Causes, Treatment, and Prevention of Acid Reflux (GERD) in Infants
Spit up and babies go hand in hand. We are no strangers to the white, icky stuff splashed on our arms and dribbling down our backs, but when it causes other problems or is associated with other symptoms, it may be due to a disease called gastroesophageal reflux or GERD.
This may seem a little hasty. All—or at least most—babies have some sort of reflux, right? You’re right. They do. Most babies will spit up from time to time, sometimes, due to gas or from having eaten too much at one time. Sometimes, it's just because they're babies, and that’s what they do.
This article isn’t focused on the everyday spitting up, white drool, or even burping. This article focuses on those babies who have moved past the normal, occasional spitting up and into the danger zone of not eating, not sleeping, projectile vomiting, non-stop crying, and trouble breathing. If this sounds like you’re little one, or this is something that has been worrying you, this article is exactly what you need.
What Is GERD?
Gastroesophageal reflux (GERD) is simply frequent bouts of acid reflux: upward movement of stomach contents into the esophagus, and sometimes, into or out of the mouth. You probably have experienced this after eating too much, eating spicy foods, or even when you have gas. The reflux of stomach contents contains stomach acid that damages the lining of the esophagus and is very painful.
Normally, when you swallow, food travels down the long, muscular tube inside your body called the esophagus. The muscles in the wall of your esophagus contract from top to bottom, pushing the food down into your stomach the way they are supposed to go. Once you finish swallowing and all the food has entered your stomach, a circular band of muscle called the lower esophageal sphincter (LES), located where the esophagus joins the stomach, contracts and acts like a door to prevent the food from coming back up.
This is when your body begins digesting your food, and you may begin to feel sleepy. During this process, your LES is supposed to keep your stomach contents from regurgitating, or refluxing, back up into your esophagus. However, with GERD, instead of closing like it’s meant to do, the LES remains open, allowing stomach acid to come back up the esophagus, damaging the lining, the back of the infant’s throat, and even the infant’s new, developing teeth.
This stomach acid is literally eating away at the tender skin and tooth enamel, doing a great deal of destruction. If left untreated, it could cause much more serious damage to your baby’s body.
What Does Infant Reflux Look Like?
Spitting up and vomiting are the main symptoms that you can actually see with infant reflux. As long as your baby is healthy, happy, and growing well, the reflux is normal and natural and not a cause for concern. Your child will likely just outgrow it. While your little one may act fussy or seem to be uncomfortable, it is very unusual for the stomach contents to be acidic enough to cause the extensive damage to the esophagus or throat seen with more serious forms of acid reflux.
The most common symptoms of reflux in kids are:
- Frequent or recurrent vomiting
- Frequent or persistent cough
- Refusing to eat or difficulty eating (choking or gagging with feeding)
- Crying with feeding
- Heartburn, gas, or abdominal pain
If these are problems your infant struggles with, there are many easy treatments that will quickly relieve your infant’s discomfort, including over-the-counter antacids for infants. For more serious forms of reflux such as GERD, you'll need to see your pediatrician.
What Is the Difference Between Infant Reflux and GERD?
It's perfectly normal for babies to spit up after feedings or even to vomit once in a while without apparent cause or warning. In fact, some babies spit up quite frequently and show no ill effects. This is called infant reflux, or simply GER, and most babies will outgrow it by age one. For infants, just like for adults, there may be a little pain, but you can easily treat your infant’s reflux and sometimes get rid of it altogether.
On the other hand, GERD is a more serious, frequent, and chronic form of infant reflux that includes frequent vomiting associated with discomfort, difficulty feeding, and/or weight loss in the infant. Unfortunately, with GERD, the frequency of stomach acid coming back up the infant’s throat is essentially burning the sensitive lining of the esophagus, causing serious pain and may even do permanent damage. There is no simple solution.
In fact, diagnosing and treating GERD is a long, drawn-out process that may include X-rays, probes, endoscopies, and at the very worst—and thank goodness this is extremely rare—surgery.
