When To Worry About Gerd In Breastfeeding Babies
Spitting up seems to come with the territory when you care for a growing baby. It often comes at unexpected moments, and you may worry that your baby isnt getting adequate nutrition if it occurs too often. For most babies, this is a natural part of developing a strong digestive system that wont interfere with their ability to grow and thrive.
Yet, every parent needs to be aware of a more serious condition known as gastroesophageal reflux disease. Not all babies suffer from this condition, but its important to recognize the signs if it does impact your baby.
Signs And Symptoms Of Reflux
Your baby may not show any signs of reflux or they may show the following signs:
- Spitting up milk during or after feeds.
- Refusing feeds, gagging or choking.
- Persistent hiccups or coughing.
- Excessive crying or crying while feeding.
- Frequent ear infections.
You do not need to be concerned about reflux if your baby is feeding well, happy and gaining weight as normal.
How To Prevent Reflux
Here are seven ideas you can try to prevent reflux in your baby, and that may also help prevent it from turning into GERD:
Avoid overfeeding your baby
Feed your baby smaller amounts more frequently
Burp your baby more frequently, both during and after each meal
After a feeding, limit play and activities such as like tummy time where your baby lies down for longer periods
After a feeding, place your baby in an upright position for at least 30 minutes
With your healthcare providerâs approval, thicken your babyâs breast milk or formula with up to 1 tablespoon of oatmeal
If youâre giving formula, you might consider changing formulas.
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Recognizing Acid Reflux/gerd In Infants
Understanding acid reflux
Acid reflux happens when the contents of the stomach back up into the esophagus.
The esophagus is the tube that carries food from the throat to the stomach. At the bottom of the esophagus where it joins the stomach is a ring of muscle that normally opens when you swallow. This ring of muscle is known as the lower esophageal sphincter .
When the LES doesnt close completely, stomach contents and digestive juices can come back up into the esophagus.
Why Is Reflux So Common In Babies
Compared to adults, babies have a weaker valve connecting the esophagus to the stomach. The lower esophageal sphincter is a group of muscles that controls this valve and keeps stomach acid where it belongs.
A weakened valve makes it more difficult for the body to keep the stomach contents in the stomach. As a result, the valve opens more easily and allows stomach acid to travel back up.
For some babies, the stomach contents may only travel up part of the way, in which case the contents will then travel back downwards, causing heartburn or minor breathing problems. If your childs stomach acid travels all the way back through the esophagus, it can cause vomiting. However, some children will not show any signs or symptoms at all.
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Symptom #: Your Baby Is Spitting Up A Lot
Like we discussed, a newborn spitting up after some or most of their feeds is completely normal. We expect that burp rag to get wet. Even if your baby is spitting up after every single feed or in between feeds, and there appears to be a lot of milk coming out compared to what you fed them, it might be normal. As long as the baby is gaining weight, seems comfortable, and tolerates their feeds, we call them happy spitters and monitor them for any change in symptoms.
Why do infants spit up so much? Spitting up is common in newborns and persists through the first few months of life because of a few things:
Babies are still developing neuromuscular control of their lower esophageal sphincter muscle. This is a ring-like muscle between the bottom of the feeding pipe and the top of the stomach. In an older child or adult, the sphincter tightens to keep food and fluid contents in the stomach and prevent them from passing back upwards into the esophagus. In babies, this muscle is still loose. Thus, breastmilk or formula can easily pass back into the esophagus and come out of the mouth along with a burp.
Young babies who cannot sit or stand yet are almost always in a laying down position. In this situation, gravity cannot help prevent reflux in babies. Milk will naturally glide backward from the stomach into the esophagus when your child is lying down.
A baby is on a pure liquid diet. They have no solid contents in their diet that stay put in the stomach.
When To See Your Healthcare Provider
If your baby is still experiencing reflux even after you’ve 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 babyâs condition is due to an allergy.Besides thickening your breast milk or formula as mentioned above, your babyâs 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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Dont Blame Breastfeeding For Acid Reflux In Infants
Just as importantly as being ready, dont let others tell you that it is your milk. You have decided that you want to give your baby the very best of milk, but others may tell you that you should stop breastfeeding and give your baby special baby formula instead. If your doctor or nurse suggests this, seek out a more breastfeeding-friendly health professional to help.
Warning: Formula will just make matters worse. Breast is really the besteven more so if your breastfeeding baby has acid reflux. Dont let anyone tell you different. The formula companies have spent years trying to lie to you about this!
