My Infant Has Reflux. Is This Normal?

Infant reflux, known as gastroesophageal reflux (GER), occurs when the stomach contents come back up into the infant's food pipe or esophagus. The ring of muscle between the esophagus and stomach normally relaxes to let milk pass from the esophagus into the stomach and then tightens again to keep the milk in the stomach. In infants, this muscle is not fully developed and often opens at the wrong time, causing the stomach contents to reflux back into the esophagus. The stomach contents can come up and out of the mouth or nose or be re-swallowed by the infant. More than 50% of infants reflux or "spit up" during the first year of life. In most cases this is normal behavior for an infant. The infant who is known as the "happy spitter" is gaining weight and is not in pain from the reflux. Infant reflux or spitting up usually peaks at around four months of age and resolves by one year of age.  If your infant has reflux and is not in any discomfort, then further evaluation and testing is probably not necessary. A few simple things that may help reduce normal infant GER include:

• Keep your infant upright for at least 30 minutes after a feeding to allow the stomach contents to empty
• Avoid overfeeding
• Give smaller, more frequent feedings
• Frequent burping
• Avoid tight diapers 
• Elevate the head of the crib
• Avoid feeding your infant while laying flat
• Minimize time in a car seat to reduce pressure on the stomach
• Avoid smoke exposure

What Is Infant Gastroesophageal Reflux Disease?

Gastroesophageal Reflux Disease (GERD) occurs when infant GER is associated with discomfort and difficulty feeding or gaining weight. It is normal for infants to cry an average of 1-2 hours a day. However, an infant with GERD will often cry longer and appear to be in pain and inconsolable. Symptoms of GERD include:

• Inappropriate weight gain
• Pain and arching associated with feeding
• Coughing 
• Vomiting
• Extreme irritability
• Blood in the stools

How Is GERD Diagnosed in Infants?

GERD is diagnosed through a detailed history and examination by the infant's physician or pediatric gastroenterologist. Occasionally test may be ordered that include:

• Upper GI imaging to evaluate the infant's anatomy
• Barium Swallow to evaluate the infant's swallow function
• pH monitoring to evaluate the level of acidity in the infant's esophagus
• Blood test
• Upper endoscopy with biopsies

How is GERD Treated?

Based on your infant's symptoms and/or test results, your infant's physician may recommend:

• Acid-reducing medication
• Thickened feedings with cereal or commercially available thickeners
• Switching to a hypoallergenic formula
• Working with an infant feeding specialist

Having an infant with GERD can be stressful. Infants with GERD are often irritable and inconsolable which leads to sleep loss and psychological and physical stress on the parents. With proper treatment, GERD can improve. If you are concerned that your infant has GERD, then speak to your infant's physician about your concerns. 

If you would like more information about gastroesophageal reflux or gastrointestinal (GI) digestive disorders and nutrition in children, please contact Dr. Mona Dave's Frisco Office or Request Appointment Here.