Definition A baby sometimes regurgitates small amounts after a feeding. This is called reflux.
What is going on in the body? Reflux occurs in many young infants. In some children, it may continue through the first year. The problem occurs because some of the muscles in the baby's digestive system are not yet mature.
When food is swallowed, it travels to the stomach through a long muscular tube known as the oesophagus. Waves of muscle contractions propel food down the oesophagus. The valve connecting the oesophagus to the stomach is called the gastro-oesophageal sphincter. Normally, this valve closes after eating to keep food from rising back into the oesophagus. In newborns, this valve has not fully developed. That makes it easier for food to move backwards, up the oesophagus. Reflux usually occurs during or shortly after feeding. Most of the time, the food rolls out of the mouth without much force. The amount that comes out is rarely more than an ounce.
gastro-oesophageal reflux disease differs from reflux in that it involves large amounts of stomach contents coming up the oesophagus. Babies with GORD may fail to thrive, or gain weight, because of large amounts of food coming back up. Sometimes, infants with GORD may not appear to have reflux much at all.
It is important to distinguish reflux from vomiting. vomiting. With vomiting, larger amounts of stomach contents are forcefully expelled. Material may come out of the nose as well. Vomiting is usually a sign of an illness. A child who is vomiting may need medical attention.
What are the signs and symptoms of the condition? Reflux usually occurs during or after a feeding. It does not appear to cause any discomfort to the baby. It is not associated with fever or any other symptoms. The reflux material the baby expels looks like the breast milk or formula the baby has just taken in. Blood in the expelled material may indicate irritation in the oesophagus. If this occurs, a parent should contact their baby's doctor.
What are the causes and risks of the condition? Premature infants may be more likely to have reflux. This is because their digestive systems are not as mature at birth as those of full term infants.
What can be done to prevent the condition? Some infants have reflux despite prevention efforts. For most babies, however, the following steps may help minimise the problem:
burping the infant every 4 to 5 minutes during feeding. This helps prevent the stomach from filling with air.
avoiding over feeding. Some infants have an unusually strong need to suck, which can cause them to eat too much. They may have reflux because their stomachs become too full. Parents who suspect this problem should ask their paediatrician for guidance on the proper amount of formula or nursing time for their child.
refraining from vigorous play immediately after feeding. Giving the baby time to digest after a feeding may limit the problem.
feeding the baby in an upright or semi-upright position, and using appropriate techniques for infant feeding. The baby should remain upright for 20 minutes after feeding in a position that does not compress the abdomen.
adding a small amount of rice cereal to each bottle of formula. Doctors sometimes recommend doing this because the thickened formula is often less likely to come back up the oesophagus. The baby's doctor should be consulted before starting the rice cereal.
feeding the infant before he or she becomes too hungry. A very hungry baby may nurse vigorously, swallowing a lot of air in the process.
How is the condition diagnosed? There are no tests for reflux. There are tests to determine if a baby has GORD, though. The doctor will initially distinguish the problem from more serious conditions if:
undigested food is expelled only in small amounts
food is not expelled forcefully
the infant is gaining weight well
the infant shows no signs of illness or discomfort
If the doctor is concerned about the baby, he or she may order further testing.
What are the long-term effects of the condition? As the baby grows, the sphincter in the oesophagus usually gets stronger and the baby spits up less and less. Reflux usually goes away by itself sometime during the baby's first year. There are no long-term consequences.
What are the risks to others? Reflux is not contagious, so there are no risks to others.
What are the treatments for the condition? There is no treatment for normal reflux. Changing the formula usually does not help with reflux. Sometimes a doctor will recommend thickening the formula with a small amount of rice cereal to try to help.
How is the condition monitored? Reflux is of little concern for a healthy infant who is growing normally. The paediatrician should be contacted if the reflux infant also shows these signs:
Frequent irritability
Poor growth rate
Repeated vomiting
Frequent coughs
Blood in the reflux material
Author: John Wegmann, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
