What Is Infant Acid Reflux And How to Resolve it For My Baby?

Baby with acid reflux symptoms

Introduction

Since you are reading this, I’m assuming you have a newborn that has been spitting up during or shortly after eating. This article will explain the causes of Infant Acid Reflux, whether to be concerned, and what you should do to help manage this problem for your baby.

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What you will learn About Infant Acid Reflux

  • Will your baby outgrow Infant Acid Reflux?
  • Risk Factors for Infant Acid Reflux?
  • Causes of acid reflux in newborns?
  • Symptoms of acid reflux in newborns?
  • When to consult a doctor?
  • How is Infant Acid Reflux diagnosed?
  • What you can do to reduce the symptoms of Infant Acid Reflux?
  • How is Infant Acid Reflux treated?

Definitions

Gastroesophageal Reflux (GER)

GER is the back flow of stomach contents (stomach acid, food, and fluids) back into the esophagus. Gastroesophageal refers to the stomach, the LES, and the esophagus; reflux means to flow back. Over 80% of babies have GER. It occurs most commonly during the first three months but may occur up to 18 months. This is perfectly normal and rarely indicates anything serious.


Gastroesophageal Reflux Disease (GERD)

This is a more long-lasting (chronic) version of GER. This is more common in adults than infants. It's unlikely your baby has GERD.


Lower Esophageal Sphincter (LES)

This is a muscular valve located between the stomach and the esophagus. Its function is to allow food and liquid to enter the stomach and then stay shut to keep stomach contents in the stomach. In newborns, the LES may not be fully developed and will not close sufficiently to keep stomach contents from backing up into the baby’s esophagus.

Most Babies Outgrow Infant Acid Reflux (GER)

As stated above, over 80% of infants spit up while feeding or shortly after. First of all its important to understand that this is perfectly normal and is rarely serious. 


In rare instances, infant acid reflux, can indicate an underlying problem, like a food allergy, a blockage in the digestive system, a hiatal hernia, etc., but as stated, this is very rare. See Causes of infant reflux below for more info.


GER Usually Goes Away 

Usually, Infant Reflux will go away once the baby’s LES matures and their nervous system fully develops; usually, between 6 to 18 months of age at which time the symptoms will subside on their own. In 5% of babies, GER may continue as toddlers.


However, for the time being, watching your baby suffer from infant acid reflux can be a heart-wrenching experience. Since babies can only communicate by crying, it is much more difficult to know for certain that your baby has infant reflux. 

Risk Factors for Infant Acid Reflux

The following conditions increase the risk of your child having infant acid reflux:

  • One or more parents have a history of GERD
  • Premature birth – this makes even more likely that the LES and nervous system are not fully developed
  • Congenital food pipe disorders, e.g., a hiatal hernia
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    Obesity – overweight babies will have more back pressure on their LES allowing stomach contents to back up into the esophagus

Causes of Infant Acid Reflux

The main causes of infant acid reflux are: 

  • 1
    Underdeveloped LES – The babies’ lower esophageal sphincter (LES) is not yet fully developed and therefore not strong enough to keep their stomach contents from backing up into their esophagus. The least bit of bloating can cause the stomach contents to regurgitate into the throat.t
  • 2
    Neurodevelopmental Disorders – Infant acid reflux can also be caused by a poorly coordinated gastrointestinal tract resulting in the LES being too relaxed.
  • 3
    Premature Birth – same as causes 1 & 2 above – the LES and the nervous system is not yet fully developed due to being born prematurely.
  • 4
    Overfeeding – this can cause excess stomach bloating resulting in added pressure to an already weak LES allowing stomach contents to flow back up into the esophagus causing discomfort to your baby.
  • 5
    Food intolerance or food allergies, e.g., lactose intolerance. This can also cause stomach bloating with similar results to overfeeding.
  • 6
    Lying the baby down too soon after feeing – keep your baby upright for about 30 to 45 minutes after feeding; gravity helps the LES keep the stomach contents from backing up into the baby’s esophagus.
  • 7
    Improper Positioning of the baby during feeding – keep baby more upright – let gravity help the LES work better.
  • 8
    Obese Baby – excess belly fat can exert additional pressure on the contents of the stomach increasing the internal pressure on the LES.
  • 9
    Congenital GERD – if there is a parental history of acid reflux disease or GERD it's possible the child inherited this problem.
  • 10
    Congenital Pyloric Stenosis – Is the narrowing of the valve between the stomach and the small intestine. This narrowing may prevent or limit the stomach contents from emptying into the small intestine. This is four times more common in males. Babies with this condition usually want to eat again soon after vomiting. Before vomiting, you may observe wave-like contractions across your baby’s abdomen caused by the stomach muscles trying to force the stomach contents through the narrowed pylorus.
  • 11
    Eosinophilic Esophagitis (EOE) – An allergic inflammatory condition that involves a certain type of white blood cell called eosinophil that builds up and injures the lining of the esophagus. Symptoms include difficulty swallowing, vomiting, upper abdominal pain, and heartburn.

Symptoms of Infant Acid Reflux

The most common symptoms of Infant Acid Reflux as are: 

  • A persistent cough, breathing problems or wheezing
  • Frequent spitting up or regurgitation while feeding or shortly after
  • Choking or gagging while feeding
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    Colicky behavior (frequent crying and fussiness)
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    Poor growth, poor weight gain, or weight loss
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    Baby tries to avoid feeding by back arching
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    Baby’s stool may contain blood

When to see a doctor

Take your baby to the doctor if your baby: 

  • Isn’t gaining weight
  • Is projectile vomiting
  • The spit up contains a green or yellow fluid
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    The spit up contains blood or a dark material the color of coffee grounds
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    Refuses to eat and has difficulty eating or swallowing
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    There is blood in their stool
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    Has difficulty breathing, a chronic cough and/or wheezing
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    Is still spitting up after six months

Some of these symptoms may indicate serious but treatable conditions. Consult your doctor to determine if they are significant.

