Gastroesophageal reflux, commonly called acid reflux, is a condition that affects approximately one in 20 babies less than one year of age. Although many babies may spit up after a feeding, chronic gastroesophageal reflux causes symptoms that lead to pain and feeding problems over time. A baby with acid reflux will usually outgrow the condition by the time he is one year of age, but symptoms can keep both parents and babies unhappy until that time. There are several treatments available for infant acid reflux.
What is Acid Reflux
After eating, food passes down the esophagus and into the stomach, and the acid in the stomach works to begin the process of digestion. A valve at the bottom of the esophagus, called the lower esophageal sphincter (LES), prevents stomach acid from coming out of the stomach pouch. With gastroesophageal reflux, the LES does not always close properly, allowing stomach acid into the esophagus.
Symptoms of acid reflux in infants can include spitting up after meals, "wet" burps, fussiness and irritability, coughing, or gagging. Food and stomach acid that comes up can be seen as spitting up after eating, or burping after a feeding that results in a mouthful of formula or breastmilk. Many infants with acid reflux are fussy and irritable, which can be attributed to abdominal pain caused by the stomach acid coming in contact with the sensitive lining of the esophagus.
Untreated, acid reflux in infants can lead to complications involving failure to gain weight, pneumonia and esophageal stenosis. Infants may exhibit signs of weight loss or failure to thrive due to the frequent vomiting and spitting up associated with the condition. Some infants may show fussiness with eating or may eat less, associating pain with eating and leading to further weight loss. Aspiration of stomach contents can occur with regurgitation, causing pneumonia. Over time, the frequent contact of stomach acid on the esophagus can cause scar tissue to develop, which can narrow the opening of the esophagus. The narrow opening can lead to further vomiting and feeding difficulties, compounding other possible complications.
Positioning
Treatment of acid reflux in infants is aimed at providing comfort and reducing symptoms, as well as giving the infant the ability to eat without suffering the effects of acid reflux after a meal. The effect of a baby's position is a home remedy that parents may try to alleviate some symptoms of acid reflux. Because an infant may be placed in a position of lying down after eating, stomach contents may reflux more quickly without the effects of gravity. Positioning her in a sitting position during a feeding and elevating the head of the bed to a 30-degree angle for sleeping may help with symptoms by keeping some stomach fluids down. A baby may also be kept in an upright position during alert periods or supported in a car seat to avoid slumping over and putting pressure on the stomach.
Other Home Treatments
Giving small amounts of food on a frequent basis can help a baby to continue getting enough calories without overfilling the stomach. Small amounts of food mean less stomach acid production and a reduction in regurgitation.
Some parents have success with thickening formula or breastmilk for their baby. This supplies extra calories and helps keep the food in the stomach. Children that have started solids should not be given foods that irritate the stomach or that can contribute to excess production of stomach acid. Foods that are spicy, and those such as chocolate or tomato-based products should be avoided.
Medications
A physician may prescribe medications to treat the causes of acid reflux, and a combination of medications may be given to alleviate symptoms. One type of medicine works to reduce the amount of acid that the stomach produces. After eating a meal, there is less stomach acid to regurgitate, keeping more of the stomach contents out of the esophagus and relieving symptoms of burning at the esophageal sphincter. This type of medication is frequently prescribed for adults suffering from heartburn. A second type of medication involves speeding up the process of digestion, so that stomach contents empty more quickly and pass into the small intestine. This process again reduces the amount of stomach contents available for regurgitation, but may lead to diarrhea with prolonged use.
Surgery
Surgery for acid reflux in infants is done when other methods of care have failed to show adequate relief of symptoms. A surgical procedure called a fundoplication may be done for the treatment of acid reflux. Fundoplication can be done either as an open repair or laparoscopically. During the procedure, the upper portion of the stomach is wrapped around the esophagus and sewn in place. This process regulates the backflow of stomach acid into the esophagus. Recovery requires two to three days of hospitalization, and some children may need a tube placed directly into the stomach from outside of the abdomen. This allows for continuation of feedings, as eating and burping after surgery could be difficult. The tube is a temporary measure until the baby has gained weight and is able to comfortably eat again with fewer symptoms of reflux.
References
- University of Washington: Gastroesophageal Reflux
- Robert C. Byrd Health Sciences Center: Gastroesophageal Reflux Disease in Infants
- Penn State Children's Hospital: Gastroesophageal Reflux
- Pediatric Surgery: Gastroesophageal Reflux
- University of Michigan Health System: Gastroesophageal Reflux and Fundoplication
