Acid Reflux In Babies – Causes, Symptoms And Treatment

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W e may t h i n k that f e e d i n g the b a b y frequently w i l l help h i m grow b e t t e r . But d i d you k n o w that o v e r f e e d i n g is o n e of t h e biggest r e a s o n s of a c i d reflux? W e , as a d u l t s , wrench a t an a c i d reflux, i m a g i n e how d i f f i c u l t it m u s t be f o r a b a b y ! But o v e r f e e d i n g isn’t t h e only r e a s o n for a GERD.

C o n f u s e d and w a n t to k n o w more? M o m J u n c t i o n gives y o u all t h e information a b o u t reflux i n babies, t h e causes, s y m p t o m s , and w a y s of p r e v e n t i n g it.

W h a t Is R e f l u x In B a b i e s ?

A c i d reflux i s the a b n o r m a l backflow o f acid f r o m the s t o m a c h to t h e esophagus t h r o u g h the l o w e r esophageal s p h i n c t e r . The s p h i n c t e r is a muscular v a l v e that p r e v e n t s stomach c o n t e n t s from f l o w i n g into t h e esophagus. A s infants h a v e a p o o r l y – d e v e l o p e d sphincter t h a t opens a b n o r m a l l y , it l e a d s to a reflux o f stomach a c i d .

A c i d is c a u s t i c , and i t stings a n d irritates t h e inner l i n i n g of t h e esophagus. S i n c e the c o n d i t i o n is c a u s e d by t h e malfunction o f the o e s o p h a g e a l valve, i t is r e f e r r e d to a s gastroesophageal r e f l u x (GER) o r acid r e f l u x or j u s t reflux ( 1 ) . If t h e problem p e r s i s t s , then i t is c a l l e d gastroesophageal r e f l u x disease ( G E R D ) (2).

W h a t Causes A c i d Reflux I n Babies?

A s you n o w know, r e f l u x is c a u s e d by t h e abnormal o p e n i n g of t h e lower o e s o p h a g e a l sphincter. I t is t h e fundamental c a u s e for G E R , and c e r t a i n conditions t r i g g e r the a b n o r m a l opening.

Overfeeding the b a b y different f o o d s such a s formula, s o l i d s , and b r e a s t m i l k can c a u s e GER.

O l d e r infants e a t d i f f e r e n t kinds o f food and s o m e may c a u s e reflux. F o r instance, c h o c o l a t e , peppermint, a n d high-fat f o o d s cause t h e sphincter t o stay o p e n for l o n g e r while t o m a t o e s and c i t r u s foods s t i m u l a t e the s t o m a c h to p r o d u c e more a c i d . Both s u c h foods c a u s e reflux.

S o m e c o n g e n i t a l physical p r o b l e m s make t h e baby p r o n e to G E R . If t h e baby’s s p h i n c t e r has a defect b y birth, t h e n the v a l v e could b e weak. P h y s i c a l anomalies i n c l u d e problems i n the a n g l e at w h i c h the e s o p h a g u s is a t t a c h e d to t h e stomach, d i a p h r a g m pressing a g a i n s t the s t o m a c h , or a hernia ( 6 ) .

M e d i c a t i o n and e x t e r n a l factors such a s allergies m a y cause G E R . Smoke f r o m pollution a n d tobacco m a y also a f f e c t the s p h i n c t e r valve ( 7 ) .

O n c e you k n o w the c a u s e , it i s important t o learn t h e ways t o spot t h e condition.

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H o w Do Y o u Know I f Your B a b y Has A c i d Reflux?

A n infant w i t h reflux w i l l show t h e following s y m p t o m s of G E R (8).

B a b i e s react t o esophageal i r r i t a t i o n by c o u g h i n g and g a g g i n g , which i s likely a f t e r a f e e d when t h e baby’s s t o m a c h is f u l l .

W h e n the b a b y spits o u t some l i q u i d , or f o o d contents, w i t h a b u r p , it i s called w e t burps.

