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What is infant reflux – gastro-oesophageal reflux?

Newborn baby crying looks like it is in pain with refluxInfant Reflux – Gastro-oesophageal reflux (GOR/reflux) occurs when food and stomach acid flows back into the oesophagus (food pipe), which can cause pain and discomfort.

The exact cause is unknown, but may be associated with an immature digestive system, hereditary factors, food sensitivities, and other medical issues which result in weakening of the valve between the stomach and the oesophagus.

For many children and their families, this causes no real problems, and may simply be a nuisance until it is outgrown. Although there can still be family strains and anguish prior to diagnosis, this form can often be successfully controlled by simple remedies such as thickened feeds, keeping the baby upright, and/or reassuring the parents.

If your baby is happy, eating well, and gaining weight, then there may be no need for any treatment. Reflux will resolve in most children by 12 to 18 months of age, with many outgrowing it well before then. There is a very small proportion who will continue to suffer from reflux beyond the age of 2 years.

There can be a more serious side to reflux in children. When the reflux causes complications or long-term problems, it is considered to be gastro-oesophageal reflux disease (GORD). It persists despite simple lifestyle measures and can, at times, be a serious medical problem. Medical intervention is often necessary, which usually involves the child having medication and/or investigations, and further treatments may need to be established.

There is a lot of confusion and misunderstanding surrounding GORD because it is still generally referred to as ‘reflux’ within the community, with no distinction made for its severity. As a result, GORD families often struggle to cope.

How does reflux present?

Reflux commonly presents with vomiting or posseting but there are other signs children can present with. Some babies have reflux without it coming out of their mouths (termed silent reflux) which can cause more damage, but be more difficult to diagnose.

The list below gives a general overview of some of the signs that may be displayed. A child with reflux will not necessarily display all of them, and the number of signs exhibited does not indicate the severity of their ‘reflux’.

  • Irritability/crying/screaming
  • Vomiting/regurgitating or posseting
  • Appearing to be in pain
  • Repeated hiccups
  • Hoarse voice
  • Feeding problems
    • refusal to feed or only taking a small amount despite being hungry
    • comfort feeding – feeding frequently
    • pulling away and arching their back
    • crying/screaming during or after feeds
    • gagging/spluttering
  • Sleeping issues
    • catnapping during the day
    • frequent night waking (though some refluxers do sleep well at night)
    • easily disturbed from sleep, or restless
  • Respiratory issues
    • Choking
    • Wheezing/coughing
    • Recurrent chest infections
  • Failure to thrive
  • Recurrent ear, throat, or sinus infections
  • Congestion, snuffling, or appearing to have a cold

If you suspect your child may have gastro-oesophageal reflux, or have any concerns, it is important to discuss this with your child’s doctor or child health nurse. It’s also important to note that there can be other reasons for their behaviour.

Management hints

  • Keep your baby upright for at least 30 minutes after a feed
  • Use products that help you to keep your child upright during the day; such as a baby sling, which keeps your hands free; baby jumpers etc. Avoid baby slumping
  • Try elevating the head of the cot/bassinet
  • Consider using a dummy
  • Avoid vigorous movements or bouncing the baby
  • The best time to lay your baby on the floor is when baby’s tummy is empty, i.e. before a feed
  • Change nappy before a feed. Take care to elevate the baby’s head and shoulders. Avoid lifting the legs too high, and turn to the side if possible
  • Avoid any tight clothing around the waist, such as tight nappies, elastic waistbands
  • Avoid overfeeding – if the baby vomits, wait until the next feeding rather than feeding them again
  • If the baby is bottlefed, it may be worthwhile trying AR (anti-reflux) formula, or a hypoallergenic one
  • Offer a spoonful of thickened milk (breastmilk or formula) following the feed
  • If breastfeeding, avoid foods that can aggravate reflux such as citrus, tomato, fatty foods, spicy foods, chocolate, and carbonated drinks
  • Some reflux children may suffer from food sensitivities, and may need dietary restrictions (or the mother may consider an elimination diet). If you suspect foods may be responsible for your child’s condition, it is essential to discuss this with your health care provider. Do not change your or your child’s diet before seeking medical advice.
  • Avoid exposure to tobacco smoke
  • Contact a reflux support organisation for further information and support. The effect on the baby AND the family can be devastating and support groups can provide more detailed information, and offer the emotional support you may need.

