DEFINITION
Gastroesophageal reflux (GER) is a common condition seen in infants.
Vomiting is the most common symptom of GER. Babies may spit up as often as with
every feeding or as little as once a day. Spitting up may even occur hours after
a feeding. Usually, GER causes no serious problems and babies gain weight
despite frequent spitting. Most babies outgrow GER as they become more upright
and begin to sit and walk.
GER is the movement of stomach contents back into the esophagus or throat. The
lower esophageal sphincter, which is a muscle connecting the esophagus and the
stomach, is weakened and relaxes. This allows the stomach's contents to flow
back and up into the esophagus. An infant's particular symptoms will depend on
the amount of reflux occurring and may include:
Excessive vomiting
Extremely forceful vomiting
Chronic cough or congestion
Wheezing
Slow growth
Excessive crying, as if in pain.
DIAGNOSIS
Several tests are commonly used to diagnose GER. A barium swallow or "upper
GI" is a special x-ray that enables physicians to watch a chalky white substance
flow through the upper intestine. A pH Probe test uses a small wire with an acid
sensor placed through the infant's nose and down into the esophagus. Your doctor
may diagnose reflux based on symptoms alone. It will be up to your doctor to
decide if these tests are necessary. Most babies thrive and grow well despite
GER and never need these tests.
POSITIONING YOUR BABY
Positioning babies with GER is one of the key methods of treatment. While
feeding your baby, keep him or her in the upright position. This helps the food
pass down the esophagus to the stomach and stay down. After the baby has been
fed, place the child on his or her side at a 30-degree elevation. You may need
to place a pillow under the mattress. Never place a baby directly on a pillow.
Avoid positions that cause pressure on the stomach, such as those required by an
infant seat swing or car seat. Such positions force the stomach contents upward.
A reclining seat such as a "bouncer" works much better.
FEEDING YOUR INFANT
When infants are bottle-fed, make sure that they are not swallowing air. Air
fills the stomach and worsens GER. Remember to try frequent burping whether it
is feeding time or not, as infants also swallow air when they cry. Changing the
diet by switching formulas usually has no effect on GER. Occasionally, an
improvement is noted for two to three days and then vomiting and irritability
return. Babies who are breastfed should continue nursing and avoid adding
fformula as an attempt to improve GER. Your physician may suggest thickening
your baby's formula with cereal. The cereal makes the milk heavier and may keep
the baby from vomiting food. Some babies spit up less if they are given more
frequent feedings, with less milk at each feeding.
MEDICATIONS
Several medications are used to treat GER. Your doctor will recommend the
treatment that is best for your baby:
Mylicon® (simethicone) is an over-the-counter medication that
breaks down and lessens the gas in the stomach. Some parents see improvement in
their babies while others see little change after a dose.
Antacids, such as Mylanta® and Maalox® decrease or neutralize
the stomach acid. Again, these medications may or may not relieve GER symptoms.
Zantac® (ranitidine) or Pepcid® (famotidine) decrease acid
production, but require a prescription from your physician.
CONCLUSION
GER is a common condition in infants and small children. It can be
especially bothersome during the first year of life. Parents who understand this
condition, use proper positioning and administer medications when recommended by
their baby's physician will help babies with GER to be more comfortable while
they outgrow this problem.
