Gastroesophageal Reflux in Infants
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Gastroesophageal reflux (GER) occurs when stomach contents come back
up into the esophagus (the tube that connects the mouth to the stomach)
during or after a meal. A ring of muscle at the bottom of the esophagus
opens and closes to allow food to enter the stomach. This ring of
muscle is called the lower esophageal sphincter (LES). This sphincter
opens to release gas (burping) after meals in normal infants, children,
and adults. When the sphincter opens in infants, the stomach contents
often go up the esophagus and out the mouth (spitting up or vomiting).
GER can also occur when babies cough, cry, or strain. Most infants with
GER are happy and healthy even though they spit up or vomit.
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Symptoms
GER occurs often in normal infants. More than half of all babies
experience reflux in the first 3 months of life. An infant with GER may
experience
- spitting
- vomiting
- coughing
- irritability
- poor feeding
- blood in the stools
Only a small number of infants have severe symptoms due to GER. Most
infants stop spitting up between the ages of 12 to 18 months.
In a small number of babies, GER may result in symptoms that are of concern. These include problems such as
- poor growth due to an inability to hold down enough food
- irritability or refusing to feed due to pain
- blood loss from acid burning the esophagus
- breathing problems
These problems can be caused by disorders other than GER. Your
health care provider needs to determine if GER is causing your child's
symptom(s).
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| Digestive system noting the mouth, esophagus, lower esophageal sphincter (LES), stomach, and small intestine. |
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Diagnosis
An infant who spits or vomits may have GER. The doctor or nurse will
talk with you about your child's symptoms and will examine your child.
If the infant is healthy, happy, and growing well, no tests or
treatment may be needed. Tests may be ordered to help determine whether
your child's symptoms are related to GER. Sometimes, treatment is
started without tests.
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Treatment
The treatment of reflux depends on the infant's symptoms and age.
Some babies may not need treatment, because GER often resolves by
itself. Healthy, happy babies may only need their feedings thickened
with cereal and to be kept upright after they are fed. Overfeeding can
aggravate reflux, so your health care provider may suggest different
ways of handling feedings. For example, smaller quantities with more
frequent feeding can help decrease the chances of regurgitating. If a
food allergy is suspected, you may be asked to change the baby's
formula, or to modify your diet if you are breastfeeding, for 1 to 2
weeks. If a child is not growing well, feedings with higher calorie
content or tube feeding may be recommended.
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Speak with your child's health care provider if any of the following occur:
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- vomiting large amounts or persistent projectile (forceful) vomiting, particularly in infants under 2 months of age
- vomiting fluid that is green or yellow in color or looks like coffee grounds or blood
- difficulty breathing after vomiting or spitting up
- excessive irritability related to feeding, or refusing food, which seems to cause weight loss or poor weight gain
- difficult or painful swallowing
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Other treatments include the following:
- When a child is uncomfortable, has difficulty sleeping or eating, or
does not grow, the doctor or nurse may suggest a medication. Different
types of medicine can be used to treat reflux by decreasing the acid
secreted by the stomach. One class of medications, called H2-blockers,
includes cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid),
and nizatidine (Axid). Another type of medication is the proton-pump
inhibitors, such as esomeprazole (Nexium), omeprazole (Prilosec),
lansoprazole (Prevacid), rabeprazole (Aciphex), and pantoprazole
(Protonix).*
- Very rarely infants have severe GER that prevents them from growing
or causes breathing problems. In some of these infants, surgery may be
the best option.
Your child's doctor or nurse will discuss GER with you and suggest
treatment if needed. The potential complications of the medications
will be explained. Most infants don't need medications and will outgrow
reflux by 1 or 2 years of age.
* The authors of this fact sheet do not specifically
endorse the use of drugs for children that have not been tested in
children ("off label" use). Such a determination can only be made under
the recommendation of the treating health care provider.
Specific Instructions for Infants With GER
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If the baby is bottle fed, add up to one tablespoon of rice cereal to 2
ounces of infant milk (including expressed breast milk). If the mixture
is too thick for your infant to take easily, you can change the nipple
size or cross cut the nipple.
- Burp your baby after 1 or 2 ounces of formula are taken. For breastfed infants, burp after feeding on each side.
- Do not overfeed. Talk to your child's doctor or nurse about the amounts of formula or breast milk that your baby is taking.
- When possible, hold your infant upright in your arms for 30 minutes after feeding.
- Infants with GER should usually sleep on their backs, as is
suggested for all infants. Rarely, a physician may suggest other sleep
positions.
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Points to Remember
- GER occurs when stomach contents back up into the esophagus.
- GER is common in infants but most children grow out of it.
- In infants, GER may cause spitting up, vomiting, coughing, poor feeding, or blood in the stools.
- Treatment depends on the infant's symptoms and age, and may include
changes in eating and sleeping habits. Medication may also be an
option, or surgery in severe cases.
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Hope Through Research
The National Institute of Diabetes and Digestive and Kidney Diseases,
through its Division of Digestive Diseases and Nutrition, supports
basic and clinical research into gastrointestinal diseases. Researchers
are studying the risk factors for developing GER and what causes the
LES to open, with the aim of improving future treatment for GER.
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For More Information
North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition
Phone: 1-888-344-8888
Internet: www.NASPGHAN.org
www.CDHNF.org
www.KidsAcidReflux.org
www.TeensAcidReflux.org
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The U.S. Government does not endorse or favor any specific commercial
product or company. Trade, proprietary, or company names appearing in
this document are used only because they are considered necessary in the
context of the information provided. If a product is not mentioned,
this does not mean or imply that the product is unsatisfactory.
This information was prepared in partnership with the North American
Society for Pediatric Gastroenterology, Hepatology, and Nutrition
(NASPGHAN), the Children's Digestive Health and Nutrition Foundation
(CDHNF), and the Association of Pediatric Gastroenterology and Nutrition
Nurses (APGNN). The information is intended only to provide general
information and not as a definitive basis for diagnosis or treatment in
any particular case. You should consult your child's doctor about your
child's specific condition.
National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892-3570
Email: nddic@info.niddk.nih.gov
The National Digestive Diseases Information Clearinghouse (NDDIC) is a
service of the National Institute of Diabetes and Digestive and Kidney
Diseases (NIDDK). The NIDDK is part of the National Institutes of Health
under the U.S. Department of Health and Human Services. Established in
1980, the clearinghouse provides information about digestive diseases to
people with digestive disorders and to their families, health care
professionals, and the public. NDDIC answers inquiries, develops and
distributes publications, and works closely with professional and
patient organizations and Government agencies to coordinate resources
about digestive diseases.
Publications produced by the clearinghouse are carefully reviewed by
both NIDDK scientists and outside experts. This fact sheet was reviewed
by
NASPGHAN.
This e-text is not copyrighted. The clearinghouse encourages
users of this e-pub to duplicate and distribute as many copies as
desired.
NIH Publication No. 04-5419
December 2003
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