Normal Acid Reflux in babies or a more serious disease?

Burps and spitting up after meals are typical reactions for babies in the first months of their life. This is normal reflux, nothing to be worried about: your baby has just ingested air together with food or has eaten more than his stomach can hold and has spat out the surplus.

It is Acid Reflux, or GastroEsophageal Reflux, only if your baby spits large amouonts of food, not only immediately after feeding but also anytime, far from meals.

Acid reflux depends on the function of a muscle ring, a valve, that is called Lower Esophageal Sphincter (LES) and is located between the oesophagus and the stomach. This valve directs the food flow into the stomach and is normally tightly closed, preventing the stomach acids from refluxing into the oesophagus and mouth. When swallowing, the valve opens, letting the food float into the stomach. In babies, this muscle is not yet developed and is not enough strong to work properly. A wet burp or a little spit up is the result: food comes back up and brings some stomach acid within. In this form, acid reflux doesn't interfere with a baby's growth or well-being.

Recognize acid reflux

Acid reflux is very common in babies and, by itself, it is not dangerous: the problem usually disappears by the age of 12-18 months.

Apart from spitting, a baby with acid reflux may experience also vomiting, coughing, irritability, poor feeding and, sometimes, blood in the stools.

Acid Reflux or a more serious disease?

However, in some babies acid reflux may be a cause of more serious conditions, such as Gastroesophageal Reflux Disease or Pyloric Stenosis.

In Gastroesophageal Reflux Disease, acid reflux occurs very frequently, even far from meal, often accompanied by pain, vomit and poor weight gain.

Typical “spit signs” of a possible Gastroesophageal Reflux Disease are:

• copious pits, in which food and stomach acid shoot out of the mouth
• large amount of spit, more than a tablespoon or two at a time
• abnormal colour of spit, green or brown

Moreorever, the baby doesn't gain enough weight, or resists feedings but seems hungry between feedings or has other signs of illness, such as fever, diarrhea or difficulty while breathing. His diapers may be less wet and his voice may be chronically hoarse.

Acid Reflux and Feeding

To diminish infant acid reflux, in most cases simple changes in feedings are enough.

You may try to not overfeed your baby, giving him smaller but more frequent meals and interrupting them frequently to burp. Also holding your baby upright during feedings may help.

If you're breast-feeding, your paediatrician may suggest that you change your diet, avoiding certain foods that can result heavy or allergenic.

If a food allergy is suspected and you are feeding your baby with an alternate formula, you may change formula choosing another more hypoallergenic one or, at the same time, one which is more rich in nutrients.

The US National Digestive Diseases Information Clearinghouse suggests:

• If you feed your baby with a bottle, add up to 1 tablespoon of rice cereal to 2 ounces of infant milk. You can add cereal to expressed milk if you are breastfeeding. If the mixture is too thick for your baby you can change the nipple size or cut a little “x” in the nipple.
• Burp your baby after consumption of 1 or 2 ounces of formula. For breast-fed infants, burp after feeding on each side.
• Do not overfeed. Talk with your infant's doctor or nurse about the amount of formula or breast milk that your baby is consuming.
• When possible, hold your infant upright in your arms for 30 minutes after feedings.
• Infants with GER should usually sleep on their backs, as is suggested for all infants. Rarely, a physician may suggest alternative sleeping positions.

Source:

• The Mayo Clinic - Infant Acid Reflux
• The Pediatric/Adolescent Gastroesophageal Reflux Association
• The National Digestive Diseases Information Clearinghouse - Gastroesophageal Reflux in Infants