Most adults are familiar with gastroesophageal reflux, or the movement of stomach contents up into the esophagus. For us, reflux is usually caused by lifestyle choices, such as eating heavy, fatty foods, smoking or drinking too much coffee. In grownups, unmistakable symptoms like heartburn and burping are signs of acid reflux.
But reflux is much different in infants and babies, says Dr. Rachel Rosen, director of the Aerodigestive Center at Boston Children’s Hospital. “In infants, when we think about reflux, it involves spitting up formula or breast milk,” she explains. “It’s not an acid problem in the majority of babies.” Understanding the causes and mechanisms of reflux in babies can help you and your doctor better prevent and treat this problem — often without the need for medication.
It’s an anatomical issue.
In infants, reflux typically occurs when the lower esophageal sphincter (LES) relaxes, letting stomach contents escape into the esophagus. This relaxation is normal, but can happen more frequently in some babies. The diaphragm and stomach are also important in supporting the LES, so when one or both aren’t working properly, reflux may worsen. Many babies with reflux will outgrow it by the time they are about one year old, as the LES becomes stronger.
Babies have different symptoms.
Symptoms of reflux can vary, but babies with this problem generally tend to spit up after feedings, make gagging, choking or coughing sounds and act fussy around mealtime. That said, spitting up is a normal occurrence for young infants. “As long as your child is growing well and not developing other problems, such as breathing difficulties, treatment probably isn’t necessary,” says Dr. Rosen.
Feeding fixes can help.
“When you have a fussy baby, your instinct is to feed your baby, but that can just make reflux worse in these kids,” explains Dr. Rosen. Along with avoiding overfeeding, babies with reflux may respond well to thickened liquids — typically formula or breast milk that has been thickened with added rice cereal or oatmeal. The heavier you make a liquid, the more likely it is to stay in your baby’s stomach. This can also add calories, which is important for babies who have trouble gaining weight.
Medications usually aren’t necessary.
Clinicians used to prescribe medications like antacids and acid blockers for months and even years to treat reflux in babies. However, recent advances in testing and research have shown that acid isn’t the problem in most infants with reflux. In fact, studies suggest that these drugs don’t seem to help with most symptoms. Worse, a class of medications called proton-pump inhibitors (PPIs) has been found to have a number of troubling side effects in kids, including increased respiratory infections, fractures, allergies and hospitalizations. If your doctor prescribes PPIs, Dr. Rosen recommends limiting use of these drugs to no longer than one or two weeks to determine whether or not they’re helping your child.
This is the first in a four-part series about reflux in kids. Watch this space for more on testing, symptoms and other related topics.