Gastro-oesophageal reflux (GOR) occurs when stomach contents (acid) leaks from the stomach and moves up into the oesophagus (food pipe). This is also known as ‘reflux’ and can happen with or without regurgitation or vomiting. Reflux is a normal function of the body and most episodes are short and limited to the lower parts of the oesophagus.
What is regurgitation in babies (posseting)?
Regurgitation, or posseting, happens when children spit out the regurgitated stomach content. It can also cause drooling. This is normal in healthy, thriving babies and doesn’t need medical attention as long as the baby is feeding well and growing.
When does reflux become a problem?
Almost everyone has heartburn caused by acid reflux from time to time. It is considered Gastroesophageal Reflux Disease (GORD) when it happens more than twice a week. It can eventually lead to more serious health problems and impact wellbeing and quality of life. Acid from the stomach can cause oesophagitis (inflammation of the oesophagus). About 10% of children will need treatment for GORD.
Normal, healthy babies can have up to 21 episodes of reflux a day, but most of these are short and happen without any other symptoms. By six months, babies will be eating more solid food and spend more of their time upright which helps them to outgrow reflux.
However, children with heart problems, respiratory conditions like chronic lung disease, or neurological impairment like cerebral palsy are more likely to need medical or surgical intervention.
Signs that medical treatment is needed:
- Failure to thrive (poor weight gain)
- Oesophagitis (poor feeding because of pain from an inflamed oesophagus)
- Anaemia (a condition in which there is a deficiency of red cells or of haemoglobin in the blood, causing paleness and tiredness)
- Pain when swallowing
- Colic after feeding
- Chronic coughing
- Wheezing (an asthma-like attack in children less than two years of age)
- Aspiration pneumonia
- Apnoea (brief periods when the child stops breathing, especially during sleep)
- Apparent life-threatening events
Medical investigations
If Gastroesophageal Reflux Disease (GORD) is suspected, your doctor may recommend:
- A barium swallow – to check if anatomy is normal,
- A milk scan – a scan which reveals more about gastric emptying, aspiration and reflux, or
- Acid (pH) studies – gold standard but technically difficult in infants
Managing reflux in your baby
Home management
If your baby is suffering from reflux, these actions can help to relieve it:
- Give your baby smaller feeds, more often
- Keep your baby upright for a while after feeding
- Put your baby to sleep with its head slightly raised and lying on its side
- Use milk thickeners, for example, milk thickened with carob bean.
Medical management
Your doctor may also recommend you use a proton pump inhibitor on your baby e.g. omeprazole or esomeprazole, which decreases acid production in the stomach. This is usually given to the baby 30 minutes before feeding on an empty stomach. It will take a few days before it begins to work and must be used for at least six months until symptoms improve and the baby is growing well.
Surgical management
When reflux doesn’t respond to medical management and is severe, your doctor may recommend a surgical intervention where part of the stomach is wrapped around the lower oesophagus to prevent reflux upwards.
Remember
- Most babies have reflux which is normal and does not need medical treatment if they are thriving and show no other symptoms.
- If your baby has reflux along with other symptoms, like pain when swallowing, then you should see a doctor.
- Milk thickeners can help with reflux, but not if the baby has oesophagitis (an inflamed oesophagus).
- A proton pump inhibitor treats oesophagitis, but will not stop vomiting.
- Surgical management is more often needed in children with secondary reflux.
