I Think My Babys Got Reflux
In the early weeks, it is normal for a baby to spit-up and around half of all newborns do, at least once a day. As a babys digestive system matures, this usually decreases and for most mothers it is just a short-term inconvenience. 1
However, in some babies the valve between the stomach and oesophagus does not close properly. The stomach contents flow back into the oesophagus and can cause vomiting. There are several reasons a baby may vomit and a doctor will need to rule out other causes, but one possible diagnosis is GERD , also referred to as GOR .
Not all reflux is noticeable and it doesnt always make a baby uncomfortable, but when its severe it can be painful and cause distress to mother and baby.2
What are the signs to look out for?
- A baby may choke and cough, or seem to have a sore throat. Some babies have bad breath.
- A mother may notice back arching and head turning. The baby may stretch out flat as this reduces pain, instead of snuggling close to his mother.
- A baby may cry for long periods and be irritable during and after feeds. His cries may sound hoarse. This sometimes leads to a misdiagnosis of colic.
- A baby may seem to fight feeding or even refuse to feed. There may be poor weight gain.
What might help?
As the opening from the stomach to the oesophagus is usually on the right side, keeping the right side higher than the left may also help.
What causes reflux?
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What Causes Acid Reflux In Infants
First, lets ground ourselves in this truth all babies have some level of reflux. This is because their entire digestive tract is more immature than older children. The sphincter muscle that separates the esophagus from the stomach is often undeveloped and opens regularly, allowing stomach acid to flow back up the throat causing burning and pain.
As their brain and nervous system develops, they can have some weakness in their vagus nerve function, which controls bowel mobility and digestion. It also doesnt help that we often put babies on their back, whether for play or sleep, and this can only exacerbate symptoms. For some children, their reflux will be more severe or they may be more sensitive to the effects, whatever the reason, we want to help alleviate their discomfort.
What Causes Gerd In Babies And Children
Most of the time, reflux in babies is due to a poorly coordinated gastrointestinal tract. Many infants with GERD are otherwise healthy however, some infants can have problems affecting their nerves, brain, or muscles. According to the National Digestive Diseases Information Clearinghouse, a child’s immature digestive system is usually to blame and most infants grow out of the condition by their first birthday.
In older children, the causes of GERD are often the same as those seen in adults. Also, an older child is at increased risk for GERD if they experienced it as a baby. Anything that causes the muscular valve between the stomach and esophagus to relax, or anything that increases the pressure below the LES, can cause GERD.
Certain factors also may contribute to GERD, including obesity, overeating, eating spicy or fried foods, drinking caffeine, carbonation, and specific medications. There also appears to be an inherited component to GERD, as it is more common in some families than in others.
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The Best For Last: Homeopathic Remedies
The Homeopathic Remedy called Nat Phos 6X was a miracle worker! I read about it on this website and decided to give it a try. Nat Phos is a natural cell salt that we normally produce to aid in digestion but it can be insufficient in newborns. I took 1/2 a tablet and dissolved in my breastmilk and fed to Paloma with a syringe after each feeding. Within a day, she was so much happier and wasnt nearly as stiff! YAY! I kept using the remedy religiously.
After about a month of using it, I slowly started weaning her off the homeopathic and we never had to use any digestive support again. Some moms will need to keep baby on the remedy until they turn 6 months or 1 year old. As baby gets older , you could go up to 1 tablet dissolved in milk after each meal, up to 8 tablets a day.
What Treatments Might The Doctor Give For My Infant’s Gerd
If feeding changes do not help enough, the doctor may recommend medicines to treat GERD. The medicines work by lowering the amount of acid in your baby’s stomach. The doctor will only suggest medicine if your baby still has regular GERD symptoms and:
- You already tried some feeding changes
- Your baby has problems sleeping or feeding
- Your baby does not grow properly
The doctor will often prescribe a medicine on a trial basis and will explain any possible complications. You shouldn’t give your baby any medicines unless the doctor tells you to.
Medicines for GERD in babies include:
- H2 blockers, which decrease acid production
- Proton pump inhibitors , which lower the amount of acid the stomach makes
If these don’t help and your baby still has severe symptoms, then surgery might be an option. Pediatric gastroenterologists only use surgery to treat GERD in babies in rare cases. They may suggest surgery when babies have severe breathing problems or have a physical problem that causes GERD symptoms.
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When To See Your Healthcare Provider
If your baby is still experiencing reflux even after youve implemented the prevention strategies listed above, have her checked by her healthcare provider. In some cases, your provider may refer you to a pediatric gastroenterologist. If your baby is diagnosed with GERD, your provider may prescribe medicine or may suggest some dietary changes, such as switching formulas, to see if your babys condition is due to an allergy.
