Silent and not so silent Reflux

While reflux in new babies is relatively common, it can be distressing for new parents.

Typically reflux presents as a non-forceful regurgitation of milk and other stomach contents. Sometimes, as in the case of silent reflux, the milk doesn’t make it out of the baby’s mouth and is swallowed back down, so this can be harder to diagnose. In the first several months of life, infants take in huge volumes of feeds relative to their body weight. This is because they are growing and developing rapidly and they require a much higher calorie intake per kg body weight than older children or adults. A baby’s stomach is very small, and is sometimes unable to stretch to accommodate these volumes. Coupled with the fact the oesophagus in babies is relatively short, this makes it easy for stomach contents to overflow into the oesophagus and out of the mouth. This is often referred to as ‘regurgitation’, ‘spitting up’, ‘posseting’, ‘spilling’, or ‘vomiting’. This is usually effortless, but can be forceful. Approximately 85% of infants reflux and vomit during the first week of life and another 10% have symptoms by six weeks of age. Reflux is most common between one and four months old, but sometimes it can persist a little longer. Generally by the time your child is 12-18 months and settled on a diet of solids, reflux should be a distant memory.

How to know if your baby has reflux?

Regurgitation or spitting up is generally common and normal in most otherwise healthy, thriving, happy infants. In a typical case of reflux, your baby will regurgitate milk after some or all of their bottles. This may be accompanied by arching of their back, excessive crying, fussiness, and being unsettled when you lay them flat in their cot. A cough may also be present, caused by the irritation of the regurgitated milk, and can sometimes lead to a case of croup. If the reflux you are dealing with is silent, you may experience some or all of these symptoms bar the regurgitation of milk. Reflux can be particularly bothersome at night when your baby is lying flat, as it is easier for the milk to come back up the oesophagus, which can mean many nights of unsettled sleep. These symptoms can be very distressing to parents.

Most cases of infant acid reflux will clear up on their own, but there are ways to improve the symptoms, such as;

• Keep baby upright. Feed your baby in an upright position. Keep your baby sitting upright for 15 to 20 minutes after each feed. Be careful not to jiggle or move your baby too much while the food is settling.
• Try smaller, more frequent feedings. Little and often seems to help immensely. Feed your baby slightly less than usual if you’re bottle-feeding or cut back a little on the amount of nursing time if you’re breast-feeding.
• Take ample time to burp your baby. Frequent burps during and after each feeding can keep air from building up in your baby’s stomach. To burp, sit your baby upright, supporting his or her head with your hand. Avoid burping your baby over your shoulder, which puts pressure on your baby’s abdomen. Everyone has their own preferred way to burp a baby, but I find holding the baby upright on your lap, supporting their head, then slightly raising them off your lap and then back down is a gentle and effective method.
• Check the nipple. If you’re using a bottle, make sure the hole in the nipple is the right size. If it’s too large, the milk will flow too fast and will run down the baby’s chin. If it’s too small, your baby may get frustrated and gulp air. A nipple hole that’s the right size will allow a few drops of milk to fall out when you hold the bottle upside down.
• Change the feed. If you are formula feeding, switching to a thicker, ‘stay-down’ formula may improve symptoms. Be aware that you may need a larger nipple on the bottle for the thicker formula. If you are breast-feeding, eliminating certain foods from your diet e.g. dairy, on trial basis may be worthwhile also.

If there is no improvement following some lifestyle changes, further treatment may include:

• Infant Gaviscon. Infant Gaviscon sachets are available for sale over the counter in your pharmacy. These can be added to your baby’s bottle if formula feeding, or if breast feeding mixed with cool boiled water and given on a spoon or in a bottle after each feed. Add these in gradually, as these can lead to constipation.
• Prescription medication. If your baby is still uncomfortable, your Doctor may prescribe infant doses of medications commonly used to treat heartburn in adults. Choices may include H-2 blockers, ranitidine/Zantac oral suspension, or proton pump inhibitors, such as omeprazole/Losec Mups or lansoprazole/Zoton Fastabs. These medications come in liquid (Zantac) form or as soluble tablets and can be mixed with a small amount of cool boiled water and given to your baby once a day using a spoon or a paediatric syringe. Always get full instructions from your pharmacist on the dose, frequency and method of administration before you leave the pharmacy.

It is worth remembering that infant acid reflux is usually little cause for concern. Keep an ample supply of muslin cloths and always bring a change of clothes for yourself and your little one!
If you have any concerns you should always speak with your doctor as soon as possible.

Nuala can be reached at 027 63744, info@glengarriffpharmacy.ie, or call into Glengarriff Pharmacy any day of the week.