Gastro-oesophageal Reflux in Infancy

Blergggh!! Regurgitation in young infants - should I be worried?

By Dr. Alvin Khoh, Consultant Paediatric Gastroenterologist

Gleneagles Kota Kinabalu Hospital | Tel: 088-518 888

A newborn baby!

Congratulations all around! The birth of a child is definitely a joyous occasion for the family. One can spend hours just staring at a newborn baby - watching every expression and every movement that the baby makes. And then suddenly, the baby regurgitates out its milk! And not for the first time. The baby seems to regurgitate various amount of milk every now and then.

The above scenario happens quite frequently to many newborn babies and causes a lot of distress among parents. Various unhappy thoughts would often come into mind: Will my baby have enough milk, since he seems to “vomit” everything out? Will my baby grow well? Am I feeding my baby correctly? Is there anything wrong with my baby’s digestive system? Will the milk go into my baby’s lung and cause damage? Should I change formula? Thankfully, for the majority of these babies, these episodes of regurgitation are not harmful to them.

Gastro-oesophageal reflux (GOR) is a common condition and is a normal phenomenon in healthy babies. Reflux happens when there is movement of stomach content back up into the oesophagus. The oesophagus is the food tube that carries food from our mouth into our stomach. When reflux happens in babies, the milk may regurgitate all the way up into the mouth. This manifests as regurgitation or “posseting”.

Many parents often perceive these episodes of regurgitation as vomiting. From a doctor’s perspective, vomiting occurs when there is a forceful contraction of the stomach, leading to emptying of the stomach content out through the mouth. Usually, vomiting is a symptom of an underlying illness.

Compared to vomiting, the process of regurgitation is effortless and occurs spontaneously. Some babies regurgitate more than others - this does not necessarily mean that anything is wrong. It does not harm your child and is unlikely to cause problems in later life.

Why does reflux happen in babies?

The lower oesophageal sphincter (LES) is a muscle the closes the oesophagus from the stomach after we swallow. In babies, this muscle relaxes more frequently, thus allowing the stomach content to reflux upwards into the oesophagus. Studies have shown that a healthy baby can reflux up to 30 times a day, although not all reflux leads to visible regurgitation. Most babies tend to regurgitate at least once per day, although in some, it can be as frequent as after every feed. It mostly happens after feeding, but it can occasionally occurs at other times, e.g. after coughing or crying.

For most babies, you don’t have to do anything about reflux and regurgitation. It is a natural process and will resolve by itself with time. This is because as the baby grows, the oesophagus gets longer, the stomach grows larger and more importantly, the lower oesophageal junction also becomes more mature and stronger. After 6 months of age, an infant also starts to take more solids and spend more time sitting upright, and this will also lead to an improvement in symptoms. Generally, the problem disappears around 1 year of age.

When should I worry about my baby’s reflux?

Generally, if parents have any concerns or uncertainty about their baby, they should seek medical advice. You should also seek treatment if your baby has the following:

• blood or bile (greenish) in the vomit
• fever, unwell, irritable
• choking episodes
• breathing difficulty or fast breathing
• not gaining weight or losing weight
• feeding refusal

What is the treatment for reflux?

In most babies with reflux, there is NO need for medical treatment. As mentioned before, reflux is a normal phenomenon and will get better over time. However, the following practice may help in some

babies with frequent regurgitation.

You should regularly burp your child after each feed. In babies with more frequent regurgitation, some parents find it helpful if they stop and burp their baby midway, or hold the baby upright for 20 to 30 minutes after each feed. You can also try giving smaller and more frequent feeds, but definitely avoid overfeeding, especially with bottle-feeding.

Changing from breastfeeding to bottle feeding/formula is NOT RECOMMENDED as it does not have effect on reflux. If your baby is already on infant formula, it is also not recommended to routinely change formula for the same reason. There are some special infant formulas in the market that may reduce the frequency of visible regurgitation, but it is generally better to consult your doctor first before switching formulas.

Gastro-oesophageal Reflux Disease

In a small percentage of babies with reflux, it can lead to problems. This is when doctors call it Gastro-oesophageal Reflux Disease. These babies may have breathing problems due to milk aspiration, or sometimes poor weight gain. In these group of babies, the doctor may start some

medication or suggest the use of a special thickened infant formula.

Conclusion

Regurgitation or reflux is a common problem in young infants. In most cases, it does not cause harm to them and will improve with time. It does however cause parents to be distressed and often leads to

tired parents from constant washing and mopping up. It is best to seek professional advice is you are worried about your baby’s condition.


Please feel free to call Gleneagles Kota Kinabalu Hospital 088-518 888 should you need more information or advice regarding to this topic.