The number of babies diagnosed with acid reflux appears to be on the rise, with around 25% of all infants experiencing it to some degree.
What is reflux?
When we eat and swallow, the oesophagus (food pipe) automatically contracts to push food down into the stomach. At the same time, a valve, known as the lower oesophageal sphincter (LES), relaxes to allow the food to pass through. Normally, the LES closes to prevent food and stomach acids from flowing back up into the oesophagus. With reflux, also called gastroesophageal reflux (GOR), the ring doesn’t close properly, or remains open, causing a back flow of acids from the stomach into the oesophagus. This results in heartburn and discomfort.
In babies, reflux is fairly common as the LES valve is still weak and may not close properly, says Johannesburg-based paediatrician Dr Dewald Buitendag. This is why babies typically spit up or burp after eating. In some instances, this isn’t painful. In other cases, the ingested milk mixes with stomach acids and irritates the inner lining of the oesophagus when it travels back up, resulting in pain and inflammation.
Signs and symptoms
At her baby clinic, author and childcare expert Ann Richardson has seen and treated many babies with reflux. “I often sit across from tired moms who start by telling me that their babies are only content, and will only sleep for long periods, if they’re upright on the shoulder, in a chair, or carried in a pouch,” she says. “They’ll also mention that their little ones spit up often, or seem to be very uncomfortable and niggly during, or straight after, feeds.”
Your baby may also have reflux if she:
- Cries a lot at night
- Has slow weight gain
- Swallows and gags more than normal
- Sleeps better when she lies on her tummy
- Catnaps during the day and won’t settle easily
- Has recurring hiccups and ‘wet’ sounding burps
- Suffers from congestion or appears to have a cold
- Has bad or sour-smelling breath
- Possetts frequently and/or has frequent projectile vomiting.
Myth vs fact
Dr Buitendag dispels two common myths about reflux:
Myth: Only breastfed babies get reflux.
Fact: Both breastfed and formula-fed babies can get reflux. Reflux has nothing to do with the type of milk you feed your baby. It happens because the valve between the stomach and the oesophagus doesn’t close effectively.
Myth: My baby’s reflux will disappear within three months.
Fact: There’s no specific age when your baby’s reflux will disappear. As a baby with reflux gets older, the valve between the stomach and oesophagus gets stronger and the reflux slowly gets better. In most cases, reflux will disappear within a year.
The case of silent reflux
“It’s a myth that all babies with reflux have loads of symptoms and vomit often. Some babies with reflux only vomit or spit up occasionally, while others don’t vomit at all,” explains Dr Buitendag.
Silent reflux occurs when stomach contents are brought back up into the oesophagus without spilling out of the mouth. This can be more painful than regular reflux as acid secreted by the stomach sits in the oesophagus and throat and could cause
Experts at the Reflux Infants Support Association (RISA) point out that this type of reflux may be harder to recognise, so if your child is displaying other reflux symptoms, such as crying during or after feeds, then it’s worth having it checked out.
Also, not all babies with reflux refuse feeds and lose weight. There is evidence that some babies with silent reflux feed to soothe their pain and tend to comfort feed more often. This can contribute to massive weight gain, so poor growth isn’t always an issue.
Reflux can be difficult to manage and diagnose. Studies show that a baby with reflux or silent reflux may not present all of these symptoms at once, and the number of symptoms doesn’t necessarily indicate the severity of the reflux. Also, symptoms can change over time. For example, it may look like your baby’s reflux is improving because she’s no longer vomiting, but she could still be in pain and reflux may still be a factor. If you’re unsure about your baby’s symptoms, watch her closely for a week or two and write down any signs or symptoms you see, specifically around feeding and sleep times, and take your notes with you to the paediatrician.
How to treat your baby’s reflux
Although reflux can be hard to manage, take comfort in knowing that it will improve with time. Ann Richardson suggests the following to help you cope:
- Keep your baby upright after a feed and handle her gently (avoid vigorous winding).
- Don’t worry if you have to hold your baby in the upright position to sleep – you can’t spoil her at this young age. Assist her in any way to achieve sleep – even if it means holding her.
- Try to put her into her bed when she’s comfortable, but don’t be in too much of a rush.
Research suggests that increased acidity in the stomach, which could aggravate reflux, may be due to a pH imbalance. This imbalance is caused by decreased levels of good bacteria in the stomach, which are essential for healthy gut function and to prevent digestive disturbances such as lactose sensitivity and candida, which could make reflux worse. If your baby was born by C-section, or has been exposed to antibiotics (even through your breastmilk), there’s a chance that some of these good bacteria have been destroyed. Ask your pharmacist for a suitable probiotic medication for babies. It should contain bifidobacterium to restore healthy gut function.
If your little one vomits often, she may need her milk to be thickened. This is easy to do if she’s being formula fed. There are special anti-reflux formulas available. Ask your clinic sister to recommend one for you to try, or to advise you on alternate methods of thickening your baby’s milk to prevent regurgitation.
Dr Buitendag adds that it’s also important to give your baby smaller feeds more often, to burp her more frequently during and after feeds, and to avoid clothing or nappies that are tight around her tummy.
If you try all of this and your little one is still uncomfortable, see a paediatrician who will take a proper history and examine your baby. He may decide to do special investigations such as a barium swallow (a test using X-rays and contrast medium to check the oesophagus). He may also decide to try certain medications, such as omeprazole, esomeprazole or ranitidine. These drugs neutralise the acid secreted in the stomach, which will alleviate pain and irritation in the oesophagus, throat and upper airways.