Gastro-oesophagael reflux disease – GORD (or GERD, depending on how you spell it) is often overlooked or under-diagnosed and can be the bane of a baby’s and parents’ life. As a mother, I’ve gone through this with my own child, and only now do I understand the true impact it has on the baby and on everyone around him or her.
I believe that every baby has reflux to some degree. The reasons for this are simple:
1. Babies are on a liquid diet (milk).
2. They spend most of their early days lying flat.
3. The distance from their mouth to their stomach is tiny (no longer than 10cm).
4. They often have slightly loose, under-developed gastro-oesophageal sphincters that allow stomach contents to easily trickle upwards into the oesophagus, causing discomfort and heartburn. This improves and strengthens with age, just as the baby’s other muscles do.
A baby with reflux can have a whole range of scary symptoms such as frequent possetting, especially when lying flat, vomiting, back arching, pulling away while feeding, crying, hiccoughs, gulping and swallowing frequently, wanting to be held upright all the time, waking up soon after feeds (around 1 to 2 hrs afterwards – often with ‘sicky’ posset), eating less per feed and getting hungry soon before the next feed.
On the other hand, silent reflux is where a baby regurgitates partially up the length if his or her oesphagus and sometimes into the mouth, without vomiting – this is gulped and swallowed back down. Babies with silent reflux are often diagnosed later and are actually more uncomfortable, as the acidic regurgitant causes discomfort on its way up and down, whereas a baby who vomits regularly with reflux gets rid of this acidic regurgitant and is happier and in less pain, if any at all.
One of the difficulties we face when diagnosing reflux is that it very often overlaps with colic. The reasons for colic remain largely unknown, but it is thought to occur due to a combination of excess air in the intestinal system and the slight immaturity of the gut’s ability to move food along – hence resulting in abdominal cramps. Notoriously, the symptoms of colic occur in the latter part of the day with the evening being the worst.
The symptoms of reflux, on the other hand, occur throughout the day and are related more to the position of the baby than to the actual time of day. However, due to the fact that both conditions can co-exist, parents often report a worsening of their baby’s reflux in the late afternoon or evening. Colic causes a baby to draw up its legs and abdomen and strain to try and release some gas, and both of these movements cause pressure backwards against the stomach, and can hence increase reflux. Babies usually outgrow colic by the age of 3 to 4 months, and their reflux begins to settle around that time too.
If reflux disrupts a baby’s life in any way, such as causing pain, disturbed sleep, difficulty feeding and slower weight gain, then it should be treated. Treatment of reflux focuses on two main aspects: decreasing the amount and frequency of regurgitation (through positioning of the baby and thickening the feeds) and reducing the acidity (by giving antacids). If your baby displays symptoms of reflux, then you should try to hold him at an angle during his feeds, wind him often during a feed, hold him upright for several minutes after a feed and put him to sleep on an incline (around 30 degrees), by placing a wedge under his mattress or some blocks or books under the legs of his cot. Positioning a baby to sleep on his left side can also help reduce the symptoms. There are a few thickeners, such as infant gaviscon, that can help thicken his feeds, but these should be prescribed by a pediatrician. If your baby is formula-fed, there are several anti-regurgitation (AR) formulas that are pre-thickened and prove very useful.
If despite all these measures, there’s little or no improvement, an antacid can be added, but again, this should be done by a pediatrician. Another measure that can help with reflux is early weaning onto solids. The main message I’d like to convey is that reflux is common, much more common than we think, and can very often be easily managed with a few simple changes to your baby’s routine, and if a more medical approach is needed, so be it. Your baby will eventually outgrow this with no long term effect on his or her health.