Gastroesophageal reflux in infants

Definition

Gastroesophageal reflux is a condition in which stomach contents leak backward from the stomach into the esophagus (the tube from the mouth to the stomach) after eating. This article discusses reflux in infants.

Alternative Names

Reflux - infants

Causes, incidence, and risk factors

When a person eats, food passes from the throat to the stomach through the esophagus. The esophagus is called the food pipe or swallowing tube.

Once food is in the stomach, a ring of muscle fibers prevents food from moving backward into the esophagus. These muscle fibers are called the lower esophageal sphincter, or LES.

If this muscle doesn't close well, food can leak back into the esophagus.This is called gastroesophageal reflux (GERD).

In infants, a small amount of gastroesophageal reflux is normal. In fact, more than half a babies will have reflux during their first three months.

Persistent reflux with frequent vomiting leads to irritation of the esophagus and fussiness in the infant. Reflux associated with weight loss or reflux that causes breathing difficulty is considered abnormal.

Symptoms

• Cough, especially after eating
• Excessive crying as if in pain
• Excessive vomiting during the first few weeks of life; worse after eating
• Extremely forceful vomiting
• Not feeding well
• Refusing to eat
• Slow growth
• Weight loss
• Wheezing or other breathing problems

Signs and tests

The health care provider can often make the diagnosis based on the infant's symptoms and physical examination.

Tests may be ordered if your child is not healthy or growing well, or when symptoms are severe and do not get better with treatment. Tests that may be done include:

• Esophageal pH monitoring to determine how often and for how long stomach acid enters the esophagus
• X-ray of the esophagus
• X-ray of the upper gastrointestinal system after the baby has been given a special liquid, called contrast, to drink

Treatment

If your baby or infant is spitting up more than you expect but is still growing well and seems content, no changes in feeding may be needed.

Talk with your doctor or nurse about some simple changes that may be made when feeding:

• Burp your baby after drinking 1 to 2 ounces of formula, or after feeding on each side if breastfeeding
• Add 1 tablespoon of rice cereal to 2 ounces of formula, milk, or expressed breast milk. If needed, change the nipple size or cut a small x in the nipple.
• If possible, hold the baby upright for 20-30 minutes after feeding.
• Raise the head of the crib, if possible. However, your infant should still sleep on the back, unless your healthcare provider suggests otherwise.

When the infant begins to eat solid food, thickened foods may help.

Sometimes medicines are used to reduce acid or increase the movement of the intestines.

Support Groups

Expectations (prognosis)

The majority of infants outgrow this condition. In unusual cases, reflux may persist into childhood and can cause varying degrees of esophageal damage.

Complications

• Aspiration pneumonia caused by stomach contents passing into the lungs
• Irritation and swelling of the esophagus
• Scarring and narrowing of the esophagus

Calling your health care provider

Call your health care provider if your baby is vomiting frequently, especially if the vomiting is forceful or if other symptoms of reflux occur. Also call if your baby:

• Has problems breathing after vomiting
• Is refusing food, and is losing weight or not gaining weight
• Is crying often

Prevention

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References

Orenstein S, Peters J, Khan S, Youssef N, Hussain SZ. Gastroesophageal reflux disease (GERD). In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 320.