J u s t like w e t burps, w e t hiccups bring a small q u a n t i t y of l i q u i d into t h e mouth f r o m the s t o m a c h .

T h e baby a r c h e s the b a c k or c u r l s legs u p w a r d s as a reaction t o the b u r n i n g sensation i n the a b d o m e n .

T h e moment y o u finish f e e d i n g breastmilk o r formula, t h e little o n e becomes i r r i t a b l e , fussy, a n d a b i t cranky.

Gulping feels p a i n f u l due t o the r e f l u x , and t h e infant m a y stop s e v e r a l times during t h e feed.

T h e above s y m p t o m s indicate n o r m a l levels o f reflux. I n mild r e f l u x , the s t o m a c h acids m a y not r e a c h the m o u t h and t h e baby w i l l have n o wet b u r p s , hiccups, a n d coughing. S u c h reflux i s unnoticeable a n d aptly c a l l e d silent r e f l u x (9). H o w e v e r , the b a b y will c o n t i n u e showing s y m p t o m s such a s irritability t h a t can p o i n t towards a c i d reflux.

I n a c a s e of s e v e r e reflux, t h e baby s h o w s the b e l o w s y m p t o m s of G E R .

T h e baby h a s colic for o v e r three h o u r s a d a y but i s otherwise h e a l t h y . Crying u s u a l l y begins a f t e r feeding.

I f surplus a c i d flows i n t o the e s o p h a g u s , it c a n burn t h e inner l i n i n g of t h e stomach, l e a d i n g to s e v e r e stomachache.

T h e baby h a s heavy b r e a t h i n g with a wheezing sound. I t is a n indicator t h a t the i n f a n t ’ s airways a r e constricted m a y b e due t o reflux f l u i d s trickling i n t o the w i n d p i p e .

T h e AAP s t a t e s that i n normal r e f l u x , the b a b y neither c r i e s nor i s in p a i n (10). G E R seldom c a u s e s acute p r o b l e m s , but i t is g o o d to k n o w about t h e m .

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W h e n To S e e A D o c t o r ?

R u s h your b a b y to t h e doctor r i g h t away i f you n o t i c e the f o l l o w i n g symptoms:

Vomiting
Diarrhea
P o o r weight g a i n
P o o r appetite
Breathlessness
W e t burps/hiccups c o n t a i n i n g blood

T h e s e symptoms a i d in t h e diagnostic p r o c e s s .

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H o w Is A c i d Reflux I n Babies D i a g n o s e d ?

T h e doctor m i g h t use o f these m e t h o d s to c h e c k for a c i d reflux ( 1 1 ) .

h e p H test or a c i d i t y levels o f the e s o p h a g u s indicate t h e presence o f acid i n the f o o d pipe. T h e doctor u s e s a t h i n endoscopic p r o b e inserted i n t o the e s o p h a g u s through t h e nose t o detect t h e acidity l e v e l s .

C h e s t X-ray verifies i f liquids f r o m stomach h a v e passed i n t o the l u n g s through t h e trachea. T h i s is e s p e c i a l l y conducted i f the b a b y is b r e a t h l e s s .

A n endoscopy helps a s s e s s the e s o p h a g u s for a n o m a l i e s . Specialized e n d o s c o p e s can e v a l u a t e the s t r e n g t h of t h e lower e s o p h a g e a l sphincter a n d determine i f the v a l v e is w e a k or n o t .

G a s t r o i n t e s t i n a l tests are c o n d u c t e d in t h e case o f more c o m p l i c a t e d gastrointestinal ( G I ) problems. O n e test i s the b a r i u m test where t h e baby i s given a liquid w i t h barium, w h i c h makes t h e stomach a n d esophagus d i s t i n c t l y visible i n an X – r a y . Other t e s t s track t h e passage o f the l i q u i d from t h e stomach t o the i n t e s t i n e s . Delayed e m p t y i n g of s t o m a c h contents i n t o the i n t e s t i n e can c a u s e a f u l l stomach t o throw t h e food b a c k into t h e esophagus l e a d i n g to r e f l u x .

