Introduction
Gastroesophageal reflux (GER) is a common condition that affects many babies, characterized by the backward flow of stomach contents into the oesophagus. While it can be worrying for parents, it's important to know that GER is typically harmless and resolves on its own as your baby grows. Reflux starts soon after birth (not later than 6 months) and resolves before 18 months.
What Causes GER in Babies
The primary cause of GER in infants is an immature lower oesophageal sphincter (LES), which allows stomach content to flow back up into the oesophagus.
Symptoms of GER
Most babies with GER will spit up or vomit after meals, but they're usually happy and healthy otherwise. However, if your baby shows signs of distress, such as irritability during or after feedings, coughing, or choking, it could be a sign of more serious gastroesophageal reflux disease (GERD).
Home Care Tips
Here are some practical tips for managing your baby's reflux at home:
- Breast milk causes less reflux than formulas.
- Elevate the head of the baby's crib or bassinet.
- Feeding smaller amounts more frequently.
- Hold your baby upright for 30 minutes after feeding.
- Experiment with different feeding positions.
- Sleeping in a supine position is still recommended.
- Avoid tobacco smoke.
- A trial of thickened feeds. (adding infant cereal)
- Anti-reflux formulas.
When to See a Doctor
It's time to consult a paediatrician if your baby:
- is not gaining weight.
- refuses to eat.
- has recurrent breathing problems and frequent coughing or choking.
- persistent forceful or projectile vomiting.
- vomit content is green. (urgent)
- crying a lot.
These could be signs of GERD or other conditions that require medical attention.
Changes in diet of the baby or mother should be discussed with and supervised by the doctor.
Diagnosis of GER
To diagnose GER, doctors will review your baby's symptoms and feeding patterns. In some cases, additional tests might be necessary.
Treatment GERD
Proton pump inhibitors (PPIs) are a class of medications that reduce the production of stomach acid. They're commonly used to treat gastroesophageal reflux disease (GERD) in babies who don't respond to other treatments.
How PPIs Work:
- PPIs block the enzyme in the stomach lining that produces acid, thereby decreasing gastric acidity.
Common PPIs for Babies:
- Medications like omeprazole (Prilosec), lansoprazole (Prevacid), and esomeprazole (Nexium) are often prescribed.
Potential Complications:
- Increased Infection Risk: Long-term use can increase the risk of certain infections, like pneumonia and gastrointestinal infections, due to reduced stomach acidity.
- Nutrient Absorption: There may be concerns about the absorption of nutrients like calcium, magnesium, and vitamin B12.
- Bone Health: Some studies suggest a potential link between long-term PPI use and an increased risk of fractures in older adults, but it's unclear how this relates to infants.
It's crucial to use PPIs under strict medical supervision, especially in babies, and they're typically prescribed only when the benefits outweigh the risks.
Conclusion
Remember, GER is usually not a cause for concern and tends to improve as your baby's digestive system matures. As long as your baby is happy, healthy, and gaining weight, there's usually no cause for concern. However, always trust your instincts as a parent and consult with a healthcare provider if you have any worries about your child's health.
Reference
Winter HS, Gastroesophageal reflux in infants, UpToDate, updated 2023 Dec, cited 2024 Jul
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