INFANT REFLUX

Overview

Most infants will visibly spit up a small amount of breast milk or formula after their feedings for the first several weeks or months of life. This occurs because the muscle sphincter at the bottom of the esophagus is immature. This sphincter is designed to keep liquids and solids which have entered the stomach from regurgitating back into the esophagus. For most babies this common entity causes no ill effect, however, in some reflux can cause significant pain due to the irritation of the esophagus from stomach acid. Babies who experience substantial pain with feedings may begin refusing to eat well enough to maintain normal growth and nutrition. Most infants with gastroesophageal reflux will get better by their first birthday; however, reflux disease can affect children, adolescents, and adults. This information handout is focused on infant reflux.

Signs and Symptoms

• Spitting up or occasionally forcefully vomiting liquid that looks like milk.
• Arching of the back or crying during a feeding or shortly after feeding.
• A brief episode of choking or inability to take a breath.
• Crying in pain during the night.
• Recurrent episodes of wheezing that cannot be attributed to other causes.
• Poor weight gain.
• An infant with reflux may have any combination of these signs and symptoms.

Spitting up from reflux must be distinguished from other diseases. Those with fever or vomiting and diarrhea together may have a “stomach virus” or other infectious etiology. Crying spells may represent colic or other non-specific discomfort. Rarely, an infant between the ages of about 3 weeks to 7 weeks old may develop progressively worsening projectile vomiting due to a blockage from the stomach to the small intestines called pyloric stenosis. Another rare condition that must be distinguished from reflux is intestinal obstruction, which is a medical emergency that may present with bilious (green) vomiting.

Treatment

Usually treatment for reflux disease is approached in a step wise fashion. The goal of therapy is for the baby to eat with a minimum of discomfort and gain weight properly with the least possible amount of intervention. The first steps in managing problematic reflux might include giving smaller volume, more frequent feedings; giving a trial of hypoallergenic formula in those babies who are currently consuming standard formula; thickening feedings with cereal; and in some instances repositioning the baby after feedings when awake. For those who continue to experience significant symptoms, a trial of acid suppressant therapy may be prescribed. Please remember that it is the role of the clinician to exclude other diseases, and to provide guidance on formula choices and preparation, positioning, and medications.

To Learn More

Please go to our links section and visit the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition www.naspghan.org, or their sister website; Children’s Digestive Health and Nutrition Foundation www.cdhnf.org. These websites provide a wealth of information about not only reflux disease in all age groups, but other common disorders of the digestive tract including chronic abdominal pain, constipation, food allergies, and colic.