Gastric Reflux Information

What is gastric reflux?

There is a ring of muscle at the top of the stomach. This is a valve, which should close when feeding has finished. When a baby has gastric reflux this valve doesn’t close properly. The contents of the baby’s stomach (food and digestive acids) are brought up/regurgitated. These contents come up the oesophagus and may be vomited or spill out through the baby’s mouth. The acid can burn and may cause the baby great discomfort and/or pain. Adults often refer to gastric reflux symptoms as indigestion. As the child matures so does the valve/ring of muscle at the top of the stomach. Generally speaking, the more upright the baby is the more the reflux decreases. By the time the baby is walking reflux will often have disappeared. In some cases it will improve over a longer period of time.

Gastric reflux in infants is common, and most infants have some degree of reflux at birth. Babies often spill a little after feeding and this is quite normal. Most babies feel full and contented but a baby with Gastric Reflux Disease (gastric reflux that causes problems) is often uncomfortable and unhappy. Gastric reflux doesn't need treating with medications or surgery unless the baby is failing to gain weight adequately or is in pain due to acid being refluxed (or have another complication of reflux). Surgery is generally only considered if Gastric Reflux Disease is not able to be controlled with medication. Reflux is variable and unpredictable. Some days may be much better than others are.

Some babies vomit up part of every feed. Sometimes this continues for several hours, and may cause the baby discomfort/pain. This is known as Visible Reflux.

Some babies rarely vomit at all, but their feed will come part way up their oesophagus and then go back down again. This may cause pain and is known as Silent Reflux.

What are the symptoms of Gastric Reflux?

You need to take your baby to a doctor for a proper diagnosis if you think they may have gastric reflux.

Symptoms may include

• Chronic COUGHING.

• SORE EARS or ear infections (Most of these are viral, but in those children that have other symptoms of reflux and frequently require antibiotics for these infections, they might be due to reflux also.).

• May be DISTRESSED during or after FEEDING. ARCH their BACK in an attempt to relieve their pain or REFUSE to FEED. Others may COMFORT FEED (gorge constantly) and be unhappy unless feeding, and therefore have HUGE WEIGHT GAINS. Most gain weight well, but a few will FAIL to THRIVE (have a slow weight gain.)

• GAGGING.

• CAN BE HAPPY when DISTRACTED (making the parent feel like a fraud when their constantly upset baby smiles and babbles throughout the consultation with the doctor!)

• Frequent Hiccups.

• IRRITABILITY – may include SCREAMING, WHINGING, CRYING, FUSSINESS and will be inconsolable at times due to PAIN. Irritability is more common during or after feeding, or when laid down. Crying may start quite suddenly especially after hiccups and burps, or may be constant/almost constant. Parents and Health Professionals may suspect colic but the irritability does not follow a regular pattern such as colic does. A baby with reflux may have colic also, which confuses matters. If you consider your baby’s crying to be excessive seek medical help.

• OVER-SENSITIVITY to NOISE due to tiredness.

• Restlessness.

• Some may hold their head to one side in an unusual position to ease their discomfort – SANDIFER SYNDROME is the term used to describe this.

• May SLEEP LITTLE and be disturbed easily when sleeping.

• May WAKE FREQUENTLY at night but it is not uncommon for babies with reflux to sleep through the night due to exhaustion.

• SPILLING or VOMITING (may be projectile, and may vomit through their nose). These may lessen as they sit up and increase when they crawl. May occur at any time including right up until the next feed.

• DIFFICULTY SWALLOWING

• Frequent UPPER RESPIRATORY INFECTIONS (coughs or runny noses) and/or frequent SORE THROATS. (All children have their fair share of these and most are viral, but in those children that have other symptoms of reflux and frequently require antibiotics for these infections, they might be due to reflux also.)

• CHANGE in VOICE.

• Chronic WHEEZING.

Medical advice and help – more serious symptoms

If your baby has any of the symptoms on the list above in bold type please seek medical advice. Urgent medical help should be sought if any of the following occur in relation to gastric reflux:

1. Has difficulty BREATHING, is breathing faster than normal, stops breathing (apnoea), is grey or blue tinged in colour, is making grunting sounds when breathing, has decreased muscle tone (floppy) or decreased responsiveness.

2. Refuses to DRINK or drinks less than half of their normal fluid intake over a 24 hour day, has less than four wet nappies in 24 hours, or goes six hours without a wet nappy.

3. Has a HIGH TEMPERATURE (above 38.3°c, or if baby is under three months of age).

4. VOMITING is frequent and the baby fails to have four wet nappies in 24 hours or goes six hours without a wet nappy, becomes lethargic, difficult to rouse from sleep or if skin is mottled in colour. Vomit contains blood or coffee ground like material).

Always seek medical help if you are concerned about your child or yourself.

Other clues that reflux might be the problem

• Many babies, especially very sleepy ones DO NOT SHOW any pain/discomfort until UP TO THREE MONTHS of age.

• Reflux may be HEREDITARY (mother, father or siblings may have had/do have reflux).

• About one third of infants with reflux will also have a MILK ALLERGY/intolerance.

• Reflux is more common in PREMATURE babies.

• The SEVERITY of SYMPTOMS may vary at different ages.

• Symptoms may appear to WORSEN when the baby has a cold, virus, teething, infection, or allergies.

PARENTS MAY HAVE A GUT FEELING THAT THEIR CHILD IS IN PAIN, SO IF YOU ARE CONCERNED SEEK MEDICAL HELP.

References

• V.I.S.A’s "When to especially seek medical advice".

• Treasures® Baby Book

• Well Child, Tamariki Ora, Health Book

Acknowledgments

Rochelle Wilson (President of GRASP).

Crying Over Spilt Milk Gastric Reflux Support Network New Zealand for Parents of Infants and Children Charitable Trust 2004 - 2007. The Sleep Store has used this article with permission from GRSNNZ August 2007.

Page may be printed or reproduced for personal use of families, as long as copyright and this notice are included. It may not be copied to other websites or publications without permission and acknowledgment.

Disclaimer: Regardless of the legitimacy and accuracy of the information we provide, please note that we are not doctors and although we can advise what other treatment is possibly available we can not recommend one medication over another, or definitively diagnose (or exclude) reflux or any other disease. We are not a substitute for consultation with a health professional.
GRSNNZ shall not be responsible or in any way liable for the continued accuracy of any information given, or for any errors, omissions or inaccuracies in this site whether arising from negligence or otherwise, or for any consequences arising there from. Views expressed on the boards do not necessarily represent the views of the managers, coordinators or committee.

Recommended Articles