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Infant reflux

Overview

Infant reflux occurs when food backs up (refluxes) from a baby's stomach, causing the baby to spit up. Sometimes called gastroesophageal reflux (GER), the condition is rarely serious and becomes less common as a baby gets older. It's unusual for infant reflux to continue after age 18 months.

Reflux occurs in healthy infants multiple times a day. As long as your baby is healthy, content and growing well, the reflux is not a cause for concern.

Rarely, infant reflux can be a sign of a medical problem, such as an allergy, a blockage in the digestive system or gastroesophageal reflux disease (GERD).

How infant reflux occurs

If the muscle (lower esophageal sphincter) between the esophagus and the stomach relaxes at the wrong time, stomach contents might flow up the baby's esophagus.

Symptoms

Infant reflux generally isn't a cause for concern. It's very unusual for the stomach contents to have enough acid to irritate the throat or esophagus and to cause signs and symptoms.

When to see a doctor

See your baby's doctor if your baby:

  • Isn't gaining weight
  • Consistently spits up forcefully, causing stomach contents to shoot out of his or her mouth (projectile vomiting)
  • Spits up green or yellow fluid
  • Spits up blood or a material that looks like coffee grounds
  • Refuses food
  • Has blood in his or her stool
  • Has difficulty breathing or a chronic cough
  • Begins spitting up at age 6 months or older
  • Is unusually irritable after eating

Some of these signs can indicate possibly serious but treatable conditions, such as GERD or a blockage in the digestive tract.

Causes

In infants, the ring of muscle between the esophagus and the stomach — the lower esophageal sphincter (LES) — is not yet fully mature. That allows stomach contents to flow backward. Eventually, the LES will open only when your baby swallows and will remain tightly closed at other times, keeping stomach contents where they belong.

The factors that contribute to infant reflux are common in babies and often can't be avoided. These factors include:

  • Babies lying flat most of the time
  • An almost completely liquid diet
  • Babies being born prematurely

Occasionally, infant reflux can be caused by more-serious conditions, such as:

  • GERD. The reflux has enough acid to irritate and damage the lining of the esophagus.
  • Pyloric stenosis. A valve between the stomach and the small intestine is narrowed, preventing stomach contents from emptying into the small intestine.
  • Food intolerance. A protein in cow's milk is the most common trigger.
  • Eosinophilic esophagitis. A certain type of white blood cell (eosinophil) builds up and injures the lining of the esophagus.

Complications

Infant reflux usually clears up by itself without causing problems for your baby.

If your baby has a more-serious condition such as GERD, he or she might show signs of poor growth. Some research indicates that babies who have frequent episodes of spitting up may be more likely to develop GERD during later childhood.

Diagnosis

Your doctor will start with a physical exam and questions about your baby's symptoms. If your baby is healthy, growing as expected and seems content, then further testing usually isn't needed.

If further testing is needed, your doctor might recommend:

  • Ultrasound. This imaging test can detect pyloric stenosis.
  • Lab tests. Blood and urine tests can help identify or rule out possible causes of recurring vomiting and poor weight gain.
  • Esophageal pH monitoring. To measure the acidity in your baby's esophagus, the doctor will insert a thin tube through the baby's nose or mouth and into the esophagus. The tube is attached to a device that monitors acidity. Your baby might need to stay in the hospital while being monitored.
  • X-rays. These images can detect abnormalities in the digestive tract, such as an obstruction. Your baby may be given a contrast liquid (barium) from a bottle before the test.
  • Upper endoscopy. A special tube equipped with a camera lens and light (endoscope) is passed through your baby's mouth and into the esophagus, stomach and first part of the small intestine. Tissue samples may be taken for analysis. For infants and children, endoscopy is usually done under general anesthesia.

Treatment

Infant reflux usually clears up by itself. In the meantime, your doctor might recommend:

  • Giving your baby smaller, more-frequent feedings.
  • Interrupting feedings to burp your baby.
  • Holding your baby upright for 20 to 30 minutes after feedings.
  • Eliminating dairy products, beef or eggs from your diet if you're breast-feeding, to test if your baby has an allergy.
  • Switching the type of formula you feed your baby.
  • Using a different size of nipple on baby bottles. A nipple that is too large or too small can cause your baby to swallow air.
  • Thickening formula or expressed breast milk slightly and in gradual increments with rice cereal. Although recognized as a reasonable strategy, thickening adds potentially unnecessary calories to your baby's diet.

Medication

Reflux medications aren't recommended for children with uncomplicated reflux. These medications can prevent absorption of calcium and iron, and increase the risk of certain intestinal and respiratory infections.

However, a short-term trial of an acid-blocking medication — such as ranitidine for infants age 1 month to 1 year or omeprazole (Prilosec) for children age 1 year or older — might be recommended if your baby:

  • Has poor weight gain and more-conservative treatments haven't worked
  • Refuses to feed
  • Has evidence of an inflamed esophagus
  • Has chronic asthma and reflux

Surgery

Rarely, the lower esophageal sphincter is surgically tightened to prevent acid from flowing back into the esophagus. This procedure (fundoplication) is usually done only when reflux is severe enough to prevent growth or to interfere with your baby's breathing.

Preparing for an appointment

If reflux continues after your child's first birthday, or if your child is having symptoms such as lack of weight gain and breathing problems, you might be referred to a doctor who specializes in children's digestive diseases (pediatric gastroenterologist).

What you can do

  • Write down your baby's symptoms, including how frequently your baby spits up and the amount of liquid that is spit up.
  • Write down key medical information, including how often you feed your baby, how long the feedings last and the brand of any formula that you are using.
  • Write down a list of questions to ask your doctor.

Questions to ask your doctor

  • What's the most likely cause of my baby's symptoms?
  • Does my baby need any tests?
  • What treatments are available?
  • Should I make any changes in how or what I feed my baby?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may leave time to go over points you want to spend more time on. You may be asked:

  • When did your baby first begin experiencing symptoms?
  • Does your baby spit up with every feeding or only occasionally?
  • Is your baby content between feedings?
  • Have you recently switching from breast-feeding to bottle-feeding? Or have you switched infant formulas?
  • How often do you feed your baby, and how much does your baby eat at each feeding?
  • If you have different caregivers, does everyone feed the baby the same way each time?
  • Does anything seem to improve or worsen your baby's symptoms?

Lifestyle and home remedies

To minimize reflux:

  • Feed your baby in an upright position. Also hold your baby in a sitting position for 30 minutes after feeding, if possible. Gravity can help stomach contents stay where they belong. Be careful not to jostle or jiggle your baby while the food is settling.
  • Try smaller, more-frequent feedings. Feed your baby slightly less than usual if you're bottle-feeding, or cut back a little on the amount of nursing time.
  • Take time to burp your baby. Frequent burps during and after feeding can keep air from building up in your baby's stomach.
  • Put baby to sleep on his or her back. Most babies should be placed on their backs to sleep, even if they have reflux.

Remember, infant reflux is usually little cause for concern. Just keep plenty of burp cloths handy as you ride it out.

Last updated: August 8th, 2017

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