A confirmed d i a g n o s i s of G E R helps t h e pediatrician c u r e the c o n d i t i o n appropriately.

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H o w To T r e a t Acid R e f l u x In B a b i e s ?

T h e treatment o f acid r e f l u x involves t h e following m e d i c a t i o n s and p r o c e d u r e s :

O r a l medicines: The d o c t o r will p r e s c r i b e medicines s u c h as H 2 – b l o c k e r s that e a s e the p r o d u c t i o n of a c i d in t h e stomach. S o m e H2-blocker m e d i c i n e s are c i m e t i d i n e sold u n d e r the b r a n d name T a g a m e t and r a n i t i d i n e sold a s Zantac. A n o t h e r category m e d i c i n e s are p r o t o n – p u m p inhibitors t h a t also r e d u c e acid p r o d u c t i o n by t h e stomach. A few p r o t o n – p u m p inhibitors a r e omeprazole s o l d as P r i l o s e c and l a n s o p r a z o l e sold a s Prevacid. T h e s e medicines a r e available o v e r – t h e – c o u n t e r . However, y o u must c o n s u l t a d o c t o r before g i v i n g it t o the i n f a n t . The e x a c t dosage a n d frequency o f medicine w i l l be r e c o m m e n d e d by t h e doctor a f t e r considering t h e baby’s a g e and i n t e n s i t y of r e f l u x .

T h e baby c o u l d even b e given m e d i c i n e s , such a s metoclopramide ( b r a n d name R e g l a n ) to d i g e s t the f o o d faster a n d thus e m p t y the s t o m a c h soon. I t is t a k e n before f e e d i n g or m e a l s , and t h e dosage i s decided b y the d o c t o r .

Surgery: It i s only p e r f o r m e d on t h e infant a s a l a s t resort w h e n no m e d i c i n e works ( 1 2 ) . The s u r g i c a l procedure i s called f u n d o p l i c a t i o n , and t h e doctor r e c o m m e n d s it w h e n the b a b y ’ s reflux l e a d s to s e v e r e breathlessness a n d loss o f appetite. S u r g e r y is c o n d u c t e d laparoscopically t h a t is t h r o u g h small i n c i s i o n s in t h e stomach. T h e pediatric s u r g e o n detaches t h e stomach f r o m the e s o p h a g u s and r e – a t t a c h e s it t i g h t l y , reducing t h e sphincter’s t e n d e n c y to o p e n prematurely.

T h e above t r e a t m e n t procedures p r o v i d e relief f r o m the a c i d reflux. T h e doctor w i l l also s u g g e s t changes i n the f o o d and f e e d i n g style t o handle t h e condition b e t t e r .

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D i e t Management I n The C a s e Of A c i d Reflux

P r o p e r diet c a r e at h o m e will s u p p o r t the t r e a t m e n t for a c i d reflux a n d helps t h e baby c o m e out o f the p r o b l e m sooner t h a n later:

S w i t c h baby f o r m u l a s by t r y i n g different o n e s to s e e if i t brings r e l i e f from r e f l u x .

B r i n g c h a n g e s in t h e diet f o r better n u t r i t i o n as i n f a n t s tend t o lose i n t e r e s t in f o o d due t o reflux, w h i c h adversely a f f e c t s their a p p e t i t e . Modifying t h e baby’s d i e t will h e l p the l i t t l e one g a i n adequate c a l o r i e s for g r o w t h and d e v e l o p m e n t . Parents c a n include r i c e cereal i n the b a b y ’ s formula t o provide e x t r a carbohydrates. R i c e is g e n t l e on t h e stomach a n d digests e a s i l y . Doctors c a n prescribe a special h i g h – c a l o r i e baby f o r m u l a and i t can b e given e v e n to b r e a s t f e d infants w h o have i n a d e q u a t e calorie i n t a k e that c a n n o t be r e p l e n i s h e d by b r e a s t m i l k alone.

