Reflux and GER in Babies

by Brodie Williams

Reflux and GER in BabiesBabies cry -- it's a fact of life. These new beings are testing their lungs and communicating with us the best way they know how.

It's also a fact that babies will cry and spit up at some point.

Other babies seem to cry a lot but not at levels to be concerned about going to a doctor.

However, if your baby's hysterically crying for no apparent reason and won't stop or erupts like a volcano, gastroesophageal reflux might be the culprit.

Gastroesophageal reflux is a condition for both adults and children. With infants, when the lower esophageal sphincter (LES) opens, stomach contents often reflux into the esophagus and out the mouth, resulting in spitting up, and vomiting. GER can also occur when babies cough, cry, or strain.

Amount of Spit Up for Babies

About two-thirds of all babies have some degree of reflux. The spitting up doesn't bother these babies, dubbed "happy spitters." They're not in pain and they gain weight normally. It's more of a laundry problem than a medical one.

When we eat, the lower esophageal sphincter relaxes and allows food to enter the stomach. Then it closes tightly. In most newborns the sphincter is relatively lax. They frequent spitting up. This is called physiologic reflux.

It usually begins at birth or shortly thereafter, diminishes by six months and disappears by one year. According to Dr. Laurie Barclay, most "reflux" in this age group is not acidic because frequent feedings have buffered the stomach contents.

Spitting up becomes abnormal when it hurts the baby or causes health problems such as pneumonia, esophagitis or slow growth.

Is Your Baby Suffering from GER?

What makes the difference between the kind of baby referred to as a "happy spitter" and one whose parents seek medical attention?

Some call these babies "Scrawny Screamers." GER is particularly common in preemies and in babies with other health problems.

Babies suffering from gastroesophageal reflux seem to be in pain. Sometimes they spit up even hours after a feeding. They act hungry but when they start feeding they seem uncomfortable and take a break. They might grimace and swallow.

Clues that your baby suffers from GER and needs treatment include:

  • Frequent spitting up or vomiting (not all babies with GER spit up)
  • Painful cries
  • Excessive drooling
  • Stop-breathing episodes
  • Throaty noises: swallowing noises, choking, gagging
  • Poor sleep habits, night-waking as if in pain
  • Colicky, abdominal pain after eating
  • Writhing as if in pain: drawing up legs, arching back
  • Erratic feeding patterns
  • Projectile vomiting or as a your friend might say, "spits up like a volcano"

Treating GER and What Works

Parents who have babies that cry constantly, resort to hammock sleepers, positioning wedges, and a medical arsenal -- from gas-absorbers like simethicone to proton pump inhibitors like prevacid.

What can you do that actually works? Here are a few suggestions.

Feeding Your Baby

It's suggested that you feed your baby smaller amounts of food. During the feeding, it's also a good idea to burp your baby several times. They say this helps GER.

Along those same lines, changing your diet if you're breastfeeding or changing to a hypoallergenic formulas for bottle-feeding infants can also ease GER. Your pediatrician might also suggest thickening formula with cereal.

Breastfeeding and GER: Your otherwise healthy infant's cries could be caused by a sensitivity to cow's milk protein, soy or wheat. If cutting out those products hasn't worked, continue tweaking. Try taking out caffeine, chocolate and garlic, which are known to promote acid reflux.

"Rachel quit sleeping and started screaming when she was 10 days old. She'd arch her back and cry so hard she turned red. She was losing weight," Melissa, a Pregnancy.org mom shares. "I called La Leche League and the counselor suggested that I quit eating dairy for a few days. What a change! Rachel ate, and slept and got chubby (she gained a pound the following week)."

Positioning Your Baby

For the typical GER baby, changing what position your baby is in can be helpful. Allow gravity to help keep the food down.

For example, try holding your baby upright for at least 30 minutes after feeding. A front pack, backpack or sling can give free up your hands. At night, elevate the head of the crib with a few blocks or a wedge.

Try to discourage others from "vigorous play" with your baby right after meals. Casually mentioning that your baby tends to spit up can be the ticket to gentle handling. They've been warned.

Loose and Comfy Clothing

Avoid tight diapers and clothing, as they can add unwanted pressure on baby's stomach. A one-piece article of clothing with a non-restricting waist band prevents extra pressure on your baby's tummy.

For babies who don't respond to these measures, the next step is using medications to help ease the condition.

Medications

The types of medication your pediatrician might try include (always consult your physician before using any medications):

  • Drugs to lessen gas like Mylicon or Gaviscon
  • Antacids such as Mylanta and Maalox: Given three or four times a day with each feeding. They start working rapidly but the neutralizing effect lasts only a couple of hours or less.
  • Acid blockers such as Pepcid, Tagamet or Zantac: They can take anywhere from 30 minutes to a couple of hours to take effect, yet may last for 8 hours. They are usually given twice a day. If GER awakens your child give a dose one hour before bedtime.
  • Proton-pump inhibitors (PPIs) such as Axid, Nexium, Prevacid and Prilosec. These products reduce the production of acid by blocking the enzyme in the wall of the stomach that produces acid.

"Mary's tummy wasn't closing all the way. Stomach acid was coming up her esophagus and burning her. She was arching her back and screaming because it hurt," Elizabeth Soutter Schwarzer shares. "She wasn't eating because eating hurt. Our pediatrician put her on a prescription for Zantac. From that point on, our life with a newborn was redefined."

Are GER Medicines Safe?

A Food and Drug Administration review found an 11-fold increase in number of new prescriptions for PPI's dispensed between 2002 and 2009. These medicines aren't approved for infants with reflux, or GERD. Still, some doctors have been prescribing them off-label anyway.

"Gastric acid is an early line of defense against bacteria," said Eric Hassall, gastroenterologist at Sutter Pacific Medical Foundation in San Francisco. By prescribing acid reflux medication, the babies are at higher risk for pneumonia and gastroenteritis.

Advisers to the FDA have been looking at this issue. They say the limited data in infants suggest that PPI's are fairly safe, but there are reports of intestinal inflammation, and one study found a slightly increased risk of pneumonia.

Are you dealing with a reflux/GER baby? What's worked for you?


SOURCE: Eric Hassall MBChB, FRCPC, FACG. "Over-Prescription of Acid-Suppressing Medications in Infants: How It Came About, Why It’s Wrong, and What to Do About It." The Journal of Pediatrics (www.jpeds.com), DOI 10.1016/j.jpeds.2011.08.067.

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