“I think my child has reflux”. I get asked this question countless times a week in my practice. It is a very common problem that is difficult to diagnose and the treatment remains controversial.
Young babies are susceptible to GOR - Gasro-Osophageal reflux - for three main reasons. Firstly babies spend most of their time asleep on their backs as a very well documented move to prevent Sudden Infant Death Syndrome. Secondly the valve between the stomach and the food pipe - the oesophagus - is very lax and only tightens at about 6 months and thirdly almost all feeds are liquid whether that is breast milk or formula.
I believe that all babies are born with reflux but the vast majority cope on their own with no problems and no need to see an early childhood nurse or doctor. However in a small number of babies - say less than 3% - the problem can be very severe and may well require medication to reduce the reflux.
In most babies the stomach begins to produce acid at about 8 weeks and peaks at about 14 weeks. As mentioned earlier almost all reflux settles down between 6 and 9 months of age. Most parents that present to me with their babies give a classic history of reflux symptoms. It is important to note that some babies may not have all symptoms at presentation. The most notable symptom is pain and screaming after feeds. This often includes back arching. Babies are often described as swallowing all the time and almost all of them have persistent hiccoughing. Day-time sleeps are often short lasting approximately 40 minutes. At the end of the day babies are exhausted and are described as very good night-time sleepers. Some but not all babies have vomiting which can have an acidy smell. Silent reflux is when babies have the above symptoms with no vomiting at all.
There are no investigations that are particularly helpful. Occasionally I might order a barium meal to exclude a structural problem with the airways and food pipe that the baby may have been born with. The treatment of reflux is through medicines and non- medical means. In terms of non-medical the options include thickening the feeds, using an anti-reflux formula (AR formula) and elevating the cot. The safest way to elevate the cot is by using a foam wedge placed UNDER the mattress as nothing should be placed on top of the mattress.
The most popular medication used is Zantac (Ranitidine) and Losec (Omeprazole). Both of these medicines are available as syrups although the Losec often needs to be obtained from a compounding pharmacist. The Zantac is an antacid and the Losec reduces acid production. They are often prescribed together in the beginning as the Losec can take up to 5 days to work. I generally commence weaning the medication from 6-7 months of age. It is important for parents to realise that the medical treatment of reflux needs to be under the supervision of a doctor, either your GP or Paediatrician.
Remember if you are concerned that your baby has reflux please ensure that you get professional help as soon as possible as no-one wants your baby to be in pain!