Reflux

What is reflux?

Reflux is when liquid from the stomach comes back up the esophagus (food pipe). It may come all the way back to the mouth causing the baby to "spit up".
    
Is reflux common?
It is common in babies under a year of age. It is even more common in preemie babies.
   
Why do babies have reflux?
Normally the muscles of the food pipe propel the food or liquid down to the stomach by a series of squeezes. Once in the stomach, the food or drink is mixed with acid to start digestion. When this mixing occurs, the mucles at the lower end of the esophagus should become tight keeping the food from backing up. In premature infants and some term infants these mucles are not yet fully developed and coordinated. They sometimes relax when they should be squeezing. This allows the liquid to come back up again.
    
Why is reflux a problem?
Because the liquid from the stomach is mixed with stomach acid, it can cause irritation to the esophagus. Also milk that is spit up can not help the baby grow.
    
How does a baby with reflux act?
A baby with reflux may have any or all of the following:
    
Spitting up often

• Apnea (breathing pauses). More frequent or more severe than expected for the age of the baby.
• Fussing or coughing after feeds
• Arching of the back or crying
• Poor growth
• Pneumonia from breathing the food into the lungs, or more difficult breathing

How does the doctor know if my baby has reflux?
Often it is suspected by the symptoms listed above. The doctor may do one or more tests also:

• A test where the baby swallows barium while a special x-ray machine views what is happening to the barium.
• A test where they monitor the acid in the lower part of the esophagus with tube with a special instrument on the end, called a pH probe.

How is reflux treated?

• Positioning - Usually with the baby placed on his/her tummy with the head of the bed up. This lets the stomach fall more foreward and its contents stay near the end of the stomach that joins the intestine. Avoid the slumped-over position. It makes reflux worse.
• Feeding changes - Thicken the feeds with cereal or more solid food. This milk mixture is thicker, heavier and less likely to go back up. Or, try a commercial formula with "added rice starch". Smaller amounts at a feeding with more frequent feeds.
• Medicines - Can reduce acid or improve the coordination of the muscles.
• Surgery - If none of the other things help, the baby is not gaining weight and the reflux is very severe, surgery can be done to tighten the area above the stomach.

How long will my baby have reflux?
Usually reflux improves slowly and is much better or gone by a year of age.