The Causes of Reflux Disease in Infants
Spit up and babies go hand in hand. We are no strangers to the white icky stuff splashed on our arms and dribbling down our backs, but when it causes other problems, or is associated with other symptoms, it may be due to a disease called gastroesophageal reflux or GERD.
This may seem a little hasty. All, or at least most, babies have some sort of reflux right? You’re right. They do. Most babies will spit up from time to time, sometimes due to gas, sometimes having eaten too much or eaten too much at one time, and sometimes just because their babies and that’s what they do.
This article isn’t focused on the everyday spitting up, the white drool, or even burping. This article focuses in on those babies that have passed the normal okay point in spitting up and have moved into the danger zone of not eating, not sleeping, projectile vomiting, crying non-stop, and having trouble breathing. If this sounds like you’re little one, or this is something that has been worrying you, this article is exactly what you need.
What is GERD?
Reflux is simply the upward movement of stomach contents into the esophagus and sometimes into or out of the mouth. You probably recognize this feeling yourself from occasional bouts after eating too much, eating spicy foods, or even having gas.
But in GERD, the reflux contains stomach acid which damages the lining of the esophagus and is very painful. Although this is possible in older children, rarely does it go this far in adults.
Normally during swallowing, food travels down the long, muscular tube inside your body called the esophagus. The muscles in the wall of your esophagus contract from top to bottom pushing the food down into your stomach the way they are supposed to.
Once swallowing is over and all the food has entered your stomach, a circular band of muscle called the lower esophageal sphincter (LES), where the esophagus joins the stomach, contracts and acts like a door that closes to the rest of your body.
This is when your body begins digesting your food and you may begin to feel sleepy. During this process, your LES is supposed to keep your stomach contents and stomach acids from regurgitating, or refluxing, back up into your esophagus. (Ask Dr. Sears)
However, with GERD, instead of closing like it’s meant to do, the LES remains open allowing stomach acid to come back up the GI tract to damage the stomach lining, the back of the infant’s throat, and even the infant’s new developing teeth.
This stomach acid is literally eating away at tender skin, and tooth enamel doing a great deal of destruction. If left untreated, it could cause much more serious damage than just this in your baby’s body.
Have you experienced GERD or reflux with an infant? What did you try that helped?
What Does GERD Look Like?
Spitting up and vomiting are the main symptoms that you can actually see with infant reflux. As long as your baby is healthy, content and growing well, the reflux is normal and natural and not a cause for concern. Your child will likely just outgrow it. While your little one may act fussy or seem to be uncomfortable, it is very unusual for the stomach contents to be acidic enough to do any damage to the esophagus or throat, as happens with more serious forms of acid reflux. (Mayo Clinic)
The most common symptoms of reflux in kids are:
- Frequent or recurrent vomiting
- Frequent or persistent cough
- Refusing to eat or difficulty eating (choking or gagging with feeding)
- Crying with feeding
- Heartburn, gas, or abdominal pain (Medicine Net)
If this is a problem your infant struggles with, there are many easy treatments that will quickly relieve your infant’s discomfort in the future, including simple over the counter gas medicine for infants. Not so is the case for more serious forms, such as GERD.
What is the Difference Between Infant Reflux and GERD?
It's perfectly normal for babies to spit up after feedings or even to vomit once in a while without apparent cause or warning. In fact, some babies spit up quite frequently and show no ill effects. This is called reflux, or simply GER, and most babies outgrow it by age 1. (BabyCenter)
With infant reflux, just like adult acid reflux, there may be a little pain, but with a few simple solutions, you can easily treat your infant’s reflux and sometimes get rid of it altogether.
On the other hand, GERD is a more serious, chronic, long lasting form of infant reflux, that includes frequent vomiting associated with discomfort, difficulty feeding, and/or weight loss on the part of the infant. Unfortunately with GERD, the stomach acid coming back up the infant’s throat is essentially burning the sensitive lining of the esophagus causing serious pain and sometimes even damage to the infant’s body. There are no simple solutions.
In fact, diagnosing and treating GERD is a long, drawn out process that may include x-rays, probes, endoscopies, and at the very worst (and thank goodness this is extremely rare), surgery.
Danger Signs to Look For With GERD
- refusal to eat
- colic signs
- arching his/her back during or after feeding
- vomit of a strange color
- projectile vomiting
- gagging or choking
- trouble breathing
How Do I Know If My Baby Has GERD?
