgitation becomes persistently projectile
• If you see bile stained (green/yellow green) vomiting or blood in the vomit
• If you have new concerns, like signs of marked distress, feeding difficulties or faltering growth
• If you see persistent, frequent regurgitation beyond their first year

If you believe your baby might be allergic to baby formula or cow's milk, it's a good idea to let your GP know. Skin rash, vomiting and diarrhoea are signs that they may have an allergy.

Although this is quite rare, another reason for reflux could be that your baby has a blockage in their digestive tract. Your GP could consider this as a possible cause if other reasons have been ruled out.

Tests for GORD and associated problems

It's possible that if your baby shows symptoms that concern your doctor, they can make a referral to a baby or child specialist, or Paediatrician. Various tests can be carried out to help find what their problem might be, together with its cause.

Endoscopy

A long thin flexible tube that's a bit like a telescope can be put down baby's oesophagus to have a look for possible problems. The endoscope can also be used to take a small sample of tissue from the oesophagus. This is known as a biopsy. The tissue sample then gets sent to the hospital lab for analysis. Should your baby need to have this procedure, they will at first be sedated and given extra oxygen before it is carried out.

Impedence-pH monitoring of the oesophagus

This test simply measures the amount of liquid and acid that may be in your baby's oesophagus. The procedure involves putting a small tube through their mouth or nose and down into their tummy, where it will stay for about twenty four hours. During this time it is connected to a monitor that measures and records how much liquid may travel up baby's oesophagus.

Barium swallow test

Firstly the baby is given a solution of barium to swallow, which will coat their digestive tract. Then they will be put in front of an X-ray machine to take a picture of the tract. The barium shows up on the X-ray to let doctors see the shape of the tract and check whether it's as it should be.

The results of any or all of these tests are interpreted by doctors and other specialists to try to identify what the problem might be.

Helping to keep reflux in your baby to a minimum

The main considerations in preventing reflux are the food you give your baby and also the way you feed your baby.

How to feed a baby with symptoms of reflux

Feeding your baby is a wonderful feeling and a great time for bonding. However, if they have shown signs of reflux, you may need to reconsider how you have been doing this and adapt it a little:

• Hold your baby upright, rather than on their back or partly reclined when feeding them
• Take your time and feed your baby slowly
• Remember to burp your baby frequently when you are feeding them
• Holding your baby upright for about half an hour after feeding may also help prevent symptoms
• Check that your baby's nappy isn't too tight, so that there isn't excess pressure pushing on their tummy or digestive tract
• Baby massage may also help your baby, but it's a good idea to ask for advice from a healthcare professional before attempting to do this

 

What to feed a baby with symptoms of reflux

However you choose to feed your baby, here are some tips to help prevent or reduce reflux:

Breast milk is digested faster than baby formula, and it also contains enzymes that can help baby's digestion. Therefore breast milk could reduce the chance of reflux occurring.

If you are feeding your baby with formula milk, try to give them smaller amounts, more often. By doing this, there will be less volume of milk for each feed that can be digested faster. The combination of the two can help to reduce the chances of reflux.

Treatment for reflux

Treatments are generally not needed, since babies simply grow out of the condition.

As we have already mentioned, reflux or posseting is very common and mostly there is no great cause for concern if it happens. However, should you ever be in any doubt about your baby or young child's symptoms, always ask for advice from a healthcare profession, such as your paediatric dietician, paediatric nurse or your GP.

 

All information presented is not meant to diagnose or prescribe. Gaviscon Extra Oral Suspension, Gaviscon Extra Chewable Tablets contain sodium alginate, sodium hydrogen carbonate, calcium carbonate. Always read the label. If symptoms are severe or prolonged you should consult a doctor or pharmacist.