What is reflux?
Reflux, also known as possetting or spitting up, happens when the milk your baby has swallowed comes back up into his food pipe (esophagus). The full medical term for this is gastroesophageal reflux or GER.
Your baby’s stomach contains acid that helps him to break down his milk. This mixture of milk and acid can come up and may make your baby uncomfortable. If you’ve ever had heartburn, you’ll know the burning feeling that acid reflux can cause.
Reflux is messy and may be frustrating, but it’s normal for babies and isn’t usually a sign of illness. At least 40 per cent of babies get it, with five per cent of these having six or more episodes a day. Reflux is a temporary problem that usually gets better as your baby’s digestive system matures.
However, a small percentage of babies have troublesome, severe or persistent reflux (gastroesophageal reflux disease or GERD).
What causes reflux?
Your baby’s food pipe (esophagus) connects his mouth with his stomach. There is a valve, controlled by a ring of muscle, where his food pipe joins his stomach. When your baby eats, the valve opens to allow the milk through, then closes to keep it in his tummy. As this ring of muscle is still developing, it doesn’t always work properly. This means that when your baby’s tummy is full, milk and acid can come back up the food pipe, causing discomfort.
Bear in mind that your baby’s stomach is still tiny, so he may not be able to have much milk without some of it coming back up. When he’s a newborn, his stomach will only be about the size of a hazelnut. By day three, this will have increased to about the size of a walnut. Even by day 10, it will still only be about the size of a large hen’s egg.
Over time, the muscular valve at the entrance to your baby’s tummy will get stronger. Along with his growing stomach capacity, this means that your baby will grow out of reflux. 90 percent of babies who have it get better on their own before the end of their first year.
How will I know if my baby has reflux?
Your baby may bring up small amounts of milk (possetting) or occasionally vomit after eating. He may also have hiccups and cough and splutter a little.
This is normal and, as long as your baby is otherwise well, you don’t need to worry. Just make sure you always have a tissue handy.
How can I prevent reflux?
If your baby’s reflux is mild, and he’s still feeding well and isn’t too upset by it, these tips may help:
- Feed your baby in an upright position.
- Hold your baby upright for 20 minutes to 30 minutes after each feed.
- Try giving your baby smaller, but more frequent, feeds.
- If you bottle-feed your baby, burp him every two minutes or three minutes during feeds, and make sure that the hole in the teat isn’t too large. A teat that’s too big can cause milk to come out too fast.
When should I take my baby to see a doctor?
Bringing up a little milk or occasional vomiting after feeds is nothing to worry about. But speak to your health visitor or doctor if you notice that your baby:
- has frequent reflux
- is irritable during or after feeds, crying and arching his back
- regularly vomits large amounts up to two hours after feeding
- is bringing up green or yellow vomit, or vomit that has blood in it, which will look like coffee grounds
- starts to fuss or refuse feeds, but will suck on a pacifier, if you use one
- seems to have a sore tummy or throat
- isn’t gaining weight
Keep a diary of your baby’s reflux to take to the doctor with you, if you can. Make a note of:
- when your baby feeds
- when he has bouts of crying
- how often and how much he’s bringing up
This information will help your doctor to decide whether other problems could be involved.
Are there any treatments for reflux?
If your baby’s reflux is severe or troublesome, your doctor may advise a Proton-Pump Inhibitor (PPI). PPIs help to block the enzyme in the wall of the baby’s stomach that produces acid.
Most of the time Zantac (Ranitidine) is prescribed as the first line of defense against reflux. Another form of the same medication is Prevacid. It’s the pediatrician’s personal choice, however, most peditrician’s commonly prescribe Zantac now a days as it decreases gastric acid secretions as opposed to completely blocking the production of acid in the stomach.