This article appeared in the June/July edition of Tots to Teens magazine:
Gastric reflux is very common in infants. Babies are born with immature digestive systems. Within the first days, weeks and months of their lives the ring of muscle at the top of the stomach gradually matures and strengthens. This muscle should open and close to allow food through in one direction, and prevent it travelling back up.
In 50% of babies, this valve may function poorly, letting food pass back up the oesophageal passage. Breast or bottle-fed infants who regurgitate (also referred to as ‘spilling’) once a day (or more) after feeding are referred to as experiencing uncomplicated gastric reflux.
Other symptoms of reflux may include a persistent cough, refusing to feed, crying with feeding or refusing to feed at all, gagging, difficulty swallowing, hiccups, chronic wheezing, irritability or restlessness/sleeplessness.
Although reflux can be unpleasant and worrying for parents, in most cases the development of the digestive system progresses normally, and the reflux resolves itself within the first 3 months to a year of life.
The Gastric Reflux Support Network of New Zealand is a non-profit charity dedicated to providing support and information to babies and their families dealing with infant gastric reflux. Their website ‘www.cryingoverspiltmilk.co.nz’ is a very comprehensive resource. If your reflux baby appears mostly contended, sleeps well and is gaining weight, he/she is what the Network calls a ‘happy chucker’. Their recommendation to help ease reflux is for breast-feeding mothers to switch to a dairy-free diet for two weeks, in addition to checking your milk latch position is correct for baby. For bottle-fed infants, they suggest switching to a non-cow’s milk formula.
General reflux resolution techniques (no matter how severe) include feeding baby sitting up, interrupting the feed to burp high on the shoulder so baby’s body is straight, and offering smaller, more frequent feeds. These at-home remedies may help to resolve reflux issues more quickly, although many parents of ‘happy chuckers’ simply choose to ride it out knowing the issue will resolve when the digestive system matures. The use of thickeners is an older strategy which is no longer universally recommended. The idea behind thickening additives is to encourage food to continue its journey down to the stomach. But research now suggests the number of reflux episodes will remain unchanged, while you risk adding unnecessary extra calories to baby’s diet, and increase the risk of choking and other feeding problems.
It is rare but possible for reflux problems to persist through to school-age, with some children being diagnosed with Gastric Oesophageal Reflux Disease (GORD), a diagnosis that usually requires medical or surgical intervention to correct.
Uncomplicated gastric reflux becomes GORD when the acid content of the regurgitation creates problems like asthma, failure to thrive, or irritation to the oesophagus. Medical treatment options are designed to prevent one or more of these events from occurring.
An alternative treatment may be probiotic supplementation. A 2014 Italian study showed favourable results for reflux infants with the use of probiotics (beneficial gut bacteria). The study involved 554 infants in nine hospital paediatric units. The infants given the probiotic supplement cried for 38 minutes at a time and regurgitated three times, as opposed to 71 minutes of crying and five ‘spit-ups’ in the placebo group.
The Gastric Reflux Support Network of NZ explains that medications- particularly antibiotics- can promote an overgrowth of ‘bad’ bacteria in the gut, which is why a probiotic supplement may harmonise the system and relieve symptoms. Gut motility issues are a problem for those with reflux- perhaps even being the cause of reflux- because the stomach is too slow to empty and remains full for longer than it should. Probiotics can improve gut motility, so while further evidence is required into their efficacy, the use of probiotic supplements could be a worthwhile natural avenue to explore. Just ensure you check with your doctor and/or take appropriate advice as to their use.
Some authorities are concerned that gastric reflux may be misdiagnosed, or over-reported. The UK’s National Institute for Care and Health Excellence (NICE) recently issued a new set of guidelines for medical professionals to reassure and inform new parents on the issue of reflux. The guideline recommends parents and carers are given advice about gastric reflux and are reassured that in healthy infants, effortless regurgitation of feeds is very common and will become less frequent with time, usually not needing further investigation or treatment. NICE presents a number of ‘red flag’ symptoms for identifying more severe reflux (potentially GORD) or an incorrect diagnosis. These symptoms are forceful vomiting, abdominal tenderness, chronic diarrhoea, a bulging fontanelle or head circumference increasing by more than 1cm per week.
If your baby experiences any of these symptoms in addition to reflux, consult your doctor immediately, as they may indicate alternative disorders ranging from intestinal obstruction to cow’s milk protein allergy.