Reviewed by DR. D. DATTA., Ex. Emergency Medical Officer.
It is a condition when the solid or liquid content of a baby’s stomach moves upwards in reverse direction in the esophagus and the baby spits or vomits the food or liquid. (Esophagus is a tube through which food or liquid goes to the stomach from the mouth).
Reflux is quite common in a healthy baby and may occur several times a day. More than 50% infants suffer acid reflux to some extent. Usually, infant acid reflux subsides without any intervention before the age of 12 months, and it is uncommon after the age of 18 months.
Symptoms of acid reflux
Forceful and repeated expulsion of stomach contents (projectile vomiting).
Baby refuses feeding.
Trouble swallowing.
Gagging or choking.
Excessive cry during and after feeding.
Baby becomes irritated during and after feeding.
Wet burp or wet hiccup – Baby spit up liquid when burping or hiccup.
Abnormal arching of the back during feeding, may be due to irritation of the stomach content in the esophagus.
Loss of weight.Â
Failure to achieve normal weight gain.
Green, yellow or coffee colored vomitus.
Frank blood vomiting.
Respiratory problems such as wheezing, asthma, recurrent cough, pneumonia, due to aspiration of stomach contents into the lungs.
Sleep disturbances.
Causes of infant acid reflux
At the junction of esophagus and stomach there is a ring of muscle called lower esophageal sphincter (LES), that opens transiently when food or liquid enters the stomach from the esophagus. Development of lower esophageal sphincter (LES) in infants is gradual. As a result of underdeveloped LES, infant reflux is quite common and as the LES gradually matures the condition gradually improves.
Lying flat after feeding.
Total liquid food.
Serious conditions that may be associated with infant reflux are,
GERD.
Pyloric stenosis or gastric outlet obstruction- in this condition there is narrowing of the opening from the stomach to the first part of duodenum.
Food allergy- Baby may be allergic to protein in cow’s milk.
Eosinophilic esophagitis- Eosinophil is one type of white blood cell. Eosinophils may cause injury to the esophageal lining.
Risk factor of infant acid reflux
Premature baby.
Cerebral palsy.
Previous surgery of esophagus due to some reason.
Diagnosis of infant acid reflux
Proper history taking and physical examination. Whether the baby is growing normally or not. Whether there is any loss of weight and symptoms like projectile vomiting.
Investigations for infant acid reflux
USG– may detect pyloric stenosis. There is thickening of pylorus (the last part of stomach that connects the stomach with small intestine.Â
Barium swallow x-ray– Barium swallow x ray- Barium solution is swallowed; several x-rays are taken after drinking barium solution. The solution coats the inner lining of the esophagus.
Upper gastrointestinal endoscopy (upper g i endoscopy)– A flexible tube mounted with light and camera (endoscope) can be passed through the esophagus to directly visualize the esophagus. Samples of tissue for biopsy can also be taken by endoscope.
Esophageal pH monitoring- A thin tube with a sensor is passed through the patient’s nose into distal esophagus. The sensor is connected with a small computer. The sensor can detect acid reflux and the computer record reflux of acid in the esophagus from the stomach. This test is performed for 24 hours.
Treatment of infant acid reflux
Lifestyle changes
Feeding the baby in upright position and then keeping the baby in upright position for 30 minutes after feeding. This will help food or liquid to stay in the stomach by gravity.
Feeding small amounts in frequent intervals.
Avoid overfeeding.
Burping during and after feeding. It will cause expulsion of extra gas from the stomach and prevent reflux.
Adding some rice cereal to make it thick in baby’s food as per doctor’s advice.
If food allergy is suspected and the baby is on formula food, then switch to another type of formula.
Medicines for infant acid reflux
When lifestyle changes cannot help enough, medicines can be prescribed by a doctor. These medicines lower the acid production of the stomach. H2 blocker and proton pump inhibitors are such medicines used for this purpose.
Surgery for infant acid reflux
In rare cases in spite of lifestyle changes and medicines the baby suffers from severe symptoms a pediatric gastroenterologist may consider surgical procedure. The lower end of the esophagus is tightened to prevent acid reflux (Fundoplication).