Effects on Families

Reflux is so common it is almost seen as ‘normal’, or even trivial, and most people just don’t understand how difficult life can be for many families, or understand the impact reflux can have on their lives! They may think of it erroneously as ‘just a bit of vomiting’, or ‘just a behavioural issue’. They don’t see how it impacts on the child’s eating, sleeping, growth, behaviour, or quality of life – or on the family’s quality of life, relationships between partners, siblings, or other children, finances, and even leisure time. The truth is, only families who have experienced it for themselves really understand.

Many families:

  • Have difficulty getting people to believe just how bad the vomiting and/or the screaming really are
  • receive conflicting and confusing advice
  • become socially isolated
  • feel like failures as parents
  • have family and friends who just didn’t understand

Even when a baby is suffering from relatively uncomplicated reflux, families often need reassurance, and enjoy talking to someone who understands. For the families whose infants suffer complications, it is even more important that they can talk to other parents, and have the support, reassurance and understanding they need to get through this stressful experience.

Survival Tips

  • Don’t expect that you have all the answers from the beginning – it is a really steep learning curve, and chances are you didn’t know much about reflux before this!
  • Babies are not born with a manual, and there are generally no right or wrong answers on how to best handle this. They are all individual, and what works for one may not work for another. It really is a matter of trial and error until you find something that works for you and your family.
  • Accept you are doing your best, and try not to be too hard on yourself.
  • Try to focus on what you are doing right, not on what you feel is going wrong. You aren’t doing anything wrong; you just may not have worked out the best answers yet.
  • Infants with reflux can be VERY high needs babies – only most family and friends don’t seem to ever understand that.
  • This is NOT your fault and you are NOT doing anything wrong!
  • Trust your instincts. Do what feels right for you and your baby and family, and do what works (but remember to discuss issues with your doctor first).
  • Look after yourself – not only are YOU as important as your baby, but who’s there to look after them if you fall apart?
  • Reflux can flare when anything stresses them – hot sticky weather is a common trigger, along with over-tiredness (vicious cycle), change in routine, colds, infections, teething, vaccinations etc. Sometimes it can help to know that, so that any changes make more sense.
  • Take each day as it comes, and just maybe it helps to know that life really can get better, no matter how hard it is right now. Remember though, if you aren’t coping, please ask for help, and seek medical guidance.

– this article was kindly provided by Reflux Infants Support Association (RISA) Inc

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3 Comments so far -
  • Renee Shilkin says:

    Your reflux article was excellent–as is all information supplied by RISA, who are an excellent resource and source of advice and information.
    I would like to add two comments from my experience as a doctor looking after reflux infants–especially with an interest in their ear problems and the many issues that may continue in later childhood.
    1. The infants who have problems from reflux seem to be the ones who have allergies/food sensitivities, etc. These have increased greatly in our community over the past 20 or 30 years.

    2. The earliest ear problems from reflux are often the development of negative pressure in the ear.
    This develops because irritation from reflux produces swelling and mucus in the back of the throat. This interferes with the Eustachian tube [the small tube connecting the throat to the middle ear] being able to keep the middle ear at normal pressure. This causes pain when the infant is sucking or lying down.
    Negative pressure in the ear isn’t easy to diagnose. It usually isn’t diagnosed by just looking at the ear. It needs the doctor to have a machine called a tympanometer to test the ear pressure. Audiologists have this equipment and can test even very young babies.
    After developing abnormal pressure in the ear, the problem can progress to fluid in the ear [glue ear] and/or ear infections. When the ear drum is red doctors can easily diagnose the ear infection, but it is harder to diagnose fluid being present especially in very young infants.

    When ear problems start early and are not diagnosed and treated early the child is at high risk of developing many later issues including a condition called Auditory Processing Disorder which can affect many aspects of their development–including later school learning issues.

    Obviously it is very important that these infants ear problems are diagnosed early and treated vigorously to prevent later issues.

    Because the majority of the infants outgrow their reflux the recommendation is often to ‘wait and see’, but this may not be good advice if the child has developed ear problems as well.

    Sometimes infants with reflux are treated with antireflux medication, but don’t improve much and the parents are told that the reflux isn’t causing the baby’s distress. Usually the distress is a combination of the reflux itself plus the infant’s allergies [food sensitivities] AND ear problems. All aspects of the problem need to be treated for the baby to become comfortable and settled.

    • Wow. Thanks for this extra info. Very important for parents who may not have known the link between reflux and ear issues. More info means they can ask more questions when they’re at their doctor. Thanks again! xx

    • Jasmyn says:

      Renee what are the signs to look for if ear problems are present? Very interested as I have a little 18 week old with silent reflux!

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