Your child will exhibit many symptoms that can alert you to the serious nature of their reflux, that go beyond the typical spitting up and gas of the common infant reflux.
Obviously if your infant is vomiting, irritable during or after feedings, arching his or her back during or after feedings, or even crying more than normal, he or she is definitely having problems with reflux and/or gas. This is a good first sign to start helping them with their reflux, which may include contacting your doctor for advice, and to keep an eye on them for further more serious problems. You also need to discuss this problem with any of your infant’s other caregivers so they can keep an eye out as well.
There is cause for concern though, when these initial symptoms turn into a refusal to eat or poor feeding, weight loss or poor growth, coughing, and colic. If you see any of these symptoms, your baby is trying to tell you that he needs to see a doctor right away to stop this before it gets too far along.
If you or one of your caregivers notice that your little one is projectile vomiting, that the vomit is green or yellow, looks like coffee grounds, or contains blood, or has difficulty breathing after vomiting or spitting up, these are really bad signs that he needs to be taken to the ER immediately. Some infants even show signs of dehydration, such as dry diapers or no tears when crying, they gag or have trouble swallowing, wheeze when breathing, or even have trouble drawing air in at all. All of these signs should signal Emergency Room and right away. (NDDIC)
The Dangers of GERD in Infants?
If the acid reflux is severe, the baby may spit-up a little, or a lot. Sometimes the refluxed gastric contents can enter the back of the throat, causing a sore throat, choking, gagging, coughing, erosion of dental enamel, and even be aspirated into the lungs, causing respiratory infections, wheezing, and asthma-like symptoms. GERD can also lead to other breathing problems in infants, as well as full-blown asthma and other chest infections.
If left untreated, or not addressed right away, this reflux can lead to disjointed and poor sleep, sleep apnea, breathing problems and other conditions. Infant reflux by itself is recognized as contributing to sleep apnea, which is when a baby stops breathing momentarily, disrupting baby's sleep, and normally waking them up many times during the night. For infants, this can cause Sudden Infant Death Syndrome (SIDS). (See my article on The Truth About SIDS for more information about this.)
The danger of SIDS is the highest, particularly during the first six months of a baby's life, which just happens to be the most common time frame for infant reflux and GERD as well. This makes it imperative that parents of babies who suffer from acid reflux take precautions against acid reflux as soon as the condition is recognized, because the dangers could go from a little pain and gas to being as serious as immediate and sudden death. (Ask Dr. Sears)
Did I Do Something to Cause It?
Most likely, an infant's immature digestive system is to blame. In infants, the ring of muscle between the esophagus and the stomach (LES) is not yet fully mature, allowing their stomach contents to flow backwards back up their GI tracts and into their throats.
Eventually as the baby grows and completely develops, the LES will open only when baby swallows and will remain tightly closed the rest of the time, keeping stomach contents where they belong. The risk for reflux is typically only through 6 months of age, but can range all the way up through 1 year depending on the baby.
Not only their immature and developing bodies, but many typical infant characteristics lend to the development to reflux. First of all, infants are lying flat on their backs most of the time, which makes reflux more likely. Moreover, their diet is completely liquid, also favoring infant reflux. And neither of these can be helped in the first delicate few months of their lives.
Sometimes air bubbles in their little stomachs may push liquids backwards for no good reason. In other cases, your baby may simply drink too much, too fast at one time causing it to come back up out of their little systems. Although infant reflux most often occurs after a feeding, it can happen anytime your baby coughs, cries or strains. (Mayo Clinic)
Remember that GERD can adversely affect your infant’s overall health and temperament. Infants with severe symptoms or with infant reflux that lasts beyond 12 to 14 months may actually have GERD and should see a pediatrician who specializes in treating children with this disease. Your doctor will likely be able to refer you to exactly the right person, if he or she cannot help you him/herself.
Let’s look at how to treat your infant’s reflux if you believe that you see some of the common symptoms listed above. Nothing that will relieve reflux can harm your baby if he or she does not in fact suffer from this.
What Can I Do to Help My Baby Get Better?
One of the most important things to remember is that most infants grow out of GERD by the time they are 6 months old. If it does last longer, it won’t last past 1 year old. Hang on, it’s almost over. In the meantime, there are many simple tricks of the trade that you can use if you believe that your little one is suffering from reflux.
Hold your infant upright during feedings and sit up in a rocker or bouncer for at least 30 minutes after a feeding. This will allow the food to naturally make its way down into your child’s stomach and gravity will do most of the work for you.
