Continuing our hugely popular column Medical Matters, Dr Ciaran Roarty of Scally/McDaid Medical Practise addresses the issue of Child Reflux.
Reflux (or gasto-oesophageal reflux to give the full title) is very common in babies and young children.
Bringing up a small amount of milk after feeding without any other symptoms is known as posseting and is harmless in young infants.
It is thought to affect half of all babies. Sometimes the infant may actually vomit a larger amount of milk/food.
This is more common in premature babies or low-birth weight babies and is usually due to the muscle at the bottom of the gullet ( oesophagus) being too relaxed. It is also seen more commonly in babies or children with cows milk allergy.
When reflux is accompanied with troublesome symptoms such as reduced weight gain, distress or excessive/unexplained crying we call it gastro-oesophageal reflux disease (or GORD).
This is thought to occur because the lining of the gullet can be irritated by the acidic stomach contents. Reflux can occur in either bottle fed or breast-fed babies.
Symptoms of reflux
Many babies and children regurgitate food into their mouths, and often this the only symptom. Other troublesome symptoms described can be similar to colic and include excessive uncontrolled crying, pulling the legs up towards the abdomen and pain in the tummy after feeding.
This may lead to refusing food in older babies. Very uncommonly there may be blood in the nappies or vomit. Children who are a little older may be able to describe heartburn – or bad tasting fluid coming into their mouths. Some babies with troublesome reflux may not put on weight as expected and be more irritable. Sometimes it can even cause babies to sound wheezy.
How does the doctor diagnose troublesome reflux ( or GORD)?
Usually, your doctor will be able to diagnose this by taking a thorough history from mum ( or dad) and examining your baby. It may be useful to record for the doctor how much food your child is taking and how often they regurgitate their food. In rare cases, if symptoms are severe, it may be necessary to refer to baby for further tests in hospital.
How is it treated?
Bringing up small amounts (posseting) of milk after feeding without any other symptoms is not a cause for worry in young infants and this is not usually investigated or treated.
If your baby is otherwise well, reflux will improve with time and specific treatment is not usually needed. Your doctor may want to keep an eye on your babies weight to ensure that it is increasing as expected (bring your baby’s orange giraffe book with you to see the doctor if this is the case as they may wish to plot the weight on the graph in the book).
The doctor may also suggest raising the top of the cot slightly ( but still lay your baby on their back to sleep) or increasing the frequency of feeding with smaller volumes each time. Some babies can have symptoms of reflux due to cows milk allergy and eliminating cows milk derived formula/feed from their diet for 2 weeks will result in a substantial reduction in vomiting, if cows milk allergy is the problem.
If there is no change then cows milk allergy is unlikely to be the cause. For breastfed babies mum must eliminate cows milk from their diet for this trial 2 week period.
Your doctor may advise thickening products to thicken your babies milk and help it stay down. You should really talk to your doctor before trying this and remember the hole in the teat must be bigger.
For more severe reflux symptoms specific anti-regurgitant formula may be prescribed and you will be advised to give these for 6 months and not mix with any other medication.
Gaviscon powder may be prescribed to mix with your baby’s milk (or water for breast-fed babies) and works to thicken the contents of the stomach as well as help form a protective coating over the lower gullet.
In the vast majority of cases children do not need other medicines for their reflux but in some cases, it may be necessary to prescribe specific medications to help reduce the acid in your baby’s tummy.
Thankfully the vast majority of babies with reflux grow out of it and it usually is gone by 18 months, even without any treatment.
The above information is intended as advice only and should you have any concerns contact your own Doctor.
Dr Ciaran Roarty MB BCh BAO MICGP DRCOG is a full-time GP at Scally McDaid Medical Practice , Scally Place, Letterkenny, Tel 0749164111