- Category: Gastroenterology
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Infant reflux occurs when food backs up (refluxes) from a baby's stomach, causing the baby to spit up. Sometimes called gastroesophageal reflux (GER), the condition is rarely serious and becomes less common as a baby gets older. It's unusual for infant reflux to continue after age 18 months.
Reflux occurs in healthy infants multiple times a day. As long as your baby is healthy, content and growing well, the reflux is not a cause for concern.
Rarely, infant reflux can be a sign of a medical problem, such as an allergy, a blockage in the digestive system or gastroesophageal reflux disease (GERD).
Symptoms of the Infant reflux
Infant reflux generally isn't a cause for concern. It's very unusual for the stomach contents to have enough acid to irritate the throat or esophagus and to cause signs and symptoms.
When to see a doctor
See your baby's doctor if your baby:
- Isn't gaining weight
- Consistently spits up forcefully, causing stomach contents to shoot out of his or her mouth (projectile vomiting)
- Spits up green or yellow fluid
- Spits up blood or a material that looks like coffee grounds
- Refuses food
- Has blood in his or her stool
- Has difficulty breathing or a chronic cough
- Begins spitting up at age 6 months or older
- Is unusually irritable after eating
Some of these signs can indicate possibly serious but treatable conditions, such as GERD or a blockage in the digestive tract.
Causes of the Infant reflux
In infants, the ring of muscle between the esophagus and the stomach — the lower esophageal sphincter (LES) — is not yet fully mature. That allows stomach contents to flow backward. Eventually, the LES will open only when your baby swallows and will remain tightly closed at other times, keeping stomach contents where they belong.
The factors that contribute to infant reflux are common in babies and often can't be avoided. These factors include:
- Babies lying flat most of the time
- An almost completely liquid diet
- Babies being born prematurely
Occasionally, infant reflux can be caused by more-serious conditions, such as:
- GERD. The reflux has enough acid to irritate and damage the lining of the esophagus.
- Pyloric stenosis. A valve between the stomach and the small intestine is narrowed, preventing stomach contents from emptying into the small intestine.
- Food intolerance. A protein in cow's milk is the most common trigger.
- Eosinophilic esophagitis. A certain type of white blood cell (eosinophil) builds up and injures the lining of the esophagus.
Complications of the Infant reflux
Infant reflux usually clears up by itself without causing problems for your baby.
If your baby has a more-serious condition such as GERD, he or she might show signs of poor growth. Some research indicates that babies who have frequent episodes of spitting up may be more likely to develop GERD during later childhood.
Diagnosis of the Infant reflux
Your doctor will start with a physical exam and questions about your baby's symptoms. If your baby is healthy, growing as expected and seems content, then further testing usually isn't needed.
If further testing is needed, your doctor might recommend:
- Ultrasound. This imaging test can detect pyloric stenosis.
- Lab tests. Blood and urine tests can help identify or rule out possible causes of recurring vomiting and poor weight gain.
- Esophageal pH monitoring. To measure the acidity in your baby's esophagus, the doctor will insert a thin tube through the baby's nose or mouth and into the esophagus. The tube is attached to a device that monitors acidity. Your baby might need to stay in the hospital while being monitored.
- X-rays. These images can detect abnormalities in the digestive tract, such as an obstruction. Your baby may be given a contrast liquid (barium) from a bottle before the test.
- Upper endoscopy. A special tube equipped with a camera lens and light (endoscope) is passed through your baby's mouth and into the esophagus, stomach and first part of the small intestine. Tissue samples may be taken for analysis. For infants and children, endoscopy is usually done under general anesthesia.
Treatment of the Infant reflux
Infant reflux usually clears up by itself. In the meantime, your doctor might recommend:
- Giving your baby smaller, more-frequent feedings.
- Interrupting feedings to burp your baby.
- Holding your baby upright for 20 to 30 minutes after feedings.
- Eliminating dairy products, beef or eggs from your diet if you're breast-feeding, to test if your baby has an allergy.
- Switching the type of formula you feed your baby.
- Using a different size of nipple on baby bottles. A nipple that is too large or too small can cause your baby to swallow air.
- Thickening formula or expressed breast milk slightly and in gradual increments with rice cereal. Although recognized as a reasonable strategy, thickening adds potentially unnecessary calories to your baby's diet.
Reflux medications aren't recommended for children with uncomplicated reflux. These medications can prevent absorption of calcium and iron, and increase the risk of certain intestinal and respiratory infections.
However, a short-term trial of an acid-blocking medication — such as ranitidine for infants age 1 month to 1 year or omeprazole (Prilosec) for children age 1 year or older — might be recommended if your baby:
- Has poor weight gain and more-conservative treatments haven't worked
- Refuses to feed
- Has evidence of an inflamed esophagus
- Has chronic asthma and reflux
Rarely, the lower esophageal sphincter is surgically tightened to prevent acid from flowing back into the esophagus. This procedure (fundoplication) is usually done only when reflux is severe enough to prevent growth or to interfere with your baby's breathing.