While all babies spit-up a bit, some regurgitate excessive
amounts of milk, because of a condition called gastroesophageal
reflux (GER). GE reflux or GER results from stomach
acid rising up the esophagus through the inadequate
closure of a valve between the baby's esophagus and
stomach. The condition typically shows up within the
baby's first few weeks and can last for several months.
The many faces of reflux are evident in the following:
a baby who spits up all the time. an adult with chronic
heartburn, a child who won't gain weight, an unhappy
toddler, an infant who cries and cries, continuous
wheezing, recurrent coughing. Most parents will agree
that GE reflux can be a nightmare, especially when
it persists beyond the simple spit ups and babyhood.
Who
gets it?
In most newborns up to 3 months of age,
the lower esophageal sphincter or valve is relatively
lax. Thus, frequent spitting up is common. Otherwise
the baby is normal, happy, eats well, gains weight,
and has no other symptoms. Still, this spitting
up is often upsetting to parents. It can also be
quite inconvenient in that parents frequently must
change clothes -- theirs and the child's. With time,
physiologic reflux as its termed, remedies itself
when the valve becomes more competent; children
eat more solid food; they assume a more upright
posture; the spitting up diminishes.
The other version is more persistent in nature and
is called pathologic reflux. About two-thirds of
children with pathologic reflux have poor weight
gain.
Symptoms?
Symptoms might include poor weight gain,
heartburn, vomiting irritability (especially after
eating or while lying down) wheezing, chronic cough,
pain with eating, and blood in the stools. A child
might have any or all of these symptoms, but not
actually spit up, if the stomach contents are re-swallowed.
Duration?
In most cases, the spitting up resolves without
treatment by about 18 months of age. If reflux persists
beyond age 2, there is generally not much improvement
until age 4. If the condition still exists when
the child is closer to puberty, then the likelihood
of having reflux as adults is high -- unless corrected.
Diagnosis?
When reflux lasts beyond about 18 months, or when
it is associated with other symptoms at any age,
it should be evaluated. Mention the possibility
of GER to your doctor. If the infant is healthy,
happy, and growing well, no tests or treatment may
be needed. The diagnosis is usually made based on
the history given by the parents.
Treatment?
Doctors won't jump to medical solutions as a means
of treatment. They may recommend other ways, which
might include changing feeding and posture habits
or i f a child is not growing well, feedings with
higher calorie content foods. Medical treatment for
pathologic reflux is usually quite effective. Some
medications can help speed the emptying of stomach
contents into the intestine or lower the production
of stomach acid. In severe cases an operation may
be necessary. Discuss with your baby's paediatrician.
Prevention?
• Sometimes smaller, more frequent feedings
will prevent reflux.
• Avoid overfeeding baby as it can aggravate
reflux.
• Keep baby upright and quiet for at least thirty
minutes after feeding.
• Wear your baby in a carrier as long as possible.
Carried babies cry less. Babies reflux more while
crying.
• Breastfeed. Studies show that GER is less
in breastfed babies.
• If you are bottle-feeding (and if recommended
by your doctor), thicken baby's feedings with rice
cereal.
• Discuss with your doctor the safest sleeping
position for your baby. Babies with severe reflux
sleep best on their stomach and propped up at a 30-degree
angle by elevating the head of the crib. (Babies without
reflux should be put down to sleep on their backs.)
THE FINAL WORD
• GER occurs when stomach contents back up into
the esophagus due to laxness in the lower valve.
• GER is common in infants but they grow out
of it by 3 months of age or the problem resolves by
itself before they turn two.
• In infant related GER, symptoms include spitting
up, vomiting, coughing, poor feeding, or blood in
the stools.
• Treatment depends on the infant's symptoms
and age, and may include changes in eating and sleeping
habits. Medication may also be an option, or surgery
in severe cases.
Take heart! It's a temporary problem and there
are always ways to mend this situation either through
home remedies or with your pediatrician's help.