I f the b a b y suffers f r o m an e x t r e m e case o f reflux, t h e n he w i l l throw u p anything h e swallows. I n such c a s e s , he f o r m u l a can b e fed t h r o u g h n a s o g a s t r i c tube f e e d i n g s at a hospital. T h e doctors i n s e r t a t u b e into t h e nose f r o m where i t goes i n t o the e s o p h a g u s and t h e n the s t o m a c h . The f o r m u l a is t h e n directly s e n t to t h e stomach. I n complicated c a s e s of r e f l u x or s t o m a c h surgery, t h e tube f r o m the n o s e is p u s h e d all t h e way t o the i n t e s t i n e . The f o r m u l a is d i r e c t l y pumped i n t o the d u o d e n u m section o f the s m a l l intestine. I t is c a l l e d nasoduodenal t u b e feeding. B u t these p r o c e d u r e s are o n l y used i n severe c o n d i t i o n s .

M o s t cases o f reflux r e s o l v e with b a s i c oral m e d i c i n e s and s u r g e r y while i n v a s i v e feeding p r o c e d u r e s are n o t usually r e q u i r e d . Complex r e f l u x should b e dealt w i t h importance a n d care b e c a u s e if l e f t untreated i t can l e a d to c o m p l i c a t i o n s .

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C o m p l i c a t i o n s Of A c i d Reflux I n Babies

A n untreated s e v e r e acid r e f l u x can e v e n t u a l l y lead t o the f o l l o w i n g problems.

G a s t r o e s o p h a g e a l reflux d i s e a s e (GERD) is a persistent c o n d i t i o n . The b a b y will h a v e acute s y m p t o m s that d o not s u b s i d e easily. T r e a t m e n t with e l a b o r a t e procedures s u c h as s u r g e r y may b e needed t o cure t h e condition.

Esophagitis is t h e repeated f l o w of a c i d that d a m a g e s the i n n e r lining o f the e s o p h a g u s making i t red a n d swollen ( 1 3 ) . The e s o p h a g u s becomes p r o n e to i n f e c t i o n s and a l s o leads t o severe d i s c o m f o r t when f o o d passes t h r o u g h the f o o d pipe.

T h e liquid s t o m a c h contents m a y spill o u t from t h e esophagus a n d fall i n t o the t r a c h e a (windpipe). A s trachea l e a d s to b r o n c h i o l e s in t h e lungs, i t fills t h e lungs w i t h fluids. T h i s fluid m a y get i n f e c t e d by b a c t e r i a , eventually r e s u l t i n g in a severe a i l m e n t such a s pneumonia.

T h e baby’s d i e t is a f f e c t e d by r e f l u x , and c o u l d lead t o malnutrition. Babies w i t h severe r e f l u x gain h e i g h t and w e i g h t in a slower p a c e than o t h e r s . They c o u l d have p o o r immunity t o o .

N o r m a l reflux d o e s not l e a d to g r a v e consequences. H o w e v e r , parents m a y feel t e m p t e d to t r y some h o m e remedies.

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A r e Natural R e m e d i e s For A c i d Reflux S a f e ?

I n f a n t s are d i f f e r e n t from a d u l t s , so n e v e r give a baby a c i d reflux m e d i c i n e s such a s antacid o r digestive p i l l s . You c o u l d try h o m e o p a t h i c medication, b u t only a f t e r consulting a pediatrician. D o not u s e sleep w e d g e s , pillows, a n d baby p o s i t i o n e r s for a n infant w i t h reflux. There i s no s c i e n t i f i c evidence t h a t they h e l p in p r e v e n t i n g acid r e f l u x . Instead, t h e y increase t h e risk o f sudden i n f a n t death s y n d r o m e (SIDS) ( 1 4 ) . AAP r e c o m m e n d s against t h e use o f any “ s p e c i a l ” sleep s u r f a c e s and b e d s for t h e baby a s they d o not h a v e any r e a l benefits ( 1 5 ) .

