Acid reflux is a common problem in infants and toddlers. It results from the backward flow of stomach acid or food into the esophagus. Most babies have mild symptoms that do not interfere with their daily lives or with their growth and development. If symptoms worsen, the baby may be suffering from gastroesophageal reflux disease, or GERD.
Causes of Infant Reflux
Infants and toddlers develop reflux when the lower esophageal sphincter, the muscle that closes the stomach after food enters it, is weak and not working properly. This is particularly common among premature infants, although the National Digestive Diseases Information Clearinghouse reports that over half of all babies have acid reflux in their first three months of life. Most babies outgrow their reflux by the time they turn one year old. Toddlers may also experience reflux as a result of food allergies, or the introduction of fatty or spicy foods in their diets.
Symptoms of Acid Reflux
Most babies with acid reflux only have frequent episodes of spitting up milk or formula. In severe cases, or those that develop gastroesophageal reflux disease, they may exhibit forceful vomiting with feeds, coughing and gagging, poor feeding and weight loss. Infants with reflux can be extremely irritable, refusing to take their milk and arching their back as a symptom of pain. The acidity of the reflux can cause irritation in the esophagus, which can then lead to bleeding, either when vomiting or, in rare cases, the presence of blood specks in the stool.
Treatment
Most infants with reflux only need supportive measures to adjust the feeds and decrease the episodes of reflux. The Mayo Clinic recommends small, frequent feeds with pauses for burping; and holding or sitting the baby upright during and for 15 to 30 minutes after each feed to decrease the symptoms of reflux. For babies and toddlers who exhibit symptoms of pain or irritability, medications may be prescribed to decrease the acidity of the stomach. These include H-2 blockers like ranitidine, or proton pump inhibitors, like omeprazole.
Other Therapies
Infants may benefit from thickening the formula or expressed breast milk with rice cereal. The size of the nipple opening may impact the amount of milk the infant is getting, and could be leading to excess causing reflux. At the same time, if you are thickening the milk, you may need to slightly enlarge the hole in the nipple. Overfeeding infants can also cause reflux symptoms.