Try feeding your little one smaller amounts of food more often throughout the day. Smaller feedings every two to three hours, while your infant is awake, will reduce the occurrence of possibly feeding him too much at one time and will help him to digest his food completely before taking more in. Overfeeding can increase abdominal pressure, which increases the likelihood for gas, which can lead to reflux, or the food coming back up.
Burping your infant several times during each feeding will also help keep gas low, and will help your baby to eat slower, take breaks while eating, and completely digest food before continuing. It can also minimize gastric pressure and the reflux it can cause. Waiting to burp your infant until after she has a full stomach can increase the chances of regurgitation.
If all of the above solutions are not working for you, you can try to thicken bottle feedings with cereal (do not do this without your doctor's approval). Start with one teaspoon of rice cereal to each ounce of formula. If you are breastfeeding your baby, try pumping and then adding rice cereal to the breast milk. This may reduce the amount your infant will regurgitate when used along with all of the tips above. (About.com)
You can even try keeping the top half of your infant’s body always at an incline while resting or playing throughout the day to make sure that gas is released as needed and everything is staying down like it’s supposed to.
Finally, there are many over the counter medications available for infants to lessen gas and/or decrease stomach acid in the baby’s tummy. A couple of these include Simethicone such as Mylicon, and Gaviscon. Researchers aren't sure whether decreasing stomach acid lessens reflux in infants. For the most part, drugs that decrease intestinal gas or neutralize stomach acid (antacids) are very safe for infants. However, make sure that you are consulting your doctor about using any medication, and that you are strictly following the directions on the box. Everything in moderation. (WebMD)
You should consult your baby's doctor before making any major changes in your infant's feedings, positions, etc. Your doctor will be able to tell you if your infant’s reflux is just normal spitting up, or if it’s a chronic problem that needs medical treatment. He can also give you advice on the best treatment for your baby.
Is There Anything I Can Do to Prevent It?
Many moms and dads are being proactive and trying to use these feeding tips, and even some sleeping tips, to prevent their little ones from ever having to experience reflux in the first place. Prevention is definitely a good decision!
I think everyone knows the acid reflux tip for adults to avoid foods that can create gas or indigestion. Mothers who breastfeed can use those same diet modifications for themselves to help prevent reflux in their little ones. By avoiding certain foods, such as caffeine, chocolate, garlic, and spicy foods, that can promote acid reflux, you may be saving yourself and your little one from the pain and stress infant reflux can cause.
Along with avoiding these kinds of foods yourself, don't give your infant these same items that could give them gas or indigestion. That sounds like common sense, but many parents give their infants caffeinated beverages, orange juice and other citrus juices that wreck their systems. There’s nothing wrong with your young children having these items, but save them until they are at least a year to a year and a half old before offering them these treats.
The way your infant is positioned when sitting can even cause regurgitation to increase. If the infant slouches or slumps over in his car seat, it causes abdominal compression, making digestion difficult, and increasing the risk of acid reflux. Use some simple supports on the market for infants to keep him or her upright in the high chair/car seat/stroller, and you will likely prevent this.
Just as you do for him or her while feeding, playing and sitting, elevate the head of the baby's crib or bassinet so that he is laying upright in his crib while sleeping. You won’t want to take the legs of the crib or bassinet off the floor, as this negates the safety of the item being used. Simply elevate the mattress within the crib or bassinet with a baby blanket or towel.
Be careful not to elevate the crib mattress too much. You just want the side where your baby’s head will lay a tad bit higher than the other to promote better breathing, and let gravity do its work on your baby’s digestive system.
One other thing you can do to help prevent reflux in your tiny one is to avoid tight elastic around your baby's waist. You want to make it as easy as possible for your baby to breathe, eat, and digest his or her food. BY making sure your infant’s clothes fit correctly and are not too tight, you can make a big difference in the way your baby’s body works. And make sure to keep diapers fit but loose as well. There’s no need for it to be too tight.
Just as with many baby illnesses, the biggest danger is simply with lack of parent awareness and education. The more you know about your little one and what you need to be looking out for, the better you can treat, and even prevent, many of the illness that may befall him or her.
With a few simple tricks of the trade, regular doctor’s appointments, and just keeping an eye out for any unusual symptoms, you can keep your baby healthy and ensure a long and healthy life for her.
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© 2013 Victoria Van Ness