How Is Gastroesophageal Reflux Disease Diagnosed
In most cases, your doctor or pediatrician will recognize the signs of GERD and will prescribe medication that should help relieve the symptoms. When medication doesnt seem to ease the symptoms, then additional testing is often ordered to see what is happening internally. The most common procedures to diagnose GERD include:
- Upper GI Endoscopy An endoscope fitted with a camera is inserted through the babys mouth and down the esophagus and into the stomach. This allows the gastroenterologist to look for internal signs of GERD or other conditions that may cause your babys symptoms. Biopsies are often taken for further testing.
- Upper GI Series X-rays are taken of the babys upper gastrointestinal tract to look for signs of GERD or other conditions. Most babies will drink barium mixed with another liquid prior to the x-rays, which increases the chances of detecting problems within the GI tract.
- Esophageal PH and Impedance Monitoring This is a more extensive test, but its also the most effective. A thin tube is inserted through the nose into the stomach, and then pulled up into the esophagus. It is left there while your baby continues with normal daily activities. The amount of acid entering the esophagus from the stomach is measured over time.
If most of these tests sound scary, rest assured that most infants never need to receive them. Only more severe cases of GERD that arent effectively controlled with medication will need extensive testing for further diagnosis.
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Why Acid Reflux In Babies Occurs
In infants with reflux, the lower esophageal sphincter hasn’t fully developed. Normally, this valve only opens when you swallow, allowing food to pass through the esophagus to the stomach, and it stays closed at other times. In babies with reflux, the valve isn’t mature, and it allows stomach contents to come back up the esophagus, causing your baby to spit up. Lying flat most of the time, having a liquid diet, and being born early may also contribute to reflux in babies. Once the valve is fully formed, your baby should stop spitting up.
Acid reflux often starts when a baby is between two to three weeks old, and it tends to peak around four to five months. Once a baby starts sitting up and eating solid foods, reflux may improve.
Causes Of Silent Reflux
One reason babies are prone to reflux is that they are born with underdeveloped esophageal sphincter muscles. These are the muscles responsible for opening and closing the esophagus to allow for the passage of fluid. Reflux is more commonly seen in younger infants since these muscles mature as babies grow.
Babies with neurological disorders, such as cerebral palsy, as well as those who are premature or have a family history of reflux may be at an increased risk for reflux. Having a hiatal hernia or a weak upper stomach valve also may increase the risk for reflux.
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How We Wrote This Article
The information in this article is based on the expert advice found in trusted medical and government sources, such as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. You can find a full list of sources used for this article below. The content on this page should not replace professional medical advice. Always consult medical professionals for full diagnosis and treatment.
Symptoms Of Acid Reflux In Babies
Acid reflux in babies shows up when they are between 2 to 4 weeks it peaks around when they are 4 months old and starts to subside when theyre 7 months old when they start sitting upright and take in more solids.
GERD symptoms are:
- Frequent and sometimes forceful vomiting or gagging more than 5 times a day and more than an ounce each time
- Difficulty sleeping
- Slow weight gain
Sometimes acid reflux cause irritation in the esophagus, also known as heartburn in babies, which can make them arch their back abnormally while feeding and may unlatch multiple times from the nipple during breastfeeding.
Your baby may cough frequently, or you can hear a wheezing sound when theyre feeding this is because of the stomach acids getting up in the upper airways. This symptom can worsen if your baby is lying on his back.
Surgery For Gerd In Babies And Kids
Surgery isn’t often needed to treat acid reflux in babies and kids. When it is necessary, a fundoplication is the most often performed surgery. During this procedure, the top part of the stomach is wrapped around the esophagus forming a cuff that contracts and closes off the esophagus whenever the stomach contracts — preventing reflux.
The procedure is usually effective, but it is not without risk. Discuss the potential risks and benefits of any operation with your child’s doctor.
How Can The Babocush Cushion Help With Gerd
The Babocush cushion is especially designed with babies who suffer from acid reflux in mind. Giving your baby the tummy time needed to encourage neck control and muscle development, the babocush cushion can assist your baby in working their muscles and strengthening their digestive system. Whats more, the gentle heartbeat sounds and vibrations will soothe your baby when they are suffering from GERD symptoms. The adjustable straps mean that tiny newborns can be secured safely to the cushion, as well as bigger babies, so your baby can continue use throughout their first year.
