This is gastro-oesophageal reflux disease. Babies are more likely to have a weak LES. This makes the LES relax when it should stay shut.
If your child has begun solid foods (usually recommended after 4 months of age and not sooner) rice cereal may help to reduce the amount an infant will regurgitate.
It’s unusual for infant reflux to continue after age 18 months. Obesity and gastroesophageal reflux disease and gastroesophageal reflux symptoms in children. Surgery is often considered for the child with GERD who fails medical therapy.
Gastroesophageal Reflux (GER and GERD) in Infants and Children
When GERD is suspected, many doctors first try a trial of various reflux medications (without running tests), to see if the medications improve baby’s symptoms. If testing is done, a 24-hour pH probe study () is the current “gold standard” for reflux testing in babies; this is a procedure where a tube is placed down baby’s throat to measure the acid level at the bottom of the esophagus. A barium swallow (upper GI) is not so invasive (baby swallows a barium mixture, then an x-ray is taken) but is not really effective for diagnosing reflux in babies, since most babies will reflux when given barium. An upper GI will not identify whether baby’s stomach contents are higher in acid or if there has been any esophagus damage due to reflux, but it will show if there are any blockages or narrowing of the stomach valves that may be causing or aggravating the reflux. Additional tests may be recommended in certain circumstances (see the links below for additional information).
Within the syndromes with associated injury are reflux esophagitis, stricture, Barrett’s esophagitis and adenocarcinoma. Complications of GER are listed in Table 1. If the diagnosis remains unclear or there is still a question of whether reflux is actually the cause of symptoms such as coughing or wheezing, a pediatric gastroenterologist may do tests using esophageal pH or impedance probes (see Ambulatory pH Monitoring). Caregivers record the occurrence of symptoms (manually or by using an event marker on the probe); the symptoms are then correlated with reflux events detected by the probe. A pH probe can also assess the effectiveness of acid-suppression therapy.
Infants with GER generally have no symptoms other than the obvious reflux of fluid out the mouth. As mentioned previously, they do not appear to have any discomfort associated with their reflux. GERD is the back up of stomach acid into the esophagus.
You can also talk to your doctor about giving your child probiotics, which are available as drops for infants who are breastfeeding or in powder that can be mixed into baby’s bottle. If you’re formula-feeding, you can use a formula that already has probiotics mixed in, but again, check with your pediatrician first. But in some infants – usually those born prematurely, but sometimes those born full-term – the area between the esophagus and stomach is underdeveloped, which means the muscles there relax when they should be contracting.
Thickened formula seems to reflux less, particularly when the infant is kept in an upright position for 20 to 30 min after feeding. Thickened formula may not flow through the nipple properly, so the nipple orifice may need to be cross-cut to allow adequate flow. Infants with GERD may be irritable and/or have respiratory symptoms such as chronic recurrent coughing or wheezing and sometimes stridor. Much less commonly, infants have intermittent apnea or episodes of arching the back and turning the head to one side (Sandifer syndrome).
This method has less pain and a faster recovery time. Small cuts or incisions are made in your child’s belly.
How is GERD treated in a child?
Approximately 85% of infants vomit during the first week of life, and 60-70% manifest clinical gastroesophageal reflux at age 3-4 months. Gastroesophageal reflux is most commonly seen in infancy, with a peak at age 1-4 months. However, it can be seen in children of all ages, even healthy teenagers. Although the relationship between gastroesophageal reflux and ALTEs is controversial, where an association with apnea has been found, it is as likely to occur with nonacid as with acid reflux. Accordingly, a comprehensive evaluation of this phenomenon will likely require a bioelectrical impedance study (to identify nonacid reflux; see below) in conjunction with respiratory monitoring.
Breast milk is easily digested by babies and contains infection-fighting antibodies and cholesterol, which promotes brain growth. Formula-fed babies actually need to eat somewhat less often since formula is less readily digested by the baby than human milk. This article explores the advantages and disadvantages of both forms of feeding. Slower than normal emptying of stomach contents may predispose infants or children to GERD.
What’s the best way to relieve my baby’s reflux?
Most babies with reflux have no symptoms other than spitting up often. As long as these children grow well and don’t have other issues caused by reflux, they don’t need treatment. Reflux is often caused by problems with the lower esophageal sphincter.