Infant acid reflux
Many adults experience gastroesophageal reflux diseease (GERD) or acid reflux that causes heartburn and uncomfortable pressure in the chest. Infants can also suffer from a form of acid reflux that causes frequent spitting up and loss of stomach contents. When this problem is severe, the infant may have infant acid reflux or GERD.
Definition & Facts
About one-third of infants will have a problem with frequent spitting up. Infant gastroesophageal reflux disease, often shortened to GERD, occurs when the stomach's contents flows back into the esophagus, causing burning and discomfort in the chest and throat. Infants will occasionally spit up when their stomachs become too full or when they are held in certain positions. Their stomachs are easily emptied because of the immaturity of the lower esophageal sphincter which is the ring of muscles that connects the esophagus to the stomach.
However, when the emptying of stomach contents is frequent or is accompanied by signs of discomfort in the child, it may be a more serious case of infant acid reflex. Acid reflux can cause damage to the lining of the esophagus, which can discourage normal feeding. Treating the reflux problem can help infants feed more successfully, so that they can develop normally.
In babies, GERD can be a serious problem that affects feeding and the ability to get sufficient nutrients for normal growth and development. In most babies, acid reflux occurs only occasionally, and they grow out of the condition by the age of 1 year. However, some infants continue to have problems with reflux that last well into childhood.
Symptoms & Complaints
- Forceful spitting up
- Yellow or green fluid in the contents that are expelled
- Blood in the contents or a substance that looks like coffee grounds
- Blood in stools
- Refusal to feed
- Difficulty breathing during feeding
- Failure to gain weight
These episodes of acid reflux may be frequent because infants spend a great deal of time lying down, in which gravity does not help to hold the contents inside the stomach. In addition, infants generally consume an all-liquid diet, which is more difficult for the stomach to contain. Some infants are born prematurely, which increases the likelihood of immaturity of their digestive tract.
In some cases, acid reflux in infants may be caused by allergies, a blockage in the digestive tract, or other medical issue that needs to be addressed before improvement can be seen. In these cases, a thorough diagnostic work-up may be needed to determine the origin of the problem. Treatment of the underlying condition will then help to alleviate the acid reflux problem. If the reflux problem does not resolve by 12 months of age, further investigation should be done to provide relief.
Diagnosis & Tests
The pediatrician will generally do a physical examination of the infant and ask questions about feeding habits. Physicians who require more information may order an ultrasound of the stomach to detect other problems, such as pyloric stenosis. Blood tests and urine testing can indicate other problems that may be causing the reflux issue.
If necessary, esophageal pH monitoring may be done to measure the acidity in the stomach. This test is done by inserting a very thin tube into the infant’s esophagus, via the nose or mouth. The tube is connected to a device that measures the acidity in the stomach. This test may be done in the hospital, and the infant is kept overnight until the process is completed.
The pediatrician may also order X-rays to determine if there are abnormalities in the digestive tract. The doctor may also use an endoscope, a flexible tube inserted into the upper part of the digestive system that is attached to a tiny camera, to visually see the tissue of the esophagus and stomach. A biopsy or sample of tissue may be taken at this time. This test is done under general anesthesia.
Treatment & Therapy
Pediatricians rely on a number of remedies to help infants with chronic acid reflux problems. Ranitidine and omeprazole help to block acid and reduce inflammation in the esophagus. Simethicone or calcium carbonateantacids can also be helpful for this condition. The goal of providing medications is to reduce the amount of discomfort in the infant to allow successful feeding and nourishment.
In very severe cases, in which the infant fails to thrive because of chronic acid reflux, surgery may be needed to tighten the stomach valve to prevent the excessive emptying of the contents. However, this surgery is very rare and is only performed in the most extreme cases when infants are experiencing breathing problems because of the condition or are failing to thrive because of it.
Prevention & Prophylaxis
- Formula or breast milk can be thickened with infant cereal to allow the stomach valve to hold it more securely.
- Raising the head of the infant’s bed
- Altering feeding schedules to provide smaller amounts more frequently
- Giving solid food earlier, if the pediatrician allows it.
- Holding the infant upright for 30 minutes after a feeding
- Extended burping during and after feedings
- Infants can be placed in an infant seat for a period of time after feedings instead of lying them down.