Reflux

Dr. Shruti Nathwani is a first time mum to 20 month old Jason who suffered with reflux as a newborn. She explains how to recognise signs and symptoms of reflux and when you should seek help from a healthcare professional.

Do all babies have reflux?

In order to answer this question, it is helpful to understand the mechanics of reflux. A baby’s digestive system is still maturing and therefore gastric contents containing acid can flow back

into the food pipe from the stomach. This is a common physiological event known as gastro- oesophageal reflux (GOR) and can occur in up to 40% of infants.

What are the symptoms of GOR (Gastro-oesophageal reflux)?

Reflux is often referred to as regurgitation or posseting. This is when a small amount of milk is brought back up into the mouth after a feed, without causing the baby discomfort. Your baby could also vomit some or all their feed with little force. GOR usually begins before the infant is 8 weeks old and can be quite frequent with 5% of those affected having 6 or more episodes a day. Usually no tests or treatments are needed and symptoms improve in 90% of cases over the first 12 months as your baby’s digestive tract matures and they starts to sit more upright.

When do I need to worry about reflux symptoms?

In a small proportion of infants with GOR, there may be associated signs of distress or discomfort and complications that need treating. This is known as gastro-oesophageal reflux disease (GORD).

Symptoms may include the following:

1. Regurgitation with discomfort
2. Feeding difficulties including refusing to feed, gagging or choking, irritability after feeds
3. Irritability including being upset after feeds (worse when lying flat)
4. Back arching
5. Poor weight gain leading to faltering growth
6. Chronic cough or hoarseness of the throat

You may also notice that your infant has hiccups, frequent ear infections or develops pneumonia.

Does my baby have SILENT reflux?

The appearance of milk in the mouth, regurgitation or posseting, may not occur as the infant has usually swallowed the milk back down. Most infants gain weight normally but still present with reflux symptoms. If your baby is not gaining weight, presents with reflux symptoms without obvious regurgitation/posseting contact a healthcare professional.

How can you ease your baby’s reflux symptoms?

1. Feed upright. Ask your health visitor to show you upright breastfeeding positions
2. If feed is large or switching from one breast to another, wind half way through
3. Wind after every feed
4. Hold your baby upright for 20-30 minutes post feed
5. Wear your baby in a sling to keep them upright during the day

How will a healthcare professional assess my baby’s reflux?

In formula fed babies with frequent regurgitation causing discomfort, a feeding assessment will be conducted. There may be changes to the overall volume of feed depending on weight gain, a trial of smaller or more frequent feeds (keeping the overall volume at the right level), or a trial of thickened formula if the former does not work (can cause constipation). A feeding assessment will also be conducted in breastfed infants and recommendations given.

When should medication be used to treat reflux?

If the above feeding modifications do not work, the first line of treatment is usually alginate therapy for a trial of 1-2 weeks, also known as Gaviscon. It has to be used continuously to have full effect. Side-effects include constipation. Medications such as Omeprazole/ Lansoprazole also known as proton-pump inhibitors are reserved for those with overt regurgitation and one or more of the following:

1. Unexplained feeding difficulties
2. Distressed behaviour
3. Faltering Growth

Assessment by a health care professional is always required before starting medication where the associated side-effects can be explained. *The FDA recalled all Ranitidine products due to uncovered levels of NDMA, a probable human carcinogen

Please be aware of ‘red flag’ symptoms suggesting a diagnosis other than GORD

• Projectile (forceful) vomiting
• Bile-stained (green/yellow-green) vomit
• Blood in vomit
• Onset of regurgitation/vomiting after 6 months old or persisting after 1 year
• Blood in stool
• Abdominal distension (visibly large abdomen)
• Chronic diarrhoea

If any of the above symptoms present, please seek urgent medical attention by a healthcare professional.

Disclaimer: Please note this article is made available for educational purposes only and is not a substitute for competent medical advice. If your child is unwell, you must consult a medical professional in person.

Reference:

Gastro-oesophageal reflux disease in children and young people: diagnosis and management NICE guideline Published: 14 January 2015 www.nice.org.uk/guidance/ng1

Dr. Shruti Nathwani is the founder of @thechildrensmedic, an educational Instagram account focused on evidence based medical guidance surrounding newborn, infant and

child health. She uses her own experiences as a mother and Paediatric Trainee to support parents through their parenting journey sharing practical tips and knowledge along the way.