Acid reflux and gastroesophageal reflux (GER) is not something that affects just adults. Infants can also suffer from uncomfortable symptoms of GER. While it is uncommon for the condition to persist beyond 18 months, today we will discuss some of the signs and symptoms you may see and how you can help manage reflux in your baby.
Some reflux is normal in healthy infants and may not be indicative of a chronic condition. However, persistent reflux may indicate an allergy, a digestive system blockage, or gastroesophageal reflux disease (GERD). One of the more common causes of GERD in infants is a weak lower esophageal sphincter (LES).
Signs and Symptoms
Signs of a healthy baby that has some reflux are vomiting or frequent spitting up. If the baby continues to eat well and gain weight, there is not much to worry about. You may make a few modifications to the feeding routine to help avoid these symptoms, but in general, there won’t be any long-lasting problems.
Signs and symptoms of a more serious condition that may require a little more intervention include:
- Spitting up and vomiting,
- Difficulty eating or swallowing,
- Irritability — kicking and screams of discomfort during meals or after meals,
- Weight loss or inadequate weight gain,
- Gagging or choking,
- Blood specks in stool or vomit,
- Chronic cough or several bouts of pneumonia,
- Refuses to eat,
- Difficulty sleeping laying down — needs to be held upright to sleep.
In-home Treatment Options
You should always let your pediatrician know if your baby has any regular symptoms of distress or discomfort when eating or shortly after. There are some things you can do at home to help manage your baby’s symptoms that include:
Give smaller, more frequent feedings.
This helps to prevent the stomach from becoming too full, which forces the food back up into the esophagus. Infants are not good managers of their hunger, and while they may cry for feeding when they are uncomfortable and want to eat, they do not yet recognize the cues that they are full and will continue to eat. A breastfed baby is less likely to overeat, but both breast and bottle fed babies can take in too much too quick and overfill their tiny stomachs. If your baby is spitting up after each feeding, try to feed him or her less and see if it helps.
Change the nipple or bottle.
Infant bottle nipples are numbered based on the flow rate that they offer. Nipples for newborns prevent the flow of milk or formula that would require the baby to gulp. Gulping can lead to choking, overeating and contribute to swallowing of air, which can cause gassy discomfort. Try changing up the bottle if your baby is getting a lot of air. Thinner or angled bottles can help or special slow-flow bottles can reduce excessive flow.
Burp the baby often.
Burping your baby helps to get the air out of the digestive system that causes bloating and discomfort. There is no need to wait until the end of the meal to burp the baby. Allow them to take a break from feeding every ounce or two to burp them. Not only will this help the food settle and relieve air build up, but it will also allow your baby to feel fuller and you can assess whether or not they need to eat more at that time or not. Just like adults, not every meal should be the same size, and sometimes the baby just needs a snack.
Correct feeding position.
While feeding your infant, make sure their head is above their belly. Feeding them completely upright is much better than feeding them while laying down. Never feed an infant while they are laying on their backs. Not only can this cause terrible reflux, but can also cause choking and aspiration. It is a good idea to keep baby upright while burping them and for a little bit after their meals to ensure milk or formula does not travel out of the stomach and back up the esophagus.
All babies, regardless of reflux, should be put to sleep flat on their backs on a firm surface to prevent sudden unexpected infant death (SUID).
Check the food source.
Reflux may be a symptom of food allergies or intolerances. If you are breastfeeding your infant who seems to suffer from reflux, cutting milk, eggs, and red meat out of the mother’s diet has been shown to help reduce symptoms. For formula fed babies, review the ingredients in the formula and select a reflux-friendly formula. Talk to your pediatrician about different allergens and which formula might be best.
Thicken the milk.
Before thickening your baby’s milk, speak to your pediatrician for recommendations. Thickening breast milk or formula with a little bit of infant cereal can help reduce how liquid your baby’s meal is and help keep it in the stomach, rather than creeping back up into the esophagus. Never thicken formula by reducing the water content, this can cause severe digestive problems, constipation, and dehydration. And, never thicken your infant’s milk or formula without consulting with your pediatrician.
For uncomplicated reflux, medication is not indicated for infants. Try the tips listed above, and if they do not work, speak to your pediatrician about medications. Over the counter gas drops, gripe water, or reflux medications can be used to help. Even though they are available over the counter, you should consult your pediatrician for recommendations.
In some severe cases, the LES may need to be surgically tightened. Typically, surgery will be avoided if the condition does not prevent growth or interfere with the baby’s breathing. As we stated earlier, it is not common for infant GER to persist beyond 18 months, so in most cases, the condition will be monitored and treated conservatively unless the condition warrants more aggressive intervention.
If your baby suffers from symptoms of reflux, you need a trusted team of GERD specialists that you can trust. Contact the team at Southern Reflux Center for your consultation and to learn more about managing symptoms.