Reflux is a term that is used a lot in relation to new born babies. It is often confused with colic and other digestive issues. This is primarily because it is hard to recognise and diagnose especially since the patients we are talking about have no real way to express how they are feeling.
Reflux is a term which describes the non forceful or passive regurgitation of milk. It is different to vomiting as vomiting involves the forceful contraction of muscles which cause the stomach contents to come up. Reflux just describes a baby passively posseting or spitting up whatever they have swallowed during a feed or shortly after.
It is something which is very worrying and upsetting for parents to witness but is actually often completely normal and just due to the babies oesophagus being under developed. With time the seal at the oesophagus tightens and it holds the food down more efficiently to prevent reflux from happening. It occurs in at least 40% of infants and usually starts before the baby is eight weeks old. 90% of infants will have grown out of the problem by their first birthday. Gastro-oesophageal reflux (GOR) does usually not need treatment or further investigation.
There is a more serious and long term form of gastro oesophageal reflux which is defined as reflux which is persistent and frequent and which causes symptoms such as discomfort or pain and is severe enough to merit medical treatment. This is known as gastro oesophageal reflux disease (GORD). When GORD is present the stomach contents consistently raise up into the oesophagus and irritate its lining. This can cause several symptoms such as:
- Feeding difficulties
- Distressed behaviour
- Faltering growth
- A persistent cough
If your baby is suffering from reflux and any of these other symptoms you should visit your GP to discuss their condition. It is worthwhile having a record of feeding history and a rough note of how often the reflux occurs.
You should attend the doctor if any of the following occur with or without the presence of reflux:
- Frequent forceful vomiting
- A green or yellow colour to the vomit
- Blood present in the vomit
- Vomiting is significantly worse in the morning on a regular basis
- Baby has a temperature over 39 degrees
- Baby seems unwell, distressed, or lethargic.
- Blood in their stools
- If reflux occurs for the first time after six months of age or if it persists past one year of age.
- Abdominal pain, discomfort or any unusual lumps in their tummy.
- Presence of eczema along with reflux.
- Persistant cough
- Difficulty swallowing, or gagging on feeds
- No weight gain or any weight loss.
Some things you can do at home to help a baby with GOR or GORD:
- Burp your baby regularly
- Avoid overfeeding – so little and often is a good idea
- Ensure the hole in the teat of the bottle is the right size as too big a teat can cause milk to flow too quickly which can cause regurgitation.
- Keep the baby upright after a feed for up to thirty minutes – this is where a baby carrier or sling is invaluable, alternatively a bouncer or swing that is at an incline can be useful if you have other children to care for or a lot to do!
- Raise the crib end at their head side so that they are sleeping at an incline – you can do this by propping it up with books under the two legs or by inserting a wedge or pillow under the mattress (never in the crib itself).
- Its also worth noting that babies with reflux may be hungry more often as they cant take a full feed at any time so little and often is a good approach – you are still giving the days recommended milk intake – just dividing it up into smaller feeds!
- If breastfeeding you may want to express for a minute before offering a feed as often the forceful let down milk can cause regurgitation.
Another interesting thing is that occasionally reflux can be caused by a cows milk protein allergy and other symptoms of that are eczema and congestion – just something to be aware of – if you notice all of these symptoms together its worth bringing it up with your GP.
Reflux which is persistent and causes significant discomfort is something that should always be brought to the attention of your GP so whilst I will now talk about possible treatments it is important to note that I strongly recommend you approach these options with the guidance and approval of your doctor.
Mild gasto-oesophageal reflux (GOR) or gastro-oesophageal reflux disease (GORD) may not require any treatment. You may be able to overcome it using the tips above. If not it may be necessary to try a specific anti-reflux formula such as SMA stay down or Aptamil anti-reflux. Thickening agents such as carobel are not really recommended anymore as there is not a lot of evidence to support their use, however for breast feeding mums this may be a good option as it can be used with expressed milk to act as a thickening agent which will help the milk stay down in the baby’s stomach and not come up as reflux.
SMA staydown is suitable from birth to 18 months. Its is nutritionally complete and can be used in combination with food once weaning has begun. It is easily digestible as it contains natural corn starch which helps the feed to settle more easily in the baby’s tummy. It is good because it is a normal consistency in the bottle as it does not thicken until it reaches the baby’s tummy and so a normal teat can be used. It is worth noting it must be made up with water which was been boiled and then chilled.
Aptamil Anti reflux is a thicker formula once made up, it is made with carob bean gum and so needs to be given with a teat with a single hole fast flow. It is suitable up to 12 months.
If these formulas do not work for your baby your GP may suggest using alginate therapy for a week or two to see if it will help. An example of this would be Gaviscon infant sachets. These have antacid effect and also form a raft on the top of your baby’s stomach contents to prevent them seeping up into the oesophagus and causing irritation.
If this does not work the GP may prescribe your baby some medication which will suppress the secretion of acid from your baby’s tummy. Names of commonly prescribed medications are Losec and Zantac. These may not be suitable for your baby or their symptoms and that is up to the expertise of your GP.
I hope this guide has made reflux a little clearer for you. As always if you have any questions at all please don’t hesitate to contact me at Milltown totalhealth Pharmacy on 012600262, or by sending me a message on the WonderBaba facebook page! Thanks for reading!