Besides thickening your breast milk or formula as mentioned above, your babys healthcare provider may suggest switching to a protein hydrolysate formula to see if symptoms improve in one to two weeks. If it turns out your baby has an allergy to the proteins found in a milk or soy-based formula, switching formulas may be the best resolution in preventing and keeping the reflux from returning.
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Surgery For Infant Reflux
In rare cases when GERD symptoms become life-threatening, a surgical procedure called fundoplication may be performed. Your pediatrician may recommend it if:
- GERD lasts well beyond the first year of life and does not improve with treatment.
- Your infant develops recurrent aspiration pneumonia caused by regurgitated stomach contents that are breathed into the airways.
- Your baby has episodes of apnea, in which they are fully or partially unable to breathe for more than 20 seconds when regurgitating.
- They develop an irregular heart rhythm, known as bradycardia.
- Their airways become damaged, resulting in a chronic lung disease called bronchopulmonary dysplasia.
- Your infant is not growing properly due to malnutrition.
- Your babys esophagus is abnormally tight due to inflammation, a condition that increases their risk of choking.
During fundoplication surgery, the top of the stomach is wrapped around the esophagus, tightening the LES and making it more difficult for food to come out of the stomach.
Although it can be an effective solution for children with severe reflux that doesnt respond to medication, fundoplication surgery is a major surgical procedure that has a number of possible complications. The procedure might not be effective for some children.
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It’s Easy To Get The Care You Need
See a Premier Physician Network provider near you.
Anyone who has ever burped a baby knows that spitting up is a messy and common occurrence. Overfeeding, weak abdominal muscles or a weak sphincter muscle that separates the esophagus from the stomach all can contribute to acid from the stomach coming back into the esophagus. In some infants, reflux is due to food allergies or lactose intolerance .
No parent wants to see their baby be uncomfortable. At the same time, you still need to practice safe sleep recommendations when baby has reflux. Fortunately, acid reflux is highly treatable with modest changes in daily routine or with medication. Most babies grow out of this phase by age 1.
Acid reflux is highly treatable with modest changes in daily routine or with medication.
Thicken Breast Milk Or Formula
With your pediatricians approval, adding a small amount of infant rice cereal to formula or breast milk may be an option to lessen spitting up.
Thickening the food is thought to help stop stomach contents from sloshing up into the esophagus. This option has not been shown to decrease other reflux symptoms. Check with your doctor before trying this option.
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Key Points About Gerd In Children
GERD is a long-term digestive disorder.
It happens when stomach contents come back up into the food pipe .
Heartburn or acid indigestion is the most common symptom of GERD.
Vomiting can cause problems with weight gain and poor nutrition.
In many cases, GERD can be eased by diet and lifestyle changes.
Sometimes medicines, tube feedings, or surgery may be needed.
The Truth About Acid Reflux In Babies
For many years, pediatricians have wondered if colic might actually be a burning pain caused by acid reflux in babies . One book even trumpeted it as the cause of all colic. But hundreds of millions of dollars spent on baby antacid medicine have been wasted. Its now proven that GERD rarely causes colic.
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How Is It Diagnosed
To find out if a child has gastroesophageal reflux, a doctor will do a physical examination and ask about symptoms. A baby who is healthy and growing may not need any tests. If an older child or teen is having symptoms, the doctor may want to see if medicines help before doing tests.
If a baby is not growing as expected or treatment doesn’t help a teen, the doctor may want to do tests to help find the cause of the problem. Common tests include:
- A barium swallow. This is a series of X-rays that shows the esophagus and stomach.
- Endoscopy. This lets the doctor look at the esophagus.
- An esophageal pH test. This measures how much acid is in the esophagus.
Diet Modifications For Mothers Who Breastfeed
Certain foodssuch as caffeine, chocolate, and garliccan promote reflux. So, if you breastfeed your infant, you should consider cutting these foods out of your diet. Some breastfeeding parents have also found that eliminating milk or eggs from their diet helps, as well.
Other factors may contribute to spitting up in babies who breastfeed. If you have a strong let-down reflex , your baby may choke when latching on.
If this is common for you, consider pumping for a moment before breastfeeding your infant. If you are engorged when you begin feeding, your baby may have difficulty latching on and may swallow more air. Again, pumping for a short while before feedings may be helpful.
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How Common Are Reflux And Gerd In Infants
Reflux is very common in babies. About half all babies spit up many times a day in the first 3 months of their lives. They usually stop spitting up between the ages of 12 and 14 months.
GERD is also common in younger infants. Many 4-month-olds have it. But by their first birthday, only 10% of babies still have GERD.
