Understanding Reflux in Infants
Infant reflux is a common problem, especially in babies who were born premature. In reflux, the muscle at the top of the stomach (called the lower esophageal sphincter, or LES) allows stomach contents to come up out of the stomach and into the esophagus. For most babies, reflux is mild. Babies may spit up frequently, but they are otherwise happy and healthy. This is normal and doesn't need treatment.
In other babies, reflux can be severe. Reflux that is severe enough to need treatment is called gastroesophageal reflux disease, or GERD. GERD in infants needs treatment if the baby:
- Has poor growth
- Is in severe pain
- Refuses to eat due to pain
- Has breathing problems due to inhaling refluxed milk
Read More: FAQs About Reflux in Babies
Working With Your Pediatrician
Treating GERD in infants can be frustrating. Many families try a number of remedies before finding one that works for them, only to have that remedy stop working after a couple of months.
If your baby has GERD, then developing a close relationship with a pediatrician you trust is very important. Working closely with a pediatrician who knows your child, his symptoms, and what has and has not worked before will help you to work together as a team to find the best treatments for your baby's reflux.
Home Remedies for Reflux in Infants
Whether your baby's reflux is mild or severe, there are some home remedies that may help reduce your his or her symptoms:
- Smaller, more frequent feedings: Babies are less likely to spit up if their tummies are not as full. Giving your baby smaller feedings more often may help him or her to spit up less or to have fewer reflux symptoms.
- Upright position after feedings: Holding your baby upright for about 30 minutes after each feeding can help reduce the symptoms of severe reflux. Placing your baby in a semi-upright position in a swing or bouncer after feedings can also help.
- Changing your diet: If you're breastfeeding, then your baby may be reacting to foods in your diet. Cow's milk protein is the most likely offender, and breastfed babies with cow's milk protein sensitivities may have symptoms of GERD. Eliminating all dairy from your diet may help your baby, but be patient -- it takes up to two weeks for eliminating dairy to help.
- Changing your baby's formula: If your baby's reflux symptoms are caused by a food allergy, then changing to an special infant formula with a different protein makeup (such as a soy or a hypoallergenic formula) may help. Talk to your doctor before changing your baby's formula to make sure that your baby is getting adequate nutrition.
Medications to Treat Reflux in Infants
If your baby still has symptoms of GERD even after trying the home remedies outlined above, then talk to your pediatrician to see if medications may help. It may take time to find the medication with the least number of possible side effects that is the most effective for your baby, as there are many different types of medication to treat reflux.
Even if you are using over-the-counter remedies for your baby, be sure to consult your pediatrician before using any anti-reflux medication. Medications affect infants differently from how they affect adults and older children, and may not always be safe for your baby.
- Thickening agents: Although it isn't a medication, using rice cereal to thicken your baby's feeds may help keep milk in the stomach. Use 1 to 2 tsp of rice cereal per ounce of formula, or use a formula that already has rice added. In European countries, Gaviscon for infants (different from adult Gaviscon sold in the US) is sometimes used to form a thickened layer of milk in the stomach, preventing reflux.
- Antacids: Regular antacids may help infants with mild symptoms of GERD. Mylanta, Maalox, and Tums are typical antacids that may help with acid reflux in infants.
- H-2 Blockers: H-2 blockers (Tagamet, Zantac, Pepcid, and Axid) reduce the amount of acid produced by the stomach and have been extensively used to treat reflux in babies and children. Side effects may include diarrhea, constipation, and abdominal pain.
- Proton-pump inhibitors: Proton-pump inhibitors, or PPIs, are newer medications that are more effective than H-2 blockers at reducing stomach acid. PPIs include Nexium, Prilosec, Prevacid, Aciphex, and Protonix. To get certain PPIs in liquid form, you will need to use a pharmacy that compounds, or mixes, its own medications. PPIs may cause more long-term side effects, including liver problems and polyps in the stomach, than H-2 blockers.
- Motility agents: In the past, motility agents (Reglan and Propulsid) were used to help the body to digest faster, preventing reflux by emptying the stomach faster. Due to severe side effects, these medications are no longer prescribed for infants.
Surgery for Infant Reflux
In very rare cases, GERD lasts well beyond the first year of life, causes severe symptoms, and does not respond to treatment. In these cases, a surgical procedure called fundoplication may be performed. In fundoplication, the top of the stomach is wrapped around the esophagus, tightening the LES and making it more difficult for food to reflux out of the stomach.
Although it can me a good option for children with severe reflux that doesn't respond to medications, fundoplication surgery is a major surgical procedure that has a number of possible side effects. This surgery has a high failure rate in some children; talk to your doctor to see if fundoplication might be right for your child.
Horvath, A., Dzlechclarz, P., and Szajewska, H. "The Effect of Thickened-Feed Interventions on Gastroesphageal Reflux in Infants: Systematic Review and Meta-analysis of Randomized, Controlled Trials." Pediatrics Dec. 2008: 122, e1268-e1278.
Kellymom. "Dairy and Other Food Sensitivities in Breastfed Babies" Accessed 2/24/12 from http://www.kellymom.com/babyconcerns/food-sensitivity.html
Los Altos Feeding Clinic. "Fundoplication" Accessed 2/25/12 from http://www.pediatricfeeding.org/fundoplication.html
Nerko, S. "Treating Acid Reflux in Infants." Pediatric Views August 2007. Accessed 2/20/12 from http://www.childrenshospital.org/views/august07/treating_acid_reflux_in_infants.html
Woo, J., Yang, H., Min, T., Jeon, Y., Lee, H., Lee, J., Pyun, B. "The Efficacy of the Upright Position on Gastro-Esophageal Reflux and Reflux-Related Respiratory Symptoms in Infants With Chronic Respiratory Symptoms." Allergy Asthma Immunology Research Jan. 2012; 4, 17-23.