Infant reflux

by **Nanneerose** Mon May 12, 2014 6:32 pm

When a baby finishes a feed only to bring back up what looks like large quantities of milk, it can be distressing for parents – not to mention messy.
But doctors say this phenomenon, known as infant reflux, is perfectly normal in healthy babies and is generally nothing to worry about.
Most children grow out of the problem as their digestive system matures, generally by around age one or slightly after.
A common condition
Reflux simply means the movement of the contents of the stomach back up into the oesophagus, the tube that carries food from our mouth to our stomach.
The medical term for this is gastro-oesophageal reflux, or GOR.
Sometimes, the food will be regurgitated all the way back up to the mouth. As most parents know, babies are particularly good at this and it often leads to whoever is holding them getting a generous coating of partly-digested milk.
Most of us continue to experience this occasional movement of food in the wrong direction throughout our lives without any harmful effects. In fact, we may not even notice it happening.
Reflux is much more common in babies because the lower oesophageal sphincter (the muscle that closes off the oesophagus from the stomach after we swallow) relaxes more frequently at this age. As a result, they may experience reflux up to 30 times a day, although this will not always lead to visible regurgitation.
While it can be worrying for parents, babies themselves generally take regular regurgitation in their stride.
Unlike the vomiting we experience as adults, reflux is an effortless process and is unlikely to cause babies any distress – which is lucky, given how many of them do it.
Around two-thirds of four-month-old babies regurgitate food at least once a day, with some babies doing it after every feed. Although it usually happens after feeding, reflux can also occur at other times such as when a baby coughs or cries.
In most cases, this is nothing to worry about, and parents tired of the constant washing and mopping up can be reassured that things will improve as the child's digestive system matures.
By the age of six to seven months, only one in five babies is still regurgitating every day, and the problem usually disappears by the age of 12-18 months.
Does reflux make babies cry?
When a baby cries inconsolably after feeding, family and friends often suggest the problem is reflux or perhaps "colic" or "wind".
In most cases, however, the crying is not caused by any underlying condition and is something the baby will simply have to grow out of, although this can be hard for anxious parents to believe.
It is estimated that only about 5 per cent of unsettled babies have a diagnosable medical condition as the cause.
If your baby shows symptoms of ongoing distress or pain, this is unlikely to be caused by reflux, but it is worth discussing it with your doctor or maternal and child health nurse (see 'Getting help', below) as they may be able to suggest strategies to help you and your baby cope.
They will also be able to check that there is not a more serious problem causing the crying, such as inadequate nutrition or an allergy to formula.
In rare cases, reflux can also be a symptom of more serious conditions that may require medical treatment and your doctor will be able to advise you about that.
Waiting it out
In most cases, there is little parents can do about reflux and regurgitation other than to wait for the problem to resolve itself.
Smaller, more frequent feeds may be less likely to lead to reflux and you may wish to try different breastfeeding positions to see if some work better than others.
Placing babies on their left side after feeding may also help to reduce episodes of regurgitation, although it will not make them grow out of it any sooner.
Some parents find it helps if they stop and burp their baby mid-feed or hold him or her upright for 20-30 minutes after a feed.
Changing formulas or changing from breastmilk to formula does not have any effect on reflux and doctors do not recommend it.
Getting help
If you are concerned about your baby's health or if he or she is failing to thrive, you should seek medical advice, although your doctor will probably be able to reassure you that the problem will resolve naturally with time.
In rare cases, reflux can lead to other health problems or may be a symptom of a more serious underlying condition. It is important to seek medical advice if your baby is losing weight or shows ongoing reluctance to feed as this might indicate other problems that would respond to treatment or a change in management.
Problems could include infection, difficulties with breastfeeding or an allergy to the cow's milk in formula.
You should seek medical attention if your baby:

produces blood or bile (a yellow fluid) in their vomit
repeatedly chokes or has difficulty swallowing
has a fever
suddenly starts to regurgitate regularly when they have not previously
is generally fretful and hard to settle
refuses to eat
is losing or failing to gain weight

The doctor or nurse will make sure your baby is growing as expected and check for infection or other possible causes of the reflux. They may suggest some treatment such as thickened fluids or – very occasionally – medication. Most children do not need any treatment at all.
Even if there is nothing physically wrong with your baby, it can be worth seeking advice as your doctor or maternal and child health nurse may be able to suggest strategies that can help.
Reviewed by Professor Geoff Davidson, senior staff gastroenterologist, Centre for Paediatric and Adolescent Gastroenterology, Women's and Children's Hospital, Adelaide.
http://www.abc.net.au/health/library/stories/2011/09/15/3317823.htm

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