Reflux is a physiological process that affects almost half of all infants. How can it be managed in a child?
What is reflux and how to distinguish it from reflux disease?
Gastrointestinal reflux is a physiological process in which stomach contents back up into the esophagus. Backflow of contents may occur several times a day. The stomach contents may come out through the mouth – this occurs most often in infants and is known as “drooling”, which is caused by an immature digestive system. Reflux problems affect about half of all infants and go away on their own around age 1.
Reflux disease is most often associated with troublesome symptoms or complications caused by reflux. The most common symptom of reflux disease is esophagitis. In infants, the characteristic symptom of this disease is crying while eating and refusing meals. In older children, heartburn and pain in the sternal area are the most common.
Symptoms of reflux in children
The most common symptoms of reflux in infants and young children are:
- baby’s irritability during feeding,
- insufficient weight gain,
- refusing to eat,
- taking a long time to eat,
- excessive drinking,
- swallowing disorders,
- pain when swallowing,
- choking or choking while eating,
- sleep disturbances,
- sandifer syndrome.
Reflux symptoms can also cause conditions such as:
- esophageal strictures,
- tooth decay and enamel erosion,
- apnea – especially in infants,
- echinococcal pneumonia,
- otitis media.
How to feed an infant with reflux?
Infants who have reflux should be under the care of a pediatrician or gastroenterologist. Modified milk (AR) thickeners or breast milk thickening medications are recommended for such young children. Doctors recommend that thickening syrups be given immediately before or during breastfeeding. If a woman gives her baby pumped breast milk, the thickening syrup should be poured into the bottle with the milk.
Doctors in infants with reflux recommend feeding more often, but in smaller amounts. This helps avoid overfeeding and stomach contents returning to the esophagus.
If thickening the milk does not work, doctors may introduce replacement milk that has more hydrolyzed proteins or amino acid formulas. If the baby is fed breast milk, the woman should be on an elimination diet excluding cow’s milk protein from her diet.
Many gastroenterologists recommend:
- holding the baby upright during feeding,
- placing the baby on its stomach in a “froggy” position,
- not exposing the baby to tobacco smoke.
What diet for a child over 1 year old who has reflux?
The primary treatment is proper diet and changing other elements of life. If the diet and lifestyle changes do not produce the desired results, then the doctor will order the appropriate medications.
Studies have shown that obese and overweight children have more cases of reflux than those of normal weight.
Cigarette smoke can make reflux worse. Studies conducted have not conclusively shown the effects of e-cigarettes on reflux in children.
It is recommended to limit the consumption of strong tea and energy drinks, as they can increase the symptoms of reflux. It is also advisable to exclude cocoa and chocolate from the diet because they contain theobromine, which, like caffeine, exacerbates reflux symptoms.
In children, it is also advisable to limit foods that are high in fat because they can slow down the stomach. In some young patients, eating acidic foods can make reflux symptoms worse. These foods include citrus, cola, tomatoes, and cranberries (and their products).
Diagnosing and treating reflux in children?
Diagnosing reflux in a child is very difficult – a detailed medical history and physical exam are needed. If reflux has unusual symptoms, it is very common for the doctor to order other tests such as abdominal ultrasound and esophageal X-ray, among others.
The effect of reflux therapy can be evaluated no sooner than after 2 weeks. If there is no improvement, the doctor may change the therapy to drug treatment. When there is still no improvement, the specialist may order surgical treatment of reflux in justified cases.
What is the prognosis for a baby who has reflux?
In 95% of infants, reflux goes away on its own by the time the child is 1 year old. In older children, reflux may periodically return. Long-term symptoms of reflux can lead to, among other things, inflammation of the esophagus.
Main photo: nataliaderiabina, source: stock.adobe.com