REFLUX

What is Reflux?

Dr Nické Theron, pediatrician, is here to empower our mommies with knowledge.

Most moms know the feeling of getting your little one all dressed up and ready to go, just to have them spit/vomit milk all over everything just before you leave!

Thank you for all your questions and comments about your journey with reflux. I will try to answer most of you in the next few paragraphs while I explain more about the what, why and how of reflux:

Gastro-Esophageal Reflux (GER) is a 100% physiological (natural) occurrence in healthy babies, children and adults where the contents of the stomach push back into the esophagus (swallowing tube). It is more prominent in babies (40-60% of healthy babies struggle with reflux) because of their immature lower esophageal sphincter (the gate that is supposed to contract to keep the stomach content inside), fluid diets (fluids push back easier), slower passage of food through the stomach and the fact that they are mostly laying down (yes, gravity does play a role here).

Preterm babies have even more trouble with reflux because the esophagus is still too immature to “swallow” the milk down and they are often fed via feeding tubes (which opens up the lower esophageal sphincter even more).

“So do flux and reflux–the rhythm of change–alternate and persist in everything under the sky.”
― Thomas Hardy, Tess of the D’Urbervilles

Symptoms of reflux can start from the first few days of life when they start drinking larger volumes of milk, and usually subside by the age of 12-18months. This is due to a combination of all the factors mentioned above improving. There are some studies that show that children who had reflux as a baby are more prone to struggle with it as they get older.

Babies who have reflux (GER) usually spit/vomit up milk after feeds (yes, it can come up through their noses), (yes, it can be quite a lot!), they can also be irritable after feeds or arch their backs. They often sleep for shorter stretches and want to feed often (the milk actually soothes their throats, but more milk can also cause more trouble). Remember this is still NORMAL baby-behaviour!

“Silent reflux” is a non-medical term applied when a baby has episodes of reflux into their esophagus and airways without vomiting it out. (Making it more difficult to diagnose). In the end the same diagnostic and treatment rules apply.

Most babies with reflux grow well, feed well, are not extremely irritable and do not have any danger signs. These babies are often referred to as “happy spitters” and do not need any further medical intervention. It is very rare for the stomach contents to contain enough acid to cause discomfort or damage to the esophagus / airways. Even in studies where they monitored the reflux episodes by pH monitoring, they often could not associate the episode with the baby being unhappy or waking up from the reflux.

If your baby is failing to thrive (not gaining weight, not reaching developmental milestones), is refusing feeds (turning away his head while arching his back – Sandifer syndrome) or has signs of esophagitis (this is painful inflammation of the esophagus that can only be diagnosed with a gastroscopy, clues will be excessive crying and irritability when lying flat, shortly after feeds and while refluxing) your baby has Gastro Esophageal Reflux DISEASE (GERD). This is pathological and should be treated.

There are many other causes for the symptoms of reflux. Your baby could be going through a growth spurt or be overstimulated or have flu or gastro-enteritis, but if your baby has any of the following Red Flags, please see your doctor asap to exclude more sinister diseases:

  • Recurrent projectile vomiting (when the vomit hits the other side of the room)
  • Yellow bile or blood-stained vomiting
  • Any other abdominal signs: distension or pain of the stomach, constipation or diarrhoea
  • Fever
  • Any seizures, abnormal movements, abnormal head size or other neurological signs
  • Recurrent pneumonias (lung infections)

When you visit your doctor with symptoms of reflux they will probably be able to exclude most of the dangerous conditions by taking a history from you and doing a good examination. Hopefully this, together with the knowledge you were armed with in this article will help you cope with the day-and-night realities of reflux.

I know the mountains of milk-stained washing and sleep deprivation are tough – check back tomorrow to see what you can do to make your little one a little more comfortable.

Resources:

  1. Rosen R, Vandenplas Y, Singendonk M, Cabana M, Di Lorenzo C, Gottrand F, Gupta S, Langendam M, Staiano A, Thapar N, Tipnis N, Tabbers M; “Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)”; J Pediatr Gastroenterol Nutr. 2018 Mar; 66(3): 516–554. ; doi: 10.1097/MPG.0000000000001889
  2. Rybak A, Pesce M, Thapar N, Borelli O; “Gastro-Esophageal Reflux in Children”; Int J Mol Sci. 2017 Aug; 18(8): 1671; Published online 2017 Aug 1. doi: 10.3390/ijms18081671
  3. Campanozzi A, Boccia G, Pensabene L, Panetta F, Marseglia A, Strisciuglio P, Barbera C, MagazzùG, Pettoello-Mantovani M, Staiano A; “Prevalence and natural history of gastroesophageal reflux: pediatric prospective survey.”; Pediatrics. 2009;123(3):779.
  4. Davies I, Burman-Roy S, Murphy MS, Guideline Development Group ; “Gastro-oesophageal reflux disease in children: NICE guidance”; BMJ. 2015;350:g7703. Epub 2015 Jan 14
  5. https://www.mayoclinic.org/diseases-conditions/infant-acid-reflux/symptoms-causes/syc-20351408