How Is GERD Diagnosed in Infants and Children?

Usually, the baby’s medical history is enough for the doctor to diagnose GERD, especially if the problem occurs regularly and causes discomfort. The growth chart and diet history are also helpful, but occasionally, further tests are recommended.


They may include: 

  • Barium swallow or upper GI series. This is a special X-ray test that uses barium to highlight the esophagus, stomach, and upper part of the small intestine. This test may identify any obstructions or narrowing in these areas.
  • Gastric emptying study. Some people with GERD have a slow emptying of the stomach that may be contributing to the reflux of acid. During this test, your child drinks milk or eats food mixed with a radioactive chemical. This chemical is followed through the gastrointestinal tract using a special camera.
  • pH probe. During the test, your child is asked to swallow a long, thin tube with a probe at the tip that will stay in the esophagus for 24 hours. The tip is positioned, usually at the lower part of the esophagus, and measures levels of stomach acids. It also helps determine if breathing problems are the result of GERD.
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    Upper GI endoscopy. This is done using an endoscope (a thin, flexible, lighted tube and camera) that allows the doctor to look directly inside the esophagus, stomach, and upper part of the small intestine.

What Can You Do to Reduce Your Infants Acid Reflux Symptoms?

Feeding Your Baby

Until your baby is six months old, it is best if the baby is fed exclusively breast milk. It is important to be aware that what you consume can affect the baby through your breast milk.


If your breastfed baby exhibits signs of acid reflux you should avoid these foods:

  • Caffeine – the caffeine relaxes the LES allowing the stomach contents to more easily back up into the baby’s esophagus. Foods that contain caffeine are tea, coffee, soft drinks, energy drinks, and chocolate.
  • Carbonated Drinks – the bubbles in carbonated drinks can cause stomach bloating. The bloating puts additional pressure on the LES. If the drink also contains caffeine the LES is also relaxed by the caffeine making the combination even worse.
  • Spicy Foods – spices in these foods irritate the LES causing it to swell making it more difficult for it to completely close allowing the baby’s stomach contents to back up into the esophagus.
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    Citrus Fruits and drinks – citrus fruits and citrus fruit juices also irritate the LES making it difficult to fully close. Avoid oranges, lemons and their juices.
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    Foods That Contain Preservatives – eating foods that contain a lot of preservatives cannot be effectively digested by the immature LES and gastrointestinal tract. Depending on the preservative it can cause bloating, LES irritation or LES relaxation. Best to avoid highly processed foods while you are breastfeeding.
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    Alcohol – Avoid all alcohol while breastfeeding. The alcohol irritates the baby’s gastrointestinal tract and causes the LES to relax.
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    Foods that cause gas – Certain foods can cause bloating and excess gas. These foods can cause bloating in the baby as well which increases the pressure on the LES resulting in acid reflux. Foods to avoid are broccoli, Brussel sprouts, cabbage, cauliflower, kidney beans, and black beans.
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    Fried Foods – these may contain unhealthy fats that can interfere with proper digestion causing bloating.

Burping Your Baby


When burping the baby, try and sit him or her on your lap and burp them. Do not put them on your shoulder and pat their back. Your shoulder will press up against their tummy and place pressure on the stomach. This will cause the acids to rise. It’s simple things like these that many parents should be aware of and will go a long way towards easing their baby’s suffering.


Sleeping Position

  • Always place your baby on their back to sleep. Never on their stomach or their sides.
  • Only place them on a firm mattress.
  • Remove thick blankets, pillows, other loose objects, or plush toys from their sleeping area.

Summary

Infant acid reflux is treatable. Experiment to find the lifestyle change that gets your child’s acid reflux under control.


In most cases minor adjustments is all that is needed. 


If the suggested changes like proper burping, sleeping position changes, smaller, more frequent meals,  and consideration to changes in what you eat do not help your baby's symptoms, it is important to consult your baby's physician.

References

  1. Schwartz, Steven M. “Pediatric Gastroesophageal Reflux.” Medscape, Nov 17, 2017,                                 Link to post: medicine.medscape.com/article/930029-overview
  2. Stanford Children’s Hospital. “Gastroesophageal Reflux Disease (GERD)/Heartburn in Children”
    Link to post: www.stanfordchildrens.org/en/topic/default?id=gastroesophageal-reflux-disease-gerdheartburn-in-children-90-P01994
  3. Mayo Clinic. “Pyloric Stenosis.” Jan 6, 2018                                                                                                    Link to post: www.mayoclinic.org/diseases-conditions/pyloric-stenosis/symptoms-causes/syc-20351416
  4. Mayo Clinic. “Eosinophilic esophagitis.” Dec 9, 2017                                                                                   Link to post: www.mayoclinic.org/diseases-conditions/eosinophilic-esophagitis/symptoms-causes/syc-20372197
  5. WebMD “Acid Reflux (GERD) In Babies And Children” May 2, 2018                                                       Link to post: www.webmd.com/parenting/baby/infants-children


Disclaimer

The information contained here does not constitute medical advice and is not meant to diagnose, treat, prevent, or cure disease. Please contact your doctor. The information provided is for informational purposes only and are solely the views of the author.

Low Stomach Acid is the Main Cause of Heartburn, Acid Reflux, and GERD

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