Acid reflux or simply ‘reflux’ is a common condition in babies. Around 40% of healthy, thriving babies will have reflux to some degree. Reflux generally begins before eight weeks of age and peaks at four months before gradually improving. Reflux commonly relates to a baby’s gut maturity and with time and development gets better without any specific treatment.
Reflux happens many times a day, though more commonly after feeds and when there is milk in the baby’s stomach.
Although reflux is common and most babies don’t require specific treatment, some babies are significantly affected by it and don’t grow and gain weight as they need to. When reflux is severe, it is called GORD – gastroesophageal reflux disease.
What is reflux?
Reflux happens when the ring of muscle between the end of the baby’s oesophagus (food pipe) and the top of their stomach is relaxed. This allows the stomach contents to regurgitate from the stomach up into the food pipe and come out of the baby’s mouth as a vomit, posset or spill.
Premature babies can be at greater risk of having reflux than babies born at term. Being exposed to tobacco smoke may also cause reflux in some babies. Don’t smoke around your baby and don’t allow other people to either.
Does reflux cause pain?
Milk is digested by acid in the baby’s stomach. Their stomach lining is designed to cope with the acid sensations though their food pipe is not. This is why babies often feel uncomfortable and be unsettled when they are refluxing.
How would I know if my baby has reflux?
Your baby may have reflux but not be bothered by it. Babies with reflux tend to effortlessly bring milk up into their mouth rather than actually vomit which is why they can be called ‘happy chuckers’.
Many parents have heard the term ‘silent reflux’, though current evidence does not support this exists. Babies who don’t vomit or posset are unlikely to have reflux and often, crying and unsettled periods are due to tiredness or hunger.
You may want to keep a diary to record your baby’s feeding, crying and vomiting episodes. This will make it easier to monitor any changes and give an accurate history to your child health nurse and/or doctor.
Common reflux symptoms are:
- Small spills or ‘possets’ of milk after and in-between feeds.
- Back arching and unsettledness. Babies can behave as if they’re trying to lengthen or stretch themselves in an effort to ease discomfort.
- Swallowing even when they’re not feeding.
Is reflux dangerous for my baby?
Reflux is not dangerous unless the baby regurgitates (aspirates) milk into their lungs. When a baby has GORD, their growth can be affected because they’re vomiting and may be refusing to feed well. Sometimes the baby’s oesohpagus becomes inflamed because of the effects of the stomach acid.
What’s the difference between reflux and Gastro-oesophageal reflux disease?
Babies with GORD can show a range of symptoms, though the most common are:
- Fussiness or refusal to feed. Feeding causes them pain so they learn that feeding can be stressful.
- Aspiration – milk goes into their trachea (windpipe) rather than their oesophagus (feeding tube).
- A cough, wheeze or noisy breathing.
- Changes in weight with a slowing of weight gain.
- Blood in their vomit.
Babies with cow’s milk protein allergy (CMPA) can show very similar symptoms to babies who have GORD. Though more commonly, they also have changes in their poos which show blood and mucous.
What is the management for reflux?
Treatment for reflux depends on the symptoms. There is no cure for reflux and treatment, if it’s necessary, is usually based around easing the baby’s symptoms. Mild reflux generally doesn’t need any treatment other than perhaps keeping the baby upright after feeds.
- If you are bottle feeding your baby, try to feed them in a more upright position.
- Hold your baby with their head upright for around 20-30 minutes after feeding.
- Always follow the safe sleeping guidelines and place your baby on their back to sleep. There is no evidence which supports prone (tummy) sleeping or elevating the cot makes any difference.
- Sometimes thickened feeds e.g., using an anti-reflux formula for bottle fed babies can help to reduce the amount of vomiting.
Medication can be useful to suppress the amount of acid being produced in the baby’s stomach. Generally, a four-week trial is recommended to see if it makes a difference. Reflux medication is prescribed according to a baby’s age and weight. Regular reviews, every four weeks are recommended for babies who are on reflux medications.
What not to do for reflux
You know your baby better than anyone else. Experiment with different holding positions and see what soothing strategies work best.
As a general rule:
Avoid using anti-reflux formula as well as thickening agents in the formula - this can lead to a gut obstruction.
Avoid thinking you need to stop breastfeeding. Babies who are formula fed reflux as much as breastfed babies and there is no benefit in stopping breastfeeding in the hope that it will improve reflux symptoms.
Avoid introducing solid foods early in the hope that they will help to ‘keep down’ your baby’s milk. Currently, there is no evidence to support introducing solids before (around) six months and when a baby is developmentally ready.
When will my baby grow out of their reflux?
Most babies have outgrown their reflux by around 18 months of age though show improvement when they are able to sit. Position seems to play a role in reflux and by the time a baby is spending more time upright, their reflux symptoms improve.
For more information about reflux
- Speak with your Child Health Nurse, GP or paediatrician.
- Visit Reflux Infants Support Association – check here.
Written for Nourish Baby by Jane Barry, Midwife and Child Health Nurse
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