What is Reflux and how do I identify it?

40-60 Percent of all infants suffer from baby reflux

Although Doctors are still unsure exactly what causes colic in babies, they now believe that gastroesophageal reflux (GER), or baby reflux is the most common cause. It is estimated that between 40 and 60 percent of all newborns have some degree of baby reflux in the early months due to an undeveloped lower esophagus sphincter (LES). That means that half of all newborn babies experience physical distress due to stomach acid in the esophagus.

Silent Reflux in Babies is Hard to Detect

A baby does not need spit up in order to experience baby reflux. This is called baby silent reflux and many of these babies will be mistakenly diagnosed with colic.  Silent reflux can be more painful for your baby than spitting up since the acid burns on the way up and on the way down, causing twice as much discomfort and damage to the throat.

What is Baby Reflux?

Baby reflux is the regurgitation, or spitting up of the stomach’s contents and painful acids due to an immature muscle connecting the stomach and the esophagus or reaction from something in the diet. It usually begins at birth or shortly thereafter, diminishes by 6 months and disappears by one year. A reflux baby is not to be confused with a GERD baby (gastroesophageal reflux disease). GERD is a serious condition that can require surgery to correct. A reflux baby may or may not exhibit these symptoms of reflux in babies.

While every baby is different there are many common symptoms of acid reflux in infants. Your baby may exhibit few or many symptoms of acid reflux in infants. The number of symptoms he exhibits may be unrelated to the severity of acid reflux in infants he may be experiencing. This is not a comprehensive list of symptoms of acid reflux in infants.

  • Poor weight gain or rapid weight gain
  • Frequent spitting up or gulping with a painful look on the face, as if heartburn
  • Projectile vomit, sometimes out the nose
  • Sour breath
  • Persistent hiccups or cough
  • Excessive fussiness, crying or colic
  • Sudden bursts of painful crying
  • Poor day and/or nighttime sleep habits
  • Constantly wants to nurse or refuses to nurse
  • Poor feeding habits – arches back, pulls up legs, stiffens or screams while feeding or refuses to eat while still hungry
  • Prefers upright or inclined positions
  • Always wants to be held

How do I treat Reflux?

It is worrying that pharmaceuticals have not been tested for infant safety, although this does not necessarily mean they are not safe. Wilfy was prescribed Ranitidin before he moved onto Lanzoprazole (Fastab).  Wilfy was such a severe case of Silent reflux that using a wedge wasn’t an option until we had his reflux under control. At 16 months he is still refluxing. He has had the barium test which confirmed reflux. There has been much talk of the endoscopy but I am not prepared to go down that route until he is about 2. There is also a chance that the reflux will have subsided by then.

If you take your baby to the GP initially they will probably tell you he/she has colic and to not worry. If you have read the above and ticked off at least three symptons then your baby may have reflux or silent reflux. Go back to your GP with this information and ask to be referred or at least ask to look into ways to treat it. If the reflux is mild then you can look at a wedge for them to sleep on. They are fantastic and do really help but they aren’t always the answer. I found mine on I unfortunately got it too late as wilfy was already moving around alot by then and refused to be strapped in. However I did buy a baby lift smaller cot wedge which I put under his mattress and then I put a the widgey reflux hard feeding pillow at the base of his feet so that he was unable to move down the cot and was raised at night. I also used a baby back and side sleep positioner from about 2 months. This was incredible and made a huge difference.

All Wilfy really wanted to do was sleep on his tummy. This is how I slept as a baby and probably most 60’s or 70’s babies did until it was considered too dangerous because of cot death. I have to admit I was terrified that Wilfy would be a victim of cot death so I invested in a breathing alarm. This gave me peace of mind when he was asleep and although some parents may baulk at the idea if it gives you peace of mind just do it.  I use the babysense II breathing alarm for £64.90.

What is silent reflux in infants?

Silent reflux in infants is exactly the same as infant reflux minus the spitting up. When an infant refluxes silently the stomach contents travel up the throat but the infant is able to swallow it back down again before it actually comes out. This means the stomach acid burns on the trip up the throat and on the trip back down. Silent reflux in infants is not as obvious because there is no actual spitting up, which makes it much harder to detect.

Symptoms of silent reflux in infants

Your baby may exhibit only some of these symptoms:

  • poor weight gain or rapid weight gain
  • gulping with a painful look on the face
  • sour breath, wet sounding burps
  • persistent or chronic cough
  • frequent hiccups
  • sudden burst of painful crying
  • painful wakeups from sleep or poor sleeping habits
  • poor feeding habits, possible feeding aversions
  • neck or back arching during or after feeding
  • excessive fussiness, crying or colic
  • demands to be carried constantly
  • red or salmon colored throat
  • blood in the stool or spit up

These last two signs are possible indicators of Barett’s Esophagus. The risk of Barett’s Esophagus is slightly higher with silent reflux because there is generally more damage to the throat with silent reflux in infants, although it is still a fairly low risk.

Tests for Reflux

Barium Swallow/Upper GI X-Ray Test for Infant Reflux

These are not definitive tests because your baby needs to reflux during the test in order to get positive results. A negative result (no observed reflux episode) is meaningless. These tests can also find structural problems, such as a Hiatal Hernia, Pyloric Stenosis, delayed stomach emptying or Malrotation. Your baby will be required to drink a small amount of barium before the exam and you may not be allowed to breastfeed before and during. Breastmilk can neutralize the acid in your baby’s stomach and reduce refluxing. This is one time you actually want your baby to reflux in order to get a diagnosis.

PH Probe Test for Infant Reflux

A probe is inserted through the nose into the esophagus where it remains for 24 hours to detect how many times the esophagus is exposed to acid. This test is of limited usefulness because not every child refluxes every day, and it’s very possible to get false negative (or positive) results with this test.

Upper GI Endoscopy and Esophageal Biopsy Test for Infant Reflux

This involves sedating the baby and placing a flexible plastic tube with a camera through the mouth, down the throat, esophagus and into the stomach. The walls of the stomach, esophagus and duodenum are checked for inflammation and a small piece of tissue is removed for biopsy. The entire test takes about 15 minutes.