Infant Regurgitation (Gastroesophageal Reflux)
What is infant regurgitation (reflux) ?
Regurgitation means the backward movement of stomach contents up the oesophagus (the "swallowing tube") into the mouth. Regurgitation often includes the release of the material from the mouth, as in infants who "spit up."
It occurs when the muscle between the oesophagus and stomach relaxes (as it does during burping). This allows the stomach material up because the normal pressure within the stomach is greater than the pressure in the chest and throat.
When regurgitated stomach material comes out of the mouth, it is often mistaken for vomiting, and may look exactly like vomiting. But technically, and medically speaking, vomiting is more forceful and uncomfortable. It usually includes nausea, retching, and gagging.
Is infant regurgitation normal?
Regurgitation is a symptom that is normal and common in infants. That is because of the very small volume that the infant oesophagus can hold and because of other factors, including their large liquid meals and the amount of time they spend lying down.
Infants who have a lot of regurgitation, but no actual disease, have a condition that is called functional infant regurgitation (or Physiologic Reflux). Functional means that the symptom is real, but there is no disease.
Should I worry if my infant regurgitates?
The evidence is that no matter what you do, functional infant regurgitation gets better by itself by the end of the first year in nearly all of those who have it.
It makes no difference whether the stomach contents come out the mouth, the nose, or both. Also, the apparent forcefulness of the material coming out cannot set apart functional regurgitation from non-functional diseases.
Projectile (or forceful) vomiting occurs in some serious conditions. But projectile regurgitation that looks like vomiting is also commonly seen in functional infant regurgitation.
Signs that something more serious may be going on would include your baby having problems gaining weight, crying excessively, problems feeding, problems breathing, or throwing up blood or bile (green colour).
What is the difference between GOR, GORD, and infant regurgitation?
It is important to know the differences between similar terms such as gastroesophageal reflux (GOR), gastroesophageal reflux disease (GORD), and functional infant regurgitation.
Gastroesophageal reflux episodes occur when stomach contents move backwards up into the oesophagus. Regurgitation episodes are when reflux actually reaches the mouth.
Everyone has episodes of reflux every day, but few people are aware of them. However, reflux does not cause harm in most people, because our bodies have defences against acid in the oesophagus.
Gastroesophageal reflux disease (GORD) refers to tissue damage or harmful symptoms that happen because of reflux. GORD is not common in otherwise healthy infants. GORD is common following preterm birth and in infants with chronic lung disease or cerebral palsy. Common problems due to GORD include:
Recurrent aspiration (inhaling) of refluxed material into the lungs
Inflammation in the oesophagus, causing pain, food refusal, or bleeding and anaemia (low red blood cell counts)
Failure to gain weight appropriately
Should I change formulas?
There is usually no reason to change formulas. The idea of changing formulas is usually because of suspicion of cow's milk protein allergy, which can present itself only with reflux symptoms. A healthy child with spit-ups is not likely to have protein allergy. If you are formula feeding, a hydrolyzed protein (hypoallergenic) formula may help. If you are breast feeding, a diary free diet for you for two-weeks is indicated.
What about lactose intolerance?
Lactose is the milk sugar. It is found also in human breast milk, so babies are born with the ability to digest lactose. Inborn Lactose intolerance is therefore quite rare in infants and usually happens after a severe infection of the small intestine. Lactose intolerance does not cause infant regurgitation.
The aim of the diagnosis is to determine if the baby has complications from the reflux causing it to be a disease rather than a normal physiologic condition. Diagnosis of gastroesophageal reflux disease is made by taking a medical history and physical exam. Testing is not usually needed. Some of the following tests may be done if your child doesn’t respond to treatment or if your doctor is concerned that something else may be going on.
Upper GI series (Barium swallow)- During an upper GI, the baby swallows barium from a bottle. The barium coats the oesophagus and stomach and makes it show up on the x-ray. It is a good way to make sure that there is no blockage causing the vomiting..
pH Metry- A pH probe is used to quantify gastroesophageal reflux. A small tube is placed through the baby’s nose and down into the oesophagus. A small sensor on the end of the probe detects acid when the child refluxes. The parents can push a button for markers when the baby is having symptoms so the doctor can see if they correlate with reflux. The pH probe lasts for 18-24 hours.
Gastroscopy- Although usually not required, it is the best diagnostic test to assess oesophagitis and exclude other diagnosis. It is usually recommended when there is a concern of other causes for feeding difficulties such as inflammation of the oesophagus.
Most babies with gastroesophageal reflux do not require treatment and will outgrow the reflux. Thickening the formula can often treat mild reflux. It also helps to hold your baby upright for 30 to 60 minutes after he/she eats. Placing the baby in a car seat or swing after eating may make the reflux worse. If the baby slides down and bends at the waist, the pressure on the abdomen could cause reflux.
Sometimes reflux symptoms are caused due to allergy to cow's milk protein and change of the mum's diet in breastfed babies, or changing formula is required.
If your baby is having more severe problems, he may need medicine to reduce the amount of acid produced by the stomach such as Omeprazole (Losec).
Do not overfeed
With overfeeding, the infant may become uncomfortable, and learn that regurgitation will make the abdominal discomfort disappear promptly.