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What Causes Acid Reflux Symptoms in Babies?
Reflux symptoms in babies can have several causes. The most common is that the lower esophageal sphincter, the ring of muscle between the esophagus and stomach that acts as a barrier, is not yet fully functioning. When this muscle does not close completely, stomach acid can flow back into the esophagus, causing reflux symptoms.
Other medical factors, such as a hiatal hernia, which is uncommon, differences in the development of a baby's digestive system, or a cow's milk protein allergy, may also cause reflux symptoms in babies.
Most babies improve on their own as they grow. Reflux usually begins before 8 weeks of age and improves by around 1 year of age (Source: NHS). However, if symptoms are frequent or severe, consult a doctor for a diagnosis and appropriate treatment.
Symptoms
Reflux in babies may cause the following symptoms:
Bringing up milk or vomiting: Babies may bring up milk or vomit during or shortly after feeding.
Bloating: Babies with reflux may feel bloated or have abdominal discomfort.
Coughing, hiccupping or fussiness during feeds: Babies may frequently cough or hiccup while feeding, become fussy, cry, arch their back or gulp after burping.
Fatigue: Babies affected by reflux may seem tired or show little interest in their surroundings.
Poor weight gain: Some babies bring up so much milk that they do not get enough, resulting in poor weight gain.
Warning signs that need prompt medical attention: Refusing feeds, failing to gain weight or losing weight, forceful projectile vomiting, green or yellow vomit, blood in vomit or stools, difficulty breathing, fever, unusual lethargy, inconsolable crying, or symptoms that begin after 6 months of age or persist beyond 1 year.
Take care when looking after a baby with reflux, and see a doctor for advice and further assessment. Proper care is important for relieving symptoms and preventing risks associated with reflux in babies.
Causes
Reflux is common in babies because their digestive system is still developing, their stomach is small, they spend most of their time lying flat and their diet is mainly liquid. These factors make it easy for milk to flow back up.
Key causes of reflux in babies include:
- Overfeeding at each feed: Giving more milk than a baby's small stomach can hold, or a baby swallowing a lot of air while feeding, may make bringing up milk or reflux more likely.
- Cow's milk protein allergy: Some babies with a cow's milk protein allergy may have symptoms similar to reflux. Avoid frequently changing formula on your own, and have a doctor assess your baby first (Read more: Signs Your Child May Have a Cow's Milk Allergy).
- Other factors: Babies born prematurely or with certain underlying conditions may experience reflux more frequently and for longer.
Understanding the causes and factors associated with reflux in babies helps us identify ways to prevent it and relieve symptoms.
Diagnosis, Tests and Treatment
When a baby has reflux symptoms, diagnosis and assessment involve the following steps:
Feeding and symptom history: The doctor will ask about your baby's feeding history and symptoms, such as nausea, bloating or other symptoms.
Physical examination: A physical examination looks for signs or symptoms associated with reflux, such as digestive illness.
Endoscopy: An endoscope is used to examine the digestive system and can also collect tissue samples.
Esophageal pH monitoring: Measuring acid levels in the esophagus helps with diagnosis.
Physical examination and digestive system tests: Additional examinations help establish an accurate diagnosis.
Treatment focuses on changes to feeding habits and medication as advised by a doctor. Treatment recommendations depend on the severity of symptoms and the underlying cause of reflux. Treatment should follow the advice and supervision of the doctor caring for your baby.
Prevention
Preventing reflux in babies is important and can greatly reduce the risk of symptoms and health problems. Here are ways to help prevent it properly:
Adjust the feeding position: Feed your baby with their head raised. For example, sit comfortably and lift your baby so that milk flows down into their mouth.
Hold your baby after feeding: After a feed, pick your baby up to help them burp out air that may contribute to reflux. Holding your baby over your shoulder can help them bring up trapped air (Read more: Why Does My Baby Frequently Bring Up Milk?).
Avoid laying your baby flat immediately: After feeding, do not lay your baby flat right away. Hold them upright for a while to reduce the chance of reflux.
Offer smaller, more frequent feeds: Giving smaller amounts of milk more often can help reduce the chance of reflux.
Precautions: Even if your baby has reflux, always put them to sleep on their back on a firm, flat mattress. Do not use pillows, anti-reflux pillows or devices that raise their head, and do not put them to sleep on their stomach or side. Raising the head or using these positions has not been clearly shown to reduce reflux and increases the risk of sudden infant death syndrome (SIDS), according to guidance from the American Academy of Pediatrics (Read more: 5 Things to Avoid While Your Baby Is Sleeping). Medication or special formula should only be used as prescribed by a doctor.
For babies who have started age-appropriate complementary foods, watch for foods that make symptoms worse. If you have questions or concerns about your baby's health, consult a doctor for advice and appropriate care.
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Conclusion
Reflux in babies is common and usually improves on its own as they grow. Care focuses on smaller, more frequent feeds, burping after feeding and holding your baby upright for a while, while continuing to put them to sleep on their back on a flat mattress in line with safe sleep guidance. However, if your baby refuses feeds, is not gaining weight, has projectile vomiting, vomits green fluid or shows any blood, seek medical attention immediately.