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Prognosis: What Should Parents Expect
Most cases of normal infant GER self-resolve. 99 percent of infants outgrow it by their first birthday.
In the absence of an underlying medical condition, the majority of cases of GERD respond to lifestyle modifications or supportive measures. However, infants who experience GERD for more than three months are more likely to develop symptoms later during childhood.
How To Treat Acid Reflux In Newborns
This article was co-authored by Laura Marusinec, MD. Dr. Marusinec is a board certified Pediatrician at the Children’s Hospital of Wisconsin, where she is on the Clinical Practice Council. She received her M.D. from the Medical College of Wisconsin School of Medicine in 1995 and completed her residency at the Medical College of Wisconsin in Pediatrics in 1998. She is a member of the American Medical Writers Association and the Society for Pediatric Urgent Care.There are 17 references cited in this article, which can be found at the bottom of the page. This article has been viewed 93,726 times.
Many newborns experience acid reflux, which is when food backs up from her stomach and causes your baby to spit up.XResearch source Acid reflux, also called gastroesophageal reflux disease , is generally not serious and often stops by 18 months old XResearch source however, seeing your newborn experience discomfort from acid reflux can concern or upset you.XResearch source By making some lifestyle changes or using medication, you can treat your newborns acid reflux.
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What Are The Treatments For Acid Reflux In Infants And Children
There are a variety of lifestyle measures you can try for acid reflux in babies and older children:
- Elevate the head of the baby’s crib or bassinet.
- Hold the baby upright for 30 minutes after a feeding.
- Thicken bottle feedings with cereal .
- Feed your baby smaller amounts of food more often.
- Try solid food .
For older children:
- Elevate the head of the child’s bed.
- Keep the child upright for at least two hours after eating.
- Serve several small meals throughout the day, rather than three large meals.
- Make sure your child is not overeating.
- Limit foods and beverages that seem to worsen your child’s reflux such as high fat, fried or spicy foods, carbonation, and caffeine.
- Encourage your child to get regular exercise.
If the reflux is severe or doesn’t get better, your doctor may recommend medication.
Acid Reflux Occurs When The Stomach Contents Move Upward Into The Esophagus Here’s What Parents Need To Know About This Common Newborn Digestive Problem
Babies often spit up after eating because their digestive systems aren’t fully developed. This conditionknown as acid reflux or gastroesophageal reflux rarely causes problems, and it usually disappears as your little one ages. However, extreme acid reflux symptoms may point to another problem, such as gastroesophageal reflux disease .
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Symptoms Of Silent Reflux In Babies
Babies with silent reflux may not spit up after feedings, making it more difficult to spot. Infants with silent reflux also often present with feeding difficulties, which can slow weight gain and even cause weight loss. In extreme cases, this can result in undernutrition.
Inadequate growth or inability to maintain growth during early childhood is referred to as failure to thrive and can occur as a result of reflux.
Your Digestive System & How It Works
The digestive system is made up of the gastrointestinal tractalso called the digestive tractand the liver, pancreas, and the gallbladder. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Carlo Di Lorenzo, M.D., Nationwide Children’s Hospital
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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.
Symptom #: Your Baby Is Experiencing Some Discomfort With Infant Reflux
Certain things can help reduce symptoms of reflux in babies and make your baby more comfortable during and after their feeds. These are things we discuss at length when you book an appointment to see a Concierge Pediatrician:
OFFER SMALLER, MORE FREQUENT FEEDS
Remember, your baby does not have control of that LES muscle to keep contents in their stomach. If we reduce the amount of milk thats in their stomach, its less likely to flow upwards into their esophagus. Your baby will be hungry if you give them less with each feed, so you will have to feed them more frequently. They will be happier with each feed, though!
POSITION THE BABY UPRIGHT
Try not to lay your baby flat when you are feeding them. Hold them in your arms at a 20° to 30° angle so that gravity helps the milk flow downwards. Keep your baby in an upright position in your arms, on your shoulder, or in a swing for 20 to 30 minutes after a feed to help the milk or formula stay down towards the stomach as your baby digests.
BURP THE BABY FREQUENTLY
USE THE CORRECT NIPPLE SIZE
A nipple on a bottle that has too big or too small of a hole can be problematic. It will cause the baby to swallow more air that will get trapped in their belly and push more milk upwards into their esophagus.
CHANGE MOMS DIET
CHANGE THEIR FORMULA
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