Acid reflux happens when the acidic contents of the stomach flow back into the esophagus. This is a very common problem in newborn children, although it is hard to distinguish acid reflux from normal spit-ups. Early identification of reflux in infants can help maximize treatment strategies to avoid long-term complications.
Function
According to the National Digestive Diseases Information Clearinghouse, acid reflux results from weakness in the lower esophageal sphincter. This thin band of muscle circles the part of the esophagus that enters the stomach and tightens after food goes into the stomach, preventing any backflow of acid. Weakness of the esophageal sphincter allows acid back into the esophagus and sometimes all the way up to the mouth and airway.
Symptoms
The symptoms of acid reflux in infants include frequent spit-ups, coughing if the acid reaches the airway, vomiting, poor feeding and irritability. Newborns with reflux might have feeding difficulty and refuse to feed because of the pain of acid reflux. This results in decreased weight gain, breathing problems and occasionally blood in the vomit or stools.
Diagnosis
The diagnosis of acid reflux in infants starts with an investigation of the symptoms. Several tests can be ordered to confirm the diagnosis, including an ultrasound of the abdomen to verify that there is not a blockage causing the baby to vomit, an upper GI, a radiologic study that can assess directly the presence of reflux, and an endoscopy, a tube with a camera used to directly visualize the esophagus and the stomach for signs of acid damage.
Treatment
According to MayoClinic.com, changes in feeding, such as small frequent feedings, can help decrease the symptoms of reflux. If this does not help, medical treatment is available, which might include H2-blockers like cimetidine and ranitidine, which help decrease the amount of acid in the stomach; proton-pump inhibitors like omeprazole, which reduce the production of acid; and medicines like erythromycin that speed up the passage of food from the stomach. Infants who do not respond to any of these therapies and have severe symptoms might need surgical intervention.
Considerations
Infants with acid reflux can exhibit pain by arching their backs and rolling their eyes in a manner that resembles a seizure. Other conditions that mimic reflux include blockage of the intestines or the stomach, including a condition called pyloric stenosis, in which the pylorus, the muscle that surrounds the outlet of the stomach, becomes too tight.
