While respiratory symptoms such as wheezing might seem unrelated to gastrointestinal issues, a connection between the two can exist. Infants develop gastroesophageal reflux disease, commonly known simply as acid reflux, reflux or GERD, when a muscle that allows food to pass from the esophagus to the stomach doesn't close completely. Acid flows back into the esophagus and sometimes into the lungs, irritating and sometimes permanently damaging the delicate tissues. If milk containing acid enters the lungs, respiratory symptoms develop.
Causes
Around 50 percent of infants experience some degree of reflux until the angle between the esophagus and stomach changes as your baby grows, decreasing the incidence of reflux, Harvard pediatrician Harland Winter, M.D., explains on UpToDate. You might not notice this unless the milk passes back into the mouth and the baby spits it up. A small amount of milk can enter the lungs, causing a mechanical irritation to the tissue that results in wheezing and other respiratory symptoms.
Symptoms
In addition to wheezing, acid reflux in an infant can cause other respiratory symptoms, such as apneic episodes -- periods in which the baby stops breathing briefly -- a cough or choking episodes. They might occur at any time, not just after eating. Asthma, a hoarse voice, noisy or raspy breathing, frequent episodes of pneumonia or bronchitis can all occur as respiratory symptoms of acid reflux in infants.
Treatments
Simple measure such as elevating the head of the bed to give gravity a chance to keep food in the stomach, avoiding overfeeding, holding the baby upright for 20 to 30 minutes after a feeding or thickening the formula so it's less likely to enter the esophagus might help decrease acid reflux. Medications that decrease acid production in the stomach also can decrease damage caused by acidic secretions in the esophagus and lungs. Between 15 percent and 40 percent of infants with GERD have an intolerance to cow's milk protein and do better on a hypoallergenic formula if bottle fed, Dr. Winter states. If you're breastfeeding, try cutting all dairy and soy from your diet for one to two weeks.
Complications
Without treatment, GERD can scar the esophagus and trachea, which can lead to permanent difficulties swallowing or breathing. Aspiration pneumonia also can occur. A baby with GERD also might develop failure to thrive from a disinclination to eat because of the pain associated with acid reflux. Failure to thrive can affect not only growth but mental and emotional development as well. In severe cases, surgery to tighten the muscle, known as fundoplication, might be necessary.
References
- Reflux.org: What is GER?
- National Institute of Diabetes and Digestive and Kidney Disease; Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD); May 2007
- UpToDate; Acid Reflux (Gastroesophageal Reflux) in Infants; Harland Winter, M.D.; May 2008
- MayoClinic.com; Infant Acid Reflux; August 2010
