Gastroesophageal reflux disease, or GERD, is a fairly common condition in infants. To be clear, almost all babies will have typical infant reflux, or “spitting up” to some degree, because their gastroesophageal sphincter muscles are still developing. More severe infant reflux will be painful, causing fussiness and sometimes interfering with successful feeding and weight gain.
Signs that an infant has more serious reflux issues are:
- Frequent spit ups, with crying and fussiness before, during and after spitting up
- Back arching during feeds
- Eyes watering during feeds
- Face turning red, along with grimacing and signs of pain during and after feeds and/or spit-up episodes
- Frequent hiccups
- Fussiness when lying down that improves when upright
- Baby refusing breast or bottle feeds
- Infant not meeting weight gain or growth goals at pediatrician visits
Most of the above symptoms are a direct response to the burning pain the baby feels when acidic stomach contents are refluxing up into the esophagus. In severe cases of reflux, the infant begins to develop a strong negative association of pain with breast or bottle-feeding. The infant will begin to refuse feeds in order to avoid this pain. This response becomes a learned habit, and over time, results in lower intake, slower weight gain, and dehydration in extreme cases. A baby who is refusing feeds can cause alarm for parents, who then might try forcing feeds in desperation, which can be distressing to the infant and cause further negative association with feeding. Parents should be aware of these signs of GERD and contact the pediatrician right away.
Diagnosis and Treatment of GERD:
Reflux is more common in premature infants since their gastrointestinal tracts are immature compared to term infants. It can also be a symptom of food allergies, in which case the infant may be allergic to the milk proteins in formula, or proteins from foods passing through mother’s breastmilk. In any case, a pediatrician can discern symptoms and diagnose GERD. Treatment protocols for infant GERD usually include a medication, such as ranitidine (also known as Zantac) or lansoprazole (also known as Prevacid). In some cases, the infant needs a special formula or mom may need to eliminate food allergens from her diet. A registered dietitian can help moms navigate special diet needs related to GERD, as well as ensure proper growth and transition to solids if these areas have been affected. Also, the pediatrician can educate parents on “reflux precautions”, which include feeding the baby at a more upright angle, not lying baby flat on their back after feeds, burping baby well, etc.
Sometimes the painful association of GERD creates long-term feeding issues with infants and kids. In these cases, children will continue to have “oral aversion” to eating. Signs of oral aversion stemming from reflux include difficulty transitioning to solids, very picky eating, refusal to put objects in their mouths in general, etc. If your child has signs of feeding difficulties, or if his or her growth has been impacted by GERD, contact North Shore Pediatric Therapy. A multi-disciplinary team including registered dietitians and speech therapists can work with your child to ensure adequate nutrition, growth, and development related to feeding skills.