Reflux is a common concern among parents, but it’s important to understand that it has always been a part of infancy. Dr Chantelle van der Bijl, widely known as Bloem MomDoc, shares valuable insights from a lecture by Paediatric Gastroenterologist Dr Tim de Maayer, to help decipher infant reflux.
What is reflux?
Infant reflux, or Gastro-oesophageal Reflux (GOR), occurs when stomach contents push back into the oesophagus. This is a normal phenomenon due to the immaturity of the valves (sphincters) at the stomach and oesophagus junction. “A baby’s oesophagus is much shorter, so milk can easily push up from the stomach, and the stomach also doesn’t empty into the gut as quickly as in adults,” Dr Chantelle explains.
She further mentions that regurgitation, the visible expulsion of stomach contents, affects 90% of babies by two months but typically improves with age and healthy, weight-gaining babies who experience regurgitation are often termed ‘happy spitters’. This is normal and not medically significant. However, if regurgitation starts after six months or includes alarming symptoms like bile or blood, further evaluation is needed.
When reflux becomes GOR
GOR arises when reflux leads to complications or tissue damage. Signs of GOR include refusing feeds, difficulty feeding, poor weight gain, and abnormal posture. Dr Chantelle emphasises that a paediatrician should diagnose GOR, as many other conditions can mimic its symptoms.
Managing reflux
Dr Chantelle suggests several management strategies for GOR. Educating parents about the commonality and harmlessness of GOR is crucial. “Keeping babies upright and introducing solid foods when appropriate can help. Milk thickeners and anti-reflux formulas reduce visible regurgitation but do not decrease reflux frequency.”
Medications and misuse
In cases of GOR, Proton-Pump Inhibitors (PPIs) like infant Nexiam can be prescribed to reduce stomach acid. However, Dr Chantelle warns against the overuse of PPIs, noting that PPIs should be kept for babies with confirmed erosive oesophagitis and prescribed only for a short while. “Prolonged use can lead to gastrointestinal infections and osteoporosis.”
Exploring dietary changes
Cow’s milk protein allergy can mimic GOR symptoms. A trial of a cow’s milk-free diet may help distinguish between the two. “If the baby is exclusively breastfed, the mother should avoid all dairy products for 2-4 weeks to see if symptoms improve,” Dr Chantelle advises.
