GERD and Reflux in Babies – Causes, Symptoms & Treatment by Dr. Srikanta J T

GERD (Gastroesophageal Reflux Disease) is a digestive disorder that is chronic in nature. It is more serious than acid reflux. It is also long-lasting in some cases. GERD is when the acid reflux is more frequent and long-lasting. In case of a baby, if the reflux does not subside even after 12-14 months of age, and prevents them from feeding properly, it is a cause for concern.

How Common Are GERD And Reflux?

Reflux is very common in both children and adults, GERD on the other hand is not. It is the next step of reflux when the issue does not resolve on its own and causes more trouble.

In most cases, it can be just severe reflux, which will subside on its own. In very few cases it actually progresses to GERD. Only a small percentage of babies who suffer from acid reflux an infant is diagnosed with GERD as they grow up.

Causes of GERD And Acid Reflux in Infants

In the case of infants, the ring of muscles between the esophagus and the stomach is still very immature. The muscle is responsible for retaining the stomach contents and not letting it go back up. Since these muscles are not fully mature yet, the muscles open up at other times too, causing the contents to flow back upwards.

The following factors contribute to the reflux episodes.

• Premature birth
• Mostly on a liquid diet (infant are on a milk only diet until 6 months of age, so this is a major contributor)
• Lying in a flat position most of the time, especially after a feed

Some of the more uncommon and serious causes could be

• Cystic Fibrosis i.e damage or defect in the lungs
• Cerebral Palsy, a condition that affects the nervous system.
• Previous surgeries to correct a birth defect called esophageal atresia.
• Hiatal Hernia

Signs And Symptoms of GERD And Reflux in Babies

If you notice your baby be experiencing or suffering from the following, it could be reflux or even GERD.

1. Bad breath
2. Severe damage to the teeth enamel due to stomach acids (Does not happen in case of infants with no teeth)
3. A sudden burning sensation in the throat when they try to burp
4. Feels like stomach contents are coming back up into the throat or mouth
5. Pain or discomfort in the chest due to indigestion
6. Dry cough
7. Asthma
8. Difficulty in swallowing
9. Constantly burping or belching
10. Gagging or unable to eat or drink
11. Choking
12. Constant vomits
13. Fits of cough at night
14. Fussy during meal or feed times
15. Hiccups

How Are GERD And Reflux Diagnosed?

The doctor will confirm a GERD diagnosis, in the following ways.

1. Chest X-Ray

Your doctor will ask for a chest X-Ray to check for aspiration. It is when the stomach contents move up into the lungs.

2. Barium Swallow

In this test, the top parts of your child’s digestive system will be checked. The top parts of the small intestine, the stomach, and the food pipe will be checked by making your child swallow Barium – a metallic fluid. This Barium will coat the organs as it moves down the system. Once coated, the organs will be clear on the X-ray and any ulcers, or sores will become prominent.

3. Endoscopy

In this test the inner part of the digestive tract is checked. An endoscope is a small flexible tube, which is inserted into the digestive tract. The tube has a camera and light attached to its head. This will allow the doctor to see the insides of the digestive tract and if needed tissues can be collected for testing.

4. Esophageal Manometry

In this test the strength of the esophagus muscles will be put to test. It will help identify any issues your child might have with swallowing or reflux. A small tube is inserted into the esophagus, through your child’s nostril. Then it will measure the pressure of the esophageal muscles when at rest.

5. pH Monitoring

A tube is inserted into the esophagus through the nostril. This tube has a sensor to measure the pH levels. The other end of the tube, which is outside the body, is attached to a monitor. Now, the pH levels are recorded for 24 – 48 hours. Your child can carry on with their normal activities.

The aim of the test is to see how the body functions and how the pH levels change with regular activities. The doctor will ask you to keep a detailed record of what food is consumed at what time and if your child is showing any symptoms of reflux. All this data along with the readings of the pH level will be compared to make a diagnosis.

6. Gastric Emptying Study

The time taken for gastric emptying is studied. A delayed emptying can cause reflux and GERD.

[Read : Gas in Babies]

Risk Factors For Baby GERD

Not all babies go through acid reflux or suffer from GERD. However, all babies are born with an immature system. So, why do some babies get it while others don’t? Why are some children more prone to GERD than others?