How Do I Know if My Baby Has GERD?
Obviously, if your infant is vomiting, irritable during or after feedings, arching his or her back during or after feedings, or even crying more than normal, he or she is most likely having problems with reflux and/or gas. These are the first signs that your infant may need medical attention. You'll need to keep an eye on them in case the symptoms worsen. You'll also need to discuss this problem with any of your infant’s other caregivers so that they can keep an eye out as well.
Symptoms of severe reflux include the refusal to eat, weight loss or poor growth, coughing, and colic, they become a greater cause for concern. If you notice these changes, your baby needs to see a doctor right away to stop this before it is too late.
If you or one of your caregivers notice that your little one is projectile vomiting, that the vomit is green or yellow, looks like coffee grounds, or contains blood, or that they have difficulty breathing after vomiting or spitting up, they need to be taken to the ER immediately. Some infants will show signs of severe dehydration, such as dry diapers or no tears when crying, gagging or trouble swallowing, or wheezing when breathing. All of these signs point to an emergency and need to be dealt with right away.
Dangerous signs of GERD that need immediate medical attention:
- refusal to eat
- colic signs
- arching his/her back during or after feeding
- vomit of a strange color
- projectile vomiting
- gagging or choking
- trouble breathing
The Dangers of GERD in Infants?
Sometimes the refluxed gastric contents can enter the back of the throat, causing a sore throat, choking, gagging, coughing, erosion of dental enamel, and even be aspirated into the lungs, causing respiratory infections, wheezing, and asthma-like symptoms. GERD can also lead to other breathing problems in infants like full-blown asthma.
If left untreated, this reflux can lead to disjointed and poor sleep, sleep apnea, breathing problems, and other conditions. Infant reflux, by itself, is recognized as contributing to sleep apnea: when a baby stops breathing momentarily, disrupting the baby's sleep and waking them up many times during the night. In the most extreme cases, this can lead to sudden infant death syndrome (SIDS).
The danger of SIDS is the highest during the first six months of a baby's life, which also happens to be the most common time frame for infant reflux and GERD. This makes it imperative that parents of babies who suffer from acid reflux take the necessary precautions as soon as the condition is first recognized. The dangers could go from a little discomfort and gas to being as serious as sudden death.
Have you experienced GERD or reflux with an infant? What did you try that helped?
What Causes GERD in Infants?
They Are Still Developing
The most likely cause is the baby's underdeveloped digestive system. The esophageal sphincter in infants is not yet fully developed, allowing the stomach contents to flow back up their esophagus.
Eventually, as the baby grows and develops, the LES will open only when the baby swallows and will remain closed the rest of the time. The risk of GERD is typically only present through 6 months of age but can also go up to one year depending on the baby.
Baby Behaviors and Habits Increase the Risk
Most of the time, infants lie flat on their backs, which makes it easier for stomach acid to leak through the LES. Additionally, their diet is mostly or completely liquid, which also makes leaking easier. There's not much that can be done about this, especially during the first few delicate months of their lives.
Sometimes air bubbles in their little stomachs may push liquids up for no good reason. In other cases, your baby may simply drink too much, too fast, causing the liquids to come back up. Although infant reflux most often occurs after a feeding, it can happen anytime your baby coughs, cries, or strains.
Remember that GERD can adversely affect your infant’s overall health and temperament. Babies with severe symptoms or symptoms that last beyond 12 to 14 months may actually have GERD and should see a pediatrician who specializes in treating children with this disease. If they cannot help you for some reason, they may refer you to someone who can.
Now, let’s look at how to treat your infant’s reflux. None of the treatments will harm your baby, but it's always best to talk to your doctor about any other conditions or medications that may interfere with reflux treatments.
What Can I Do to Help My Baby Get Better?
One of the most important things to remember is that most infants grow out of GERD by the time they are 6 months old. If it does last longer, it won’t last past the one year mark. Hang on, it’s almost over! In the meantime, there are many simple tips that you can use if you believe that your little one is suffering from reflux.
