Infant reflux

Infant reflux is when a baby spits up liquid or food. It happens when stomach contents move back up from a baby's stomach into the esophagus. The esophagus is the muscular tube that connects the mouth to the stomach.

Reflux happens in infants many times a day. If your baby is content and growing well, reflux is not a cause for concern. Sometimes called gastroesophageal reflux, also called GER, the condition becomes less common as a baby gets older. It's unusual for infant reflux to continue after age 18 months.

Rarely, infant reflux leads to weight loss or growth that lags behind that of other children of the same age and sex. These symptoms may mean that your baby has a medical issue. This issue could be an allergy, a blockage in the digestive system or gastroesophageal reflux disease, also called GERD. GERD is a form of GER that causes serious health issues.

Most of the time, infant reflux isn't a cause for concern. It's not usual for stomach contents to have enough acid to irritate the throat or esophagus and cause symptoms.

When to see a doctor

See a healthcare professional if a baby:

• Isn't gaining weight.
• Consistently spits up forcefully, causing stomach contents to shoot out of the mouth. This is called projectile vomiting.
• Spits up green or yellow fluid.
• Spits up blood or stomach contents that look like coffee grounds.
• Refuses to feed or eat.
• Has blood in the stool.
• Has difficulty breathing or a cough that won't go away.
• Begins spitting up at age 6 months or older.
• Is very irritable after eating.
• Doesn't have much energy.

Some of these symptoms may mean serious but treatable conditions. These include GERD or a blockage in the digestive tract.

In infants, the ring of muscle between the esophagus and the stomach is not yet fully developed. This muscle is called the lower esophageal sphincter, also known as LES. When the LES is not fully developed, it allows stomach contents to flow back up into the esophagus. Over time, the LES typically matures. It opens when a baby swallows and remains tightly closed at other times, keeping stomach contents where they belong.

Some factors that contribute to infant reflux are common in babies and often can't be avoided. These include lying flat most of the time and being fed an almost completely liquid diet.

Sometimes, 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 muscular valve allows food to leave the stomach and enter the small intestine as part of digestion. In pyloric stenosis, the valve thickens and becomes larger than it should. The thickened valve then traps food in the stomach and blocks it from entering 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 builds up and injures the lining of the esophagus. This white blood cell is called an eosinophil.
• Sandifer syndrome. This causes tilting and rotation of the head that are not usual and movements that look like seizures. It's a rare complication of GERD.

Infant reflux is common. But some things make it more likely that a baby will have infant reflux. These include:

• Premature birth.
• Lung conditions, such as cystic fibrosis.
• Conditions that affect the nervous system, such as cerebral palsy.
• Previous surgery on the esophagus.

Infant reflux usually gets better on its own. It rarely causes problems for babies.

If your baby has a more serious condition such as GERD, your baby's growth may lag behind that of other children. Some research suggests that babies who have frequent episodes of spitting up might be more likely to develop GERD later in childhood.

To diagnose infant reflux, a healthcare professional typically starts with a physical exam and asks questions about a baby's symptoms. If a baby is growing as expected and seems content, then testing usually isn't needed. In some cases, however, a healthcare professional might recommend:

• Ultrasound. This imaging test can detect pyloric stenosis.
• Lab tests. Blood and urine tests can help find or rule out possible causes of poor weight gain and vomiting that happens often.
• Esophageal pH monitoring. To measure the acidity in a baby's esophagus, the health professional places a thin tube through the baby's nose or mouth and into the esophagus. The tube is attached to a device that monitors acidity. A baby might need to stay in the hospital while being monitored.
• X-rays. These images can detect problems in the digestive tract, such as a blockage. A baby may be given a contrast liquid with a bottle before the test. This liquid is usually barium.
• Upper endoscopy. An upper endoscopy uses a tiny camera on the end of a flexible tube called an endoscope to visually examine the upper digestive system. Tissue samples may be taken for analysis. For infants and children, endoscopy usually is done under general anesthesia. General anesthesia causes a sleeplike state before surgery or other medical procedures.

For most babies, making some changes to feeding eases infant reflux until it gets better on its own.

Medicines

Reflux medicines aren't typically used in children to treat reflux that isn't complicated. But a healthcare professional may recommend an acid-blocking medicine for several weeks or months. Acid-blocking medicines include cimetidine (Tagamet HB), famotidine (Pepcid AC) and omeprazole magnesium (Prilosec). Your child's health professional may recommend an acid-blocking medicine if your baby:

• Has poor weight gain, and changes in feeding haven't worked.
• Refuses to feed.
• Has a swollen, irritated esophagus.
• Has chronic asthma.

Surgery

Rarely, a baby may need surgery. This is only done if a baby is not gaining enough weight or has trouble breathing because of reflux. During the surgery, the LES between the esophagus and the stomach is tightened. This prevents acid from flowing back up into the esophagus.

To minimize reflux:

• Feed your baby in an upright position. Then, hold your baby in a sitting position for 30 minutes after feeding. Gravity can help stomach contents stay where they belong. Be careful not to jostle or jiggle your baby while the food is settling.
• Try smaller, more frequent feedings. Feed your baby a little bit less than usual if you're bottle-feeding, or cut back a little on nursing time.
• Take time to burp your baby. Frequent burps during and after feeding can keep air from building up in your baby's stomach.
• Put baby to sleep on the back. Most babies should be placed on their backs to sleep, even if they have reflux.

Keep in mind that infant reflux is usually little cause for concern. Just keep plenty of burp cloths handy as you wait for your baby's reflux to stop.

You may start by seeing your baby's primary healthcare team. Or you may be referred to a specialist in children's digestive diseases, called a pediatric gastroenterologist.

What you can do

When you make the appointment, ask if there's anything you need to do in advance. Make a list of:

• Your baby's symptoms, including any that don't seem related to the reason for your baby's appointment.
• Key personal information, including major stresses, recent life changes and family medical history.
• All medicines, vitamins or other supplements your baby takes, including the doses.
• Questions to ask your baby's healthcare team.
• Caregivers and how they feed your baby.

Take a family member or friend along, if possible, to help you remember the information you're given.

For infant reflux, some basic questions to ask include:

• What's likely causing my baby's symptoms?
• Other than the most likely cause, what are other possible causes for my baby's symptoms?
• What tests does my baby need?
• Is my baby's condition likely temporary or chronic?
• What's the best course of action?
• What are the alternatives to the primary approach you're suggesting?
• My baby has other health conditions. How can I best manage them together?
• Are there restrictions I need to follow for my baby?
• Should I take my baby to a specialist?
• Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

You'll likely be asked a few questions, such as:

• When did your baby's symptoms begin?
• Have your baby's symptoms been continuous or occasional?
• How bad are your baby's symptoms?
• What, if anything, seems to improve your baby's condition?
• What, if anything, seems to worsen your baby's condition?

What you can do in the meantime

Avoid doing anything that seems to worsen your baby's symptoms.