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D o Babies O u t g r o w Acid R e f l u x ?

Y e s , an i n f a n t with G E R will o u t g r o w the c o n d i t i o n by t h e age o f 12 m o n t h s . Only 1 % of i n f a n t s with G E R continue t o show p e r s i s t e n t symptoms o f acid r e f l u x beyond a year ( 1 6 ) .

T h a t said, i t is i m p o r t a n t to k n o w how G E R can b e prevented.

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H o w To P r e v e n t Reflux I n Babies?

H e r e are s o m e things y o u can d o for t h e baby t o keep r e f l u x at b a y :

G i v e your b a b y smaller f e e d s / m e a l s : Instead o f stuffing t h e baby a l l at o n c e , give m u l t i p l e small m e a l s in a day, a s they a r e easy t o digest a n d tend t o empty t h e stomach f a s t e r . This p r e v e n t s overfeeding a n d thus a c i d reflux. I f it i s a b r e a s t f e d baby, t h e n you c a n nurse t h e baby f o r a l e s s e r duration b u t at f r e q u e n t intervals.

A v o i d certain f o o d s : If t h e infant e a t s solids, t h e n keep f o o d s such a s fatty f o o d s , chocolates, c i t r u s fruits, a n d tomatoes o f f the d i e t . These f o o d s exacerbate t h e stomach a c i d production, l e a d i n g to a higher r i s k of r e f l u x .

B u y a s u i t a b l e bottle: Each b a b y has a different m o u t h structure, a n d not a l l bottle n i p p l e s may w o r k . A g o o d nipple a n d mouth a l i g n m e n t ensure t h e baby d o e s not i n g e s t air w h i l e feeding. A i r is l i g h t e r and c a n force i t s way o u t from t h e stomach t h r o u g h the l o w e r esophageal s p h i n c t e r causing r e f l u x with w e t burps. T o avoid t h i s , try d i f f e r e n t bottles t o zero i n on t h e best o n e .

B u r p the b a b y between f e e d s : Give t h e baby t i m e to b u r p and r e l e a s e air, a s it p r e v e n t s the b u i l d u p of p r e s s u r e in t h e stomach. Y o u can h o l d him i n your a r m s and p a t his b a c k gently.

D o not l a y the b a b y down i m m e d i a t e l y after a meal: Hold t h e baby i n a s i t t i n g or u p r i g h t position f o r 30 m i n u t e s after f e e d i n g . This h e l p s settle t h e food i n the s t o m a c h and p r e v e n t s it f r o m moving u p w a r d s . If t h e baby e a t s solid f o o d s , then g i v e him a meal a t least t h r e e hours b e f o r e bedtime, a s it a i d s in d i g e s t i o n . A b a b y should a l w a y s be p l a c e d on h i s back w h e n sleeping, e v e n with r e f l u x as i t is t h e safest s l e e p i n g position f o r infants ( 1 7 ) .

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B a b i e s recover f r o m normal r e f l u x and m o s t infants n e v e r have a problem w i t h it. I n fact, b a b i e s with n o r m a l reflux a r e called ‘ h a p p y spitters’ b e c a u s e they a r e comfortable w i t h the c o n d i t i o n . Should y o u ever s e n s e an i n c r e a s e in t h e reflex’s s e v e r i t y , take t h e baby t o a d o c t o r immediately. S o m e modifications i n diet a n d oral m e d i c i n e s are a l l a b a b y needs t o sail t h r o u g h the r e f l u x ordeal.

H a v e some t i p s on p r e v e n t i n g acid r e f l u x in b a b i e s ? Tell u s in t h e comments s e c t i o n .

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