Gastroesophageal Reflux in Infants

GER occurs when contents from the stomach (gastro-) come back (reflux) up the esophagus. Most people have experienced this at some stage. Any time you vomit, contents from the stomach come back up the esophagus. This is gastro-esophageal reflux.

Why do babies get gastroesophageal reflux?

It is easy for babies to reflux because:

• they have a liquid diet
• they have relatively weak muscles surrounding the esophagus where is enters the stomach, so there is less resistance to keep fluid in the stomach
• they spend a lot of time lying down so gravity isn't working for them but against them. When they are upright, they don't have good muscle tone and so lean forward putting pressure on the stomach, forcing its contents out.

Does it matter that my baby has reflux ?

Not in most cases - it's a normal part of being a baby to have spills (vomits). However, it does matter if the reflux is bad enough to stop your baby gaining weight normally or is causing acid to burn your baby's esophagus. When either of these things happens, we call it Gastroesophageal Reflux Disease.

How do I know if my baby has Gastroesophageal Reflux Disease(GERD)?

If your baby has GERD, you will know because she will not be gaining weight or she will be distressed with vomiting. Sometimes, babies with GERD arch their backs with the pain.

Occasionally, no vomiting is seen although there is still acid refluxing back into the esophagus causing pain - this is called silent reflux. If your baby is not gaining weight or has a lot of distress with vomiting, your baby may have GERD. If she is arching her back and seems very distressed with that but is not vomiting, she may have silent reflux. To read more about GERD, click here.

What is the treatment of gastroesophageal reflux?

Reflux which is not causing distress and where the baby is gaining weight can be managed with relatively simple measures such as:

• keep your baby upright for a while after a feed.
• you could try thickening the feeds - however, this is not so convenient if you are breast-feeding. There are anti-reflux formulas that have a thickening agent in them if you are formula feeding. I don't think you should stop breast-feeding to give an anti-reflux formula, though (the benefits of breast-feeding are too great).
• there are anti-gas medications like alginic acid (Gaviscon) that form a foamy covering on top of the stomach contents after a feed and sometimes this can help reduce the spilling - you mix the medication with milk or water and give after feeds.

Should I prop my baby up on her tummy?

Propping babies up at 30-45 degrees can help reflux symptoms. If they are on their tummy, it is probably better for the reflux than if they are on their back. However, you should always put a baby on her back to sleep, whether she is propped up or not.

If you are going to try propping your baby, put a pillow under the mattress at the head end so the mattress is on an angle of 30-45 degrees. Tie a scarf of at least 15 cm (6 inches) width to one side of the head end of the cot (crib), bring it down over your baby's back and between her legs and then bring it back up under her to tie at the other side of the head end of the cot (crib). This is a simple harness device to keep her from slipping down the bed - because if she slipped down the end of the bed she would end up all hunched over putting pressure on her stomach and this would cause vomiting.

If you want to try propping your baby up lying on her tummy or you find that works best for her, remember to only do so when she is supervised (so you are in the room) and do not leave her to sleep on her tummy. It is very important that your baby is put to sleep on her back - sleeping on the tummy can increase the risk of sudden infant death syndrome (SIDS or cot death or crib death).

How long will gastroesophageal reflux last?

Every baby is different, but most GER will resolve by itself once your baby is more upright and having more solid food, so by 7-8 months of age. Some babies will just continue to reflux and so vomit for longer but if they are growing well, there is probably not too much to worry about.

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Useful Resources

Children's Digestive Health and Nutrition website - you can download useful guides from this site

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