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20 years
What is reflux ?
Nov 24, 2014

Dr. Zakia Dimassi Pediatrics
Babies spit occasionally, and so long as the baby is thriving and growing normally and meeting her developmental milestones, we do not worry much about it. We call such babies "happy spitters" as they have regurgitation every now and then but are not irritated and they go back to feeding. This condition is known as Gastro-esophageal reflux (GER). GER is defined as the passage of the contents of the stomach into the lower esophagus (the esophagus is the tube the connects the throat to the stomach). It is considered a physiologic (i.e., not due to disease) occurrence in healthy infants, and results from the immaturity of the muscle sphincter that separates the lower esophagus from the stomach and that usually prevents backward return of the stomach content into the esophagus. In the majority of instances episodes of reflux are brief and do not extend above the lower esophagus.
GER is particularly common in infancy and manifests most frequently as episodes of regurgitation or vomiting. The majority of cases of GER are harmless and self-limiting: 50% of infants vomit at least once per day in the first 3 months of life, the peak of GER occurs at the age of 4 months with as much as 67% of four-month-old infants having reflux, then drops to 21% by 7-9 months of age.
As the weather has gotten colder, just make sure the room where you place your baby remains warm enough (around 25 degrees Celcius) but not too hot, as cold exposure may upset the baby's intestines and induce vomiting or spitting.
You need to distinguish between gastro-esophageal reflux (GER), which is simple regurgitation of partially digested food through the mouth and/or nose, and gastro-esophageal reflux disease (GERD): physiologic GER in infants is defined as painless regurgitation that does not affect growth. These infants are known as ‘happy spitters’ and as a rule of thumb management is conservative, based on with parental education, reassurance, and thickening of formula. Most cases resolve by 18 months of age. GERD on the other hand is manifested by symptoms like weight loss, irritability, and back arching with or refusal of feeds. In such cases, a laboratory workup and imaging of the upper gastro-intestinal tract should be considered, and treatment is with lifestyle modification, medication, or for intractable cases, surgery.
Infant reflux, also known as gastro-esophageal reflux (gastro- for stomach, esophageal for the esophagus, the tube that connects the throat to the stomach), happens when the contents of the stomach are spit out, usually shortly after feeding. Spitting up becomes less frequent as a baby grows older, and it's unusual for it to persist after 18 months of age.
Spitting up and vomiting are the hallmark symptoms of this condition. As long as the baby is healthy, content and thriving, the reflux is not a cause for concern, as it is only a matter of time before he/she outgrows it.
While babies may get fussy, irritable, or seem to be uncomfortable, it is very unusual for the stomach contents to be acidic enough to irritate the esophagus or throat, as is the case with acid reflux.
Infant reflux is due to a combination of factors:
- In infants, the ring of muscle where the esophagus attaches to the stomach, called the lower esophageal sphincter (LES), is underdeveloped, so it cannot always prevent the stomach contents from flowing backward. Ultimately, the LES will open only when baby swallows and will remain tightly closed the rest of the time, keeping stomach contents where they belong.
- Babies lie flat most of the time, which facilitates reflux. In addition, their diet is completely liquid, also promoting reflux. At times, air bubbles in the stomach may push liquids backward. In other cases, babies gulp large amounts of milk in a short amount of time, so they spit a significant amount when you burp them.
Although infant reflux most often occurs after a feeding, it can happen anytime your baby coughs, cries or strains.
In a small number of cases, however, reflux can be a sign of a more serious problem, such as gastroesophageal reflux disease (GERD), an allergy or a blockage. In GERD, the reflux contains stomach acid which damages the lining of the esophagus.
The following are signs or symptoms of underlying disease, in which case the pediatrician must be notified:
• Your baby isn't gaining weight
• Your baby spits up forcefully, causing stomach contents to shoot out of his or her mouth (projectile vomiting; sign of pyloric stenosis, where the muscle ring that connects the stomach to the intestines is very narrow due to a birth defect)
• Your baby spits up green or yellow fluid
• Your baby spits up blood or a material that looks like coffee grounds (dark brown)
• Your baby refuses food
• Your baby has blood in his or her stool (signs of milk allergy or infection)
• Your baby has difficulty breathing (which means that reflux is irritating his airways)