Ask An Expert: Infants and Acid Reflux

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Ask An Expert: Infants and Acid Reflux

Question:

My niece's infant son has acid reflux. Is there any way to help control this in a child so young?

Answer:

Gastroesophageal reflux symptoms are very common in otherwise healthy infants during the first several months of life. It is caused when stomach contents, including acid, backwash into the esophagus, oftentimes in the form of a wet burp or a little spit up.

Acid reflux occurs when the muscular ring where the esophagus reaches the stomach — the lower esophageal sphincter — becomes relaxed. Most of the time, this ring only opens for swallowing and belching. On the other hand, the sphincter cannot close tightly in gastroesophageal reflux, which means backwash of stomach fluids. The acidity of this fluid irritates the esophagus; it becomes inflamed, causing the common symptom of heartburn.

It is best to try to prevent the backwash in order to reduce the pain and discomfort of reflux in young children:

• Try to keep babies upright when feeding and for about 30 minutes after meals.

• If recommended by a doctor, place babies on their stomachs after feeding, at a 20% to 30% incline with the head up (do not use a pillow or have babies sleep this way because it increases the risk of suffocation and sudden infant death syndrome).

• Feed babies slowly with frequent small meals throughout the day.

• Avoid overfeeding, tight diapers and waistbands; they increase abdominal pressure, making reflux worse.

• Burp babies often and avoid bouncing them; sway gently instead.

Exposure to cigarette smoke causes further weakening of the lower esophageal sphincter and can therefore increase reflux. Since liquids reflux more than solids, talk with your doctor about thickening with one tablespoon of cereal per ounce of formula. Breast milk is best for babies with reflux.

Most infants outgrow reflux in the first year or two of life, but if symptoms still persist or worsen, the baby should see a doctor. You should call the doctor immediately if the baby vomits blood or has trouble breathing. Talk with the doctor if your baby is not gaining weight, is dehydrated, or has pain when spitting up. Other complications include increased risk of respiratory infections, especially middle ear infections, and aspiration pneumonia.

If the baby shows any signs of severe symptoms or complications from reflux, the doctor may opt to perform tests to detect problems related to gastroesophageal reflux. The doctor can also recommend medicines. In severe cases when this does not help, the doctor may suggest surgery.

Henry (Hank) Bernstein, D.O. is a Senior Lecturer in Pediatrics at Harvard Medical School and Professor of Pediatrics at Dartmouth Medical School. Formerly the Associate Chief of General Pediatrics and Director of Primary Care at Children's Hospital Boston, he currently is the Chief of General Academic Pediatrics at Children's Hospital at Dartmouth. He has extensive and varied experience as a primary care pediatrician, and is a spokesperson for the news media on a variety of pediatric health care topics, including vaccination, common childhood illnesses, and practical information for caregivers.

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Last updated:	January 24, 2007