Feeding a baby is a lovely bonding experience, but it can also turn messy in a split second. You’ve just finished nursing or bottle feeding your little one, when suddenly a wet burp comes up, followed by a fountain of spit up drenching everything in sight. As a new parent, you worry – is this normal infant reflux or a sign of a bigger problem?
It turns out reflux is extremely common in babies due to the fact their digestive systems are still developing and maturing.
When we swallow, a ring of muscle called the lower esophageal sphincter (LES) opens to allow food into the stomach then closes to keep it there. But in infants, this sphincter is weak and underdeveloped, so it reopens easily and allows stomach contents to flow back up into the esophagus – aka reflux. This regurgitation of food is known as GER (gastroesophageal reflux).
GER is very typical in babies under 1 year old as their LES strengthens. However, excessive reflux that causes pain or feeding issues may be classified as GERD (gastroesophageal reflux disease), which warrants evaluation.
While the occasional spit up is no cause for alarm, understanding the difference between normal infant reflux (GER) and problematic reflux (GERD) requiring treatment is important.
What causes reflux in babies?
1. Underdeveloped Lower Esophageal Sphincter (LES)
In infants, the lower esophageal sphincter, a muscle that separates the esophagus from the stomach, is not yet fully developed. This muscle normally acts as a valve to prevent stomach contents from flowing back up into the esophagus. In babies, this underdevelopment can lead to occasional reflux.
2. Immature Digestive System
Newborns come into the world with immature digestive systems. Their stomachs are smaller, and their digestive processes are still developing. This can result in a greater likelihood of stomach contents flowing back into the esophagus.
3. Mostly Liquid Diet
Babies primarily consume a liquid diet, whether through breastfeeding or formula feeding. Liquid is more likely to flow back up the esophagus compared to solid foods, contributing to reflux.
4. Lots of Air Swallowed During Feeding
During feeding, babies often swallow air along with their milk, especially if they are bottle-fed. This excess air can increase the likelihood of reflux episodes.
5. Food Sensitivities or Allergies
Some babies may have sensitivities or allergies to certain components of breast milk or formula. When these substances are not tolerated well, they can lead to digestive discomfort, including reflux.
6. Anatomical Abnormalities like Hiatal Hernia
In rare cases, babies may have anatomical abnormalities that contribute to reflux. One such condition is a hiatal hernia, where a portion of the stomach protrudes into the chest cavity through an opening in the diaphragm. This can disrupt the normal functioning of the lower esophageal sphincter.
What are symptoms of reflux in babies?
Reflux in babies often peaks around 4 months and usually resolves by the first birthday. That said, it’s essential to consult a pediatrician if you suspect that your baby’s reflux is causing significant distress or interfering with their growth and development.
Symptoms to watch out for include:
- Frequent spit up or vomiting
- Wet burps or hiccups
- Difficulty eating or feeding issues
- Crying/fussiness during or after eating
- Refusing to eat or drink
- Arching back during or after feeding
- Frequent cough or gagging
- Discomfort when laid down after eating
Do pacifiers help reflux?
Pacifiers can satisfy non-nutritive sucking needs and provide comfort for newborns. However, research shows they do not significantly improve or worsen acid reflux and regurgitation in babies. More study is needed, but currently pacifiers are not considered an effective direct treatment for reflux.
The key is having overt, frequent reflux symptoms evaluated by your pediatrician. They can help determine if it is typical infant reflux that will resolve over time or if interventions are needed. While pacifiers may provide small soothing effects, managing underlying causes is most important.
Managing Reflux in Babies: Strategies for Relief
When it comes to treating reflux in babies, a combination of strategies can provide relief and improve your baby’s comfort:
1. Smaller, More Frequent Feedings
One of the simplest ways to reduce reflux symptoms is to feed your baby smaller amounts more frequently. Smaller meals can put less pressure on the lower esophageal sphincter, making it easier for your baby to keep food down. Feeding your baby on demand can be particularly helpful in this regard, as it allows you to respond to their hunger cues without overfeeding.
2. Keep Baby Upright During and After Feeding
After feeding, try to keep your baby upright for at least 30 minutes. This position can help gravity keep stomach contents from flowing back into the esophagus. Holding your baby in an upright position, whether in your arms or using a baby carrier, can also provide comfort and reduce the likelihood of reflux.
3. Thicken Feedings with Cereal
Some parents and healthcare providers opt to thicken breast milk or formula with infant cereal. The thicker consistency can help reduce the incidence of reflux episodes by making it more difficult for stomach contents to flow back up the esophagus. However, it’s essential to consult with your pediatrician before adding cereal to your baby’s diet, as they can provide guidance on the appropriate amount and timing.
4. Avoid Tight Clothing or Bending After Eating
Avoid dressing your baby in tight clothing that could put pressure on their abdomen. Additionally, it’s advisable to avoid activities that involve bending or lying flat immediately after feeding. These positions can increase the likelihood of reflux.
5. Medications Like Antacids or H2 Blockers
In some cases, pediatricians may recommend medications to manage reflux symptoms. Antacids, such as calcium carbonate, can neutralize stomach acid, while H2 blockers, like ranitidine, can reduce acid production. However, the use of medications in infants should be closely monitored and prescribed by a healthcare professional.
6. Switching Formula if Milk Allergy Suspected
If your baby is formula-fed and there’s suspicion of a milk allergy or sensitivity, your pediatrician may recommend switching to a hypoallergenic formula. These specialized formulas are designed to be gentler on sensitive digestive systems and can help alleviate reflux symptoms.
7. Surgery for Severe Cases
In extremely severe cases of reflux that do not respond to other treatments, surgical intervention may be considered. This is relatively rare and typically reserved for cases where reflux is causing significant complications or failure to thrive.
Remember that reflux is a common issue in babies, and most infants outgrow it as they develop. However, if your baby’s reflux is causing persistent discomfort, interfering with their growth, or if you have concerns, always consult your pediatrician. They can provide personalized guidance and treatment options to help manage your baby’s reflux effectively.