Gastro-Oesophageal Reflux: What Is It, and What Can You Do?

All babies vomit- any parent knows this is an irrefutable fact! But when is a vomit a vomit? Or a posset, or a regurgitation? What is the difference? And does it actually matter?

Gastro-oesophageal reflux: what is it, and what can you do?

The Terminology Of Vomiting!

You know you’re a real parent when you devote entire conversations to your child’s vomit: how, when, where and how he vomits! But do you know the difference between a vomit, a posset and a regurgitation?

• Vomit: this tends to be relatively forceful. A vomit that travels across the room is called a “projectile” vomit, and may imply an obstructive cause, such as pyloric stenosis.
• Posset: this is a benign little dribble of milk which comes up at the end of a feed, often accompanied by wind. There is no associated force; the volume is usually around a teaspoon to a tablespoon.
• Regurgitation: a passive, non-forceful, bringing up of milk, which may occur immediately after a feed, or some time afterwards. Most babies will regurgitate a little milk from time to time; most often it is painless. Occasionally, regurgitation may be painful, or babies may regurgitate significant enough volumes of milk to compromise weight gain.

What is Gastro-Oesophageal Reflux?

Reflux is the term we use to describe milk flowing back from the stomach into the oesophagus. Sometimes the milk keeps on coming until both baby and mommy are wearing it. Sometimes the milk stays inside the oesophagus, but causes symptoms of pain and discomfort with no obvious vomit or spit up. This is known as “silent reflux”.

Depending on which version of English you subscribe to, Gastro-oesophageal reflux may be abbreviated to GOR or GER (for our friends who spell oesophagus “esophagus”- it’s ok, we still love you!).

As I often say to parents, all babies reflux:

Small stomach capacity, weak sphincter muscle (the muscle that closes the entrance to the stomach, preventing milk coming back into the oesophagus), and horizontal position all contribute to babies having some degree of reflux.

Provided your baby does not appear to be in pain or discomfort, and is continuing to grow well,you can grab a few more muslin cloths and wait for your baby to outgrow it.

However, some babies (around 10% of babies with symptoms of reflux) will have some degree of discomfort or compromised weight gain. These babies have GORD, or GERD (gastro-oesophageal reflux DISEASE), and require some form of intervention.

Your Baby May Have Reflux If He Has:

• Fussiness during a feed
• Back arching (also known as opisthotonus) or trying to pull away from a feed
• Crying during or after a feed
• Crying whilst regurgitating milk
• Feed refusal, leading to poor weight gain, or “failure to thrive”

Many signs of colic may also be similar to signs of GORD, leading to some confusion over the diagnosis. If in doubt, discuss your baby’s signs and symptoms with his doctor.

What Can You Do?

Nursing Strategies:

These are often the most effective, and least invasive, interventions:

• Feed your baby in an upright position: whether you are breast feeding or bottle feeding your baby, try to feed him at an angle rather than lying flat.
• Stop regularly to “burp” or “wind” your baby: many people find that their baby brings up more milk at the end of a feed with a large burp. Frequent burping can help to reduce this.
• Keep your baby in an upright position for at least half an hour after a feed.
• Tilt the head of the cot 30 degrees up. This can be done either by placing a rolled blanket under the mattress or a few books under the legs of the cot. Never place anything on the mattress itself as this could pose a risk of suffocation.
• Lie your baby slightly left-side down: this encourages the milk to drop into the main body of the stomach, away from the oesophageal sphincter, reducing the risk of reflux.

Supplements:

Recent studies have shown that probiotics can be very useful in treatment of colic. This is especially true for babies born to mothers via Caesarean section, or in babies whose mothers received antibiotics during or following delivery.

Some studies suggest that probiotics may be beneficial in the treatment of GORD also. However, this may be due to the fact that symptoms of both these diseases can be very similar, and babies may be misdiagnosed as one or the other.

Dietary Interventions:

Although many things have been written about dietary exclusions, few have any scientific evidence. However, dairy, or cow’s milk protein, has been implicated in either contributing to or directly causing up to 40% of cases of pathological reflux disease.

Given this very high percentage, it is worth a trial of dairy-free diet in the mother if breastfeeding. If formula fed, a trial of soy formula is worth trying as only 15% of cow’s milk allergic babies will be allergic to soy protein as well. (And yes, soy is a safe alternative to cow’s milk: there are no longer any concerns about any risks associated with phyto-oestrogen exposure from soy protein).

If you are excluding dairy in your diet, you will need to exclude all forms of dairy. This includes cheese, yoghurt and butter. You will also need to exclude all foods containing dairy products, such as most breads, biscuits and cakes, and many processed foods. Read labels: anything that contains whey, casein or “lacto-anything” should be avoided whilst excluding dairy.

Try this intervention for two weeks at most. By then, you should see a difference if dairy is an issue for your child. If you are unsure, fall off the wagon! Have a latte, or a couple of scoops of ice-cream. If your baby is truly dairy intolerant, he will let you know!

Medication:

For me, medication is generally a last resort. Something we come to when all other interventions have failed. This is partly because I don’t like to give unnecessary medications. It’s hard work for parents- especially as babies don’t tend to outgrow their reflux until around 6-7 months of age (or around 9-12 months if dairy intolerant). That’s a long time for your baby to be on medication!

What medications do we use?

• Thickeners: These aim to keep the milk down with the help of gravity! Thickeners may be carob- based powders that can be added to your baby’s normal milk (a bit tricky to combine with breast milk, but can be done with perseverance!). There are also some thickened formulas on the market specifically designed for babies with reflux. They are usually labelled “AR”, or anti- reflux.
• Antacids: These don’t prevent the milk coming back up, but do reduce the acidity of what comes up, reducing the burning sensation. This is often the first true “medication” doctors try; it can be very effective in reducing pain symptoms. Examples of antacids include Omeprazole (Losec) and Ranitidine (Zantac).
• Motility Agents: Drugs such as Domperidone (Motilium) increase gastric emptying into the small intestine. The milk stays in the stomach for a much shorter period, resulting in less reflux.

What was your experience? Have you had a baby with reflux or cow’s milk intolerance? What helped for you? Join the conversation by adding your comments below. 

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