Hold Baby Upright For At Least 30 Minutes After Feeding
I always held Paloma upright for at least 30 minutes after I fed her. To make this easy, you can babywear them in an infant carrier or simply snuggle them as you walk around the house or sit in a comfy chair. If baby needs to go to sleep after feeding, be sure they sleep elevated to reduce acid reflux symptoms.
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When To Call The Doctor
Your baby loses weight or fails to gain weight.
There are streaks of blood in your baby’s vomit.
Your child has breathing problems such as difficulty breathing, breathing stops, baby turns blue, chronic cough or wheezing.
Fever – temperature taken under the arm that is higher than 100°F.
Baby seems to be in pain.
Constant crying and the baby cannot be consoled.
Baby vomits half the feeding or medicine more than once.
Vomiting of feeds worsens.
Your baby looks dehydrated .
No urination for six or more hours.
If you have any questions, be sure to ask your doctor or nurse, or call ____________________.
HH-I-96 6/81, Revised 6/14 Copyright 1981, Nationwide Childrens Hospital
How Is Baby Reflux Diagnosed
As I started to research what could be wrong with my girl, I discovered that there are actually two forms of baby reflux: acid reflux and silent acid reflux. While acid reflux in infants usually results in regular projectile vomiting and intense crying, silent reflux is more subtle. Sour breath, hiccups, and physical stiffness or discomfort are more typical symptoms. Thankfully, most doctors will diagnose acid reflux or silent acid reflux in infants by persistent symptoms. However, some doctors may suggest the following tests:
Blood tests. Some doctors will look at various blood markers to see if the eating issues stem from something else like anemia or an infection.
Ultrasound. A device that uses high frequency sound waves to create an image of the upper GI tract looking for obstructions or abnormalities.
Barium swallow or upper GI test. The baby is given barium to drink, which coats the esophagus, stomach, and upper part of small intestine. Barium is a chalky white liquid that helps to highlight any obstructions or abnormalities in an X-Ray.
pH probe. A long, thin tube with a probe at the tip will be inserted through the mouth and positioned in the lower part of esophagus. It will measure the babys stomach acid levels and determine if there are any breathing problems as well. This is a very invasive test and baby will have to be hospitalized to administer.
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How To Treat Acid Reflux In Babies
If smaller feedings and keeping the head upright doesnt seem to help, discuss medication with your pediatrician.
Fisher says medication isnt necessarily the first choice for treating acid reflux. Usually, meds are only prescribed in more severe cases, when the baby wont eat or has poor weight gain.
Then, pediatricians will usually prescribe either an H2 blocker, like Pepcid AC or Axid AR, or a proton pump inhibitor like Nexium or Prevacid.
The Sneaky Reflux: Silent Gerd
Impress the Doctor Term: Silent Gastroesophageal Reflux Disease
This type of reflux is by far the crappiest because its silent. Your sad-faced little guy re-swallows the spit-up so you never see it. This causes twice the damage, since the bile burns on the way up and on the way down. Poor baby!
Silent reflux is hard to diagnose. Look for him to be Mr. Cranky Pants, hate the sight of a bottle, and cry more after meals than at other times during the day. Call your doctor for an analysis and see if using one of these formulas for reflux can help.
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How Do You Stop Acid Reflux In Breastfed Babies
In addition to the management of general reflux there are additional measures you can take:
Why is my breast milk causing reflux?
Babies who are not latching effectively for breastfeeds may have reflux. This can be because they are taking in air when feeding or when crying. Sometimes, babies just need to be in a slightly different position to latch more deeply. Sometimes it can be a result of physiological issues such as a tongue tie.
How Is Gastroesophageal Reflux Diagnosed
In older kids, doctors usually diagnose reflux by doing an exam and hearing about the symptoms. If your child has GER symptoms, try to keep track of the foods that seem to cause them. This can help the doctor figure out what’s going on.
In younger children and babies, doctors might run these tests to diagnose GER or rule out other problems:
- Upper GI radiology study. This special X-ray can show liquid backing into the esophagus, irritation or narrowing of the esophagus, and any upper digestive tract problems. For the test, your child will swallow a small amount of a chalky liquid . This liquid appears on the X-ray and shows the swallowing process.
- 24-hour impedance-ph probe study. This is the most accurate way to detect reflux and how often its happening. A thin, flexible tube goes through the nose into the esophagus. The tip rests just above the esophageal sphincter for 24 hours to check acid levels in the esophagus and to detect any reflux.
- Milk scans. This series of X-ray scans tracks a special liquid as a child swallows it. The scans can show whether the stomach is slow to empty liquids and whether the refluxed liquid is being inhaled into the lungs.
- Upper endoscopy. Doctors look at the esophagus, stomach, and part of the small intestines using a tiny fiber-optic camera. They also may take a small tissue sample of the lining of the esophagus to rule out or find other problems.
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