Acid reflux, also known as gastroesophageal reflux disease, occurs when the stomach's acidic contents flow back into the esophagus, the tube that connects the mouth to the stomach. In infants, this problem is very common. At the same time, it is hard to distinguish gastroesophageal disease from normal spit-ups in babies. Early diagnosis and treatment can minimize the infant's discomfort and prevent long-term health problems.
Causes
Acid reflux results from weakness of the lower esophageal sphincter, a circular band of muscle that opens and closes when food goes into the stomach. Failure of the lower esophageal sphincter to close completely allows stomach contents to flow out of the stomach, causing the acid reflux symptoms. In infants with severe acid reflux, the stomach's acid can flow all the way up to the airway, and occasionally come out of the baby's mouth and nose.
Symptoms
The symptoms of acid reflux include frequent spiting up, vomiting, coughing, irritability and pain. This can lead to the baby's refusal to feed. Occasionally, infants with severe reflux can have blood-tinged stools. As the symptoms worsen, infants with severe reflux exhibit poor growth and weight gain, and can have breathing problems, especially if their stomach contents are going into the airway. Aspiration of stomach acid into the airway can lead to respiratory distress and aspiration pneumonia.
Medical Treatment
The treatment of acid reflux includes changes in feeding patterns, medicines and occasionally surgery. According to the Mayo Clinic, parents can try feeding the baby small amounts of milk at frequent intervals, interrupting the feeds with burping or by keeping the infant in an upright position. Medicines include H2 blockers, which keep acid from backing up into the stomach, and proton-pump inhibitors, which decrease the production of acid into the stomach. These medicines may decrease the acidity of the stomach contents, and therefore the irritability of the infant while feeding, but they may not stop the flow of stomach contents into the airway. If the child continues to exhibit symptoms of aspiration despite medical management, surgery may be necessary.
Surgical Treatment
Infants whose reflux is severe enough to cause aspiration may need a surgery called Nissen fundoplication. According to the University of Maryland Medical Center, this surgery entails wrapping the upper portion of the stomach around the lower esophageal sphincter, thereby increasing the sphincter's strength and preventing the back flow of acid.