Here are some factors that can make some babies more prone to GERD than others

• Parents have a history of reflux or GERD
• Premature birth
• Neurodevelopmental issues
• Congenital food pipe disorders
• Asthma
• Obesity
• Hiatal Hernia
• Epilepsy

[Read : Epilepsy In Babies]

Treatment For Acid Reflux in Babies

Small changes to the diet and lifestyle is enough to treat acid reflux and GERD. You will have to take care of what your child eats and how they eat it. Since we are discussing babies, the diet is mostly restricted to milk or semi-solids.

Here is how you can get the reflux situation under control

• After feeding your baby, hold them up for a while and burp them well. Do not let them lay flat on the bed immediately after a feed.
• If your baby is on bottles, ensure the bottle is angled in such a way that the nipple is always filled with milk. When there is not enough milk, the baby will suck in a lot of air, which can cause reflux. If the bottle is not working, try a different teat or a bottle itself.
• You can add rice to the cereal you feed your baby. It reduces the liquid consistency, thereby reducing the flow back.
• If your baby is on semi-solids and solid foods, ensure they are not eating too much junk or fried food items.
• Offer smaller portions of food at regular intervals. Having one large meal makes it difficult to digest.
• Apart from these simple changes you can do yourself, severe cases will require medical interventions.

There are many medicines, calorie supplements, or even surgery to reduce the severity of GERD. If you feel your child has a serious case of GERD, consult your paediatrician. They will be able to guide you to the specialist concerned or prescribe medicines accordingly.

Do Infants Outgrow GERD?

Yes, most of them do. As their digestive tract matures and learns to hold down the food particles and not throw them back up along with stomach acids. Different babies take different times for this to happen.

In very few cases, the reflux does not subside on its own and the child might suffer from GERD even after they grow up. This is a very small percentage, and these children might need medical assistance to get over this digestive issue.

How Long Does Baby GERD Last?

In most cases, it should not last more than a few months. GERD can last anywhere between a few months up to 14 months. If it does not subside on its own, you need to consult a concerned specialist to rule out other complications, and to decide on the next step going forward.

Complications of GERD

GERD may not really harm your child in the long run, but in some cases, the following complications can arise.

• Inability or difficulty in gaining weight
• Respiratory issues
• Inflammation in the esophagus

Feeding Advice For Reflux in Babies

If your baby is suffering from acid reflux, here are a few tips to help it get better if not cured.

• Never over-feed your baby. If you are breastfeeding and your child is suffering from reflux, consult your doctor and limit your feeding sessions based on time.
• Never put the baby down on any surface, after milk, without burping.
• Don’t let the baby lay flat, immediately after a feed. Always keep their head elevated a little, to prevent the contents from sliding back up.
• If you notice certain foods you consume are causing this reaction in your baby, try avoiding those foods and observe the baby.
• If your baby refuses food or says no after a few mouthfuls, respect it. Your baby is refusing food because of a reason valid to them. Do not force-feed them.
• Do not give them too much liquid. Give them semi-solids, as they may not flow back easily.

Home Remedies And Lifestyle Changes to Neutralise Baby Acid Reflux

If your baby is suffering from acid reflux, here is what you can do at home.

• Eat smaller meals
• Avoid smoking around the child
• Maintain a healthy weight for the baby
• Let them crawl or move around after a meal
• Do not put them to bed immediately after a meal or feed
• Don’t dress them in tight clothing
• Breastfeed as much as possible
• Give them a ripe banana after a meal
• Burp them frequently

GERD and Acid reflux are common digestive issues that will subside on their own. Very rarely do they become chronic and keep troubling the child even after they grow. Sometimes you need professional guidance and getting it at the right time might save you a lot of trouble.

FAQ’s

1. Does Acid Reflux Happen Only in Babies Eating Solids?

No. It can even happen to a newborn who is still on breast milk. It is more common with a liquid diet.

2. Should I Avoid Certain Foods if I am Breastfeeding My Child Suffering With Reflux?

Yes, you may have to. If certain foods are triggering reflux in your child, you need to avoid them.

3. Is GERD or Acid Reflux Hereditary?

No, they are not. However, if you have a history of reflux, your child is only in the risk category.

Read Also: Infant Choking – Hazards, Symptoms, Prevention And First Aid