Infant Reflux

07.02.2018

Has your little one ever spit up after a feeding? This may occur even an hour or two after eating. Maybe he burped and something consequently gave him a sour face? Or he started to move his tongue in and out for example, and then you noticed him swallow? If so, he was likely experiencing reflux.

What is Reflux?

Gastroesophageal Reflux (GER), simply referred to as reflux, occurs when contents from the stomach go back up in to the esophagus (the muscular tube that connects the throat to the stomach). Then, the contents are either pushed back down to the stomach or move up the throat, subsequently becoming spit up or sometimes vomit. Dr. Kay Toomey, pediatric psychologist, reports that children and adults may reflux up to five times following a meal, however, it typically does not bother them.

Is Reflux Normal?

Most infants have reflux. This occurs because the opening from the lower esophagus to the stomach does not mature until a baby is close to one year of age. It has been reported that as many as 60-70% of babies at 3-4 months of age experience vomiting related to reflux at least one time in a 24-hour period. Additionally, Gastroesophageal Reflux tends to peak in infants around 4 months and spitting up tends to decrease around 12 months.

For many infants this does not cause problems. They do not experience fussiness when they spit up, continue to gain weight appropriately, and stay on track to meet developmental milestones.  However, when complications arise from reflux it is referred to as Gastroesophageal Reflux Disease (GERD). Above all, if left unmanaged, GERD may lead to: failure to thrive, respiratory infections and/or possible asthma. Furthermore, it could also lead to scarring or strictures in the esophagus, ulcerations and inflammation of the esophagus. Sandifer syndrome (a combination of GERD and abnormal movements of the back and neck that may look like your little one is having a seizure), or feeding aversions to bottle, breast, and solid foods are also complications which may occur. In addition, as children get older they may be called “picky eaters” or limit what they eat due to discomfort or pain.

Do Infants With GERD Always Spit Up or Vomit?

In short, infants with GERD may not spit up or vomit every time they experience reflux.

Indications Your Infant is Experiencing GERD

  • Difficulty latching or staying latched on a bottle or breast
  • Aggressively attacking the nipple for 1-2 ounces then pulling away, arching back and crying
  • Prevalent coughing, choking, wet burps, or consequently, aspiration (when fluid enters the lungs)
  • Wheezing, difficulty breathing, as well as frequent upper respiratory infections
  • Coughing when laying on their back during naps or at night
  • Being irritable and fussy
  • Preferring to be fed in a more upright position
  • Arching their back or making a bobbing motion with their upper body
  • Not rolling over when developmentally appropriate
  • Failure to gain weight
  • Difficulty transitioning to solid foods

Signs and Symptoms Older Children are Experiencing GERD

  • Have difficulty gaining weight
  • Are described as a “picky eater”
  • Limit the volume of liquids and/or solid food
  • Prefer to “graze” throughout the day
  • Vomit or report yucky tastes in their mouth
  • Complain of discomfort in their chest or stomach
  • Exhibit swallowing difficulties
  • Have breathing issues such as asthma, wheezing, hoarseness, chronic coughing, or frequent upper respiratory infections

There are a variety of strategies to help with reflux, however, if signs/symptoms persist or worsen, such as the ones listed above, then your pediatrician may consider medical management or referral to a pediatric gastroenterologist. For additional information on reflux, MOSAIC has competent feeding therapists that can address your questions and assist your family if your infant or child is having difficulty with eating at any age.

References used for this article:

  1. Citroner, G. Medically reviewed by Gill, K. ((2017, November 20). Sandifer Syndrome. healthline. Retrieved from https://www.healthline.com/health/sandifer-syndrome.
  2. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Foundation for Children’s Digestive Health and Nutrition in collaboration with the American Academy of Pediatrics (2018). Parent’s Take Home Guide to GERD (Gastroesophageal Reflux Disease). Retrieved from https://patiented.solutions.aap.org/handout/aspx?gbosid=201474
  3. Schwarz, S.M., & Hebra, A. (November 17, 2017). Pediatric Gastroesophageal Reflux: Practice Essentials, Background, Etiology, and Pathophysiology. Medscape. Retrieved from https://emedicine.medscape/com/article/930023-overview
  4. Toomey, K. A. (2002/2010). Consequences of Gastroesophageal Reflux and Breastfeeding. Colorado Breastfeeding Update.
  5. Toomey, K. A. (2002/2010). Developmental Timeline with Reflux.