Reflux in Infants

BY LINDA STEVENSON, PhD, RN, FNP-C, PEDIAQ SENIOR NURSE PRACTITIONER

Reflux, seems like something only adults would have but it also occurs in infants. You feed your infant breast or formula, and either halfway through the feeding, or after the feeding he/she regurgitates what seems to be all that they ate. You may notice arching with or after feeding, or even gagging. Occasionally infants will begin to refuse their feedings – they may lose weight and are often irritable.

So, what is reflux (also known as GER, or gastroesophageal reflux)? The muscle between the esophagus and stomach called the esophageal sphincter should tighten after food comes down the esophagus into the stomach, but with reflux the sphincter doesn’t tighten and it allows gastric acid and formula to enter the esophagus. This is common in infants particularly in the first month of life. Since infants have increased intra-abdominal pressure, as they are unable to sit upright, spit-ups are frequent and common.  This is normal. But when your infant arches, acts fussy, and very uncomfortable after eating it is not considered normal. The good thing is that most children have resolution of their symptoms by the time they are 12 to 24 months of age.

What can you do? Most important is to have your pediatrician evaluate your infant. There are diagnostic tests that may be done or if your infant has classic symptoms they may be treated based on those symptoms. Once you have a diagnosis there are several actions that can be taken to help your infant.  One of the first is to not put your infant down to sleep until at least 30 minutes after eating, and when you do, have the head of your infant’s crib raised to at least 30 degrees.  This can be done with a foam wedge or by placing pillows under the mattress. Never place your infant on pillows, as this can increase the risk of suffocation. The pediatrician may start your infant on a 4-week trial of acid suppression to decrease the trauma from stomach acid to the esophagus. There are several different medications for acid suppression that can be used for infants – sometimes your pediatrician may trial one and then switch because your baby is not responding as well as expected.

Your pediatrician may change your infant’s formula or have you add rice cereal to thicken the formula. This frequently helps the regurgitation but may not eliminate it. Smaller more frequent feedings are helpful. Large volumes increase regurgitation and irritability. Hold your infant upright for 30 minutes after each feeding. Swings, car seats, or bouncy chairs, compress the infant’s stomach and can increase the risk of regurgitation.

In summary, healthy infants may regurgitate with no other symptoms, often called the “happy spitter”, it occurs frequently in the first month of life, decreases significantly by 5 months of age and is usually gone by one year.  If your infant has reflux that is being treated by your pediatrician and it has not resolved by the time your child is 18 to 24 months you may be referred to a pediatric gastroenterologist. Your infant may be referred earlier if they are very irritable, have a chronic cough or are gaining weight poorly.