- Keep your infant upright during feedings and sit them up in a rocker or bouncer for at least 30 minutes after a feeding. This will allow the food to naturally make its way down into your child’s stomach and gravity will do most of the work for you.
- Try feeding your little one smaller amounts of food more often throughout the day. Smaller feedings every 2-3 hours will reduce the risk feeding too much at one time. This will give them time to completely digest their food. Overfeeding can increase abdominal pressure, which increases the likelihood of gas and can lead to reflux.
- Burping your infant several times during each feeding will also help keep gas low. It will also force you to feed your baby more slowly since you will be taking small breaks in between. Waiting to burp your infant after feeding can increase the chances of regurgitation.
- If the tips above are not working for you, you can try with cereal. Try this only when your baby can move on to solid foods and when you have your doctor's approval.
- Start by adding one teaspoon of rice cereal to each ounce of formula.
- If you are breastfeeding your baby, try pumping and then adding rice cereal to the breast milk. This may reduce the amount your infant will regurgitate when used along with all of the tips above.
- Try keeping the top half of your infant’s body at an incline while resting or playing throughout the day to make sure that gas is released as needed and everything is staying down like it’s supposed to.
- Finally, there are many over-the-counter medications available for infants to lessen gas and/or decrease stomach acid. These include simethicone (Mylicon) and Gaviscon.
- It's still unclear whether antacids decrease reflux in infants, However, they are considered safe for babies. Make sure that you strictly follow the instructions on the box.
You should consult your baby's doctor before making any major changes in your infant's feedings, positions, and medications. Your doctor will be able to tell you if your infant’s reflux is just normal spitting up or if it’s a chronic problem that needs medical treatment. He can also give you advice on the best treatment for your baby.
Is There Anything I Can Do to Prevent It?
Many moms and dads are being proactive and trying these feeding tips, and even some sleeping tips, to prevent their little ones from ever having to experience reflux in the first place. Prevention is definitely a good decision!
Avoid Foods and Drinks That Irritate the Stomach
I think everyone knows the suggestion for adults is to avoid foods that can create gas or indigestion. Mothers who breastfeed can use that same advice to help prevent reflux in their little ones. By avoiding certain foods, such as caffeine, chocolate, garlic, and spicy foods, you may be saving yourself and your little one from a lot of discomfort and pain.
Also, avoid feeding your baby things that can increase their risk of reflux. This might sound like common sense, but many parents give their infants acidic drinks like orange juice and other citrus juices that can wreck their systems. There’s nothing wrong with your young children having these items, but save them until they are at least 1-1.5 years old before offering them these treats.
Let Gravity Aid Their Digestion
The way your infant is positioned when sitting can also increase the risk of regurgitation. If the infant slouches or slumps over in their car seat, it causes abdominal compression, making digestion difficult. Use some supports to keep them upright in their high chair/stroller/car seat, and you will likely prevent indigestion.
You can also try positioning them at a slight incline when they sleep. You won’t want to take the legs of the crib or bassinet off the floor, as this negates the safety of the item being used. Simply elevate one end of the mattress in the crib or bassinet with a blanket or towel. Be careful not to elevate the crib mattress too much. You want the side where your baby’s head will lay to be just a tad bit higher than the other side to promote better breathing and to let gravity help move food through their digestive system.
Avoid Overly Tight Clothing
The final thing you can try is avoiding tight elastic around your baby's waist. You want to make it as easy as possible for your baby to breathe, eat, and digest their food. By making sure your infant’s clothes fit correctly and are not too tight, you can make a big difference in the way your baby’s body works. Make sure their diapers fit but aren't too tight.
Like with most other childhood illnesses, the biggest danger is simply the lack of parental awareness and education. The more you know about your little one and what you need to be looking out for, the better you can treat and prevent many of the illness that may befall them.
With a few simple changes, regular visits to their doctor, and just keeping an eye out for any unusual symptoms, you can keep your baby healthy and ensure they have a long and healthy life.
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This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2013 Victoria Van Ness