Gastroesophageal Reflux (GER) from Infancy to Adulthood

Gastroesophageal Reflux (GER) is a common condition from infancy to adulthood. However, there are significant differences in the symptoms and treatments depending on the age of the patient. This week, I am beginning a three part series on Gastroesophageal Reflux from infancy to adulthood.

Note: The information in this blog is for informational purposes only. Report all symptoms to the doctor for a diagnosis and treatment.

Part One of a Three Part Series: Infants and Toddlers

GER vs.GERD

First, it is important define two separate but related conditions: Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD). Gastroesophageal Reflux (GER) is a normal physiological event characterized by the sensation of food coming up the esophagus in the form of a wet burp. Infants have GER after eating a large meal, ingesting air or eating too fast. On the other hand, Gastroesophageal Reflux Disease (GERD) is the abnormal backwashing of stomach contents and acid into the esophagus causing complications.

Gastroesophageal Reflux (GER) is very common in infancy, affecting as many as one in 20 infants. A much smaller percentage of infants and toddlers have GERD with estimates ranging from 3-5% of children in the United States.

Common Symptoms: GER

Babies and spit up seem to go hand in hand. That is because the vast majority of healthy babies have Gastroesophageal Reflux or GER.

Infant GER is characterized by:
o frequent spit up
o burping
o hiccups
o vomiting

Some babies with GER spit up or vomit after each meal while others spit when you least expect it such as when you are dressed to go out!

Common Symptoms: GERD

Infant GERD is characterized by a worrisome pattern of reflux episodes (food and stomach contents backwashing into the esophagus), vomiting and pain causing complications.

Symptoms may include:

o Irritability/fussiness
o Vomiting
o Irritation to the esophagus (esophagitis)
o Poor weight gain or weight loss
o Poor sleep
o Respiratory problems

Some babies seem to have digestive problems from the first feeding while other babies become more irritable and uncomfortable in the first weeks of life. Many parents tell me they have a gut feeling that something is wrong with their baby when they fuss all day and sleep poorly at night. It is important to share your concerns and observations with the doctor.

My daughter Rebecca didn’t eat or sleep like my other children from the newborn period. Even though she wasn’t diagnosed with reflux until she was older, I knew something was wrong. I kept asking the doctor why she wasn’t getting better. It was a relief to have a diagnosis and to start treating her symptoms.

Treatment

Infants and toddlers with GER do not require medical treatment. Small frequent feedings, burping and holding in an upright position may decrease spit up and vomiting until the digestive system has matured.

You may be faced with a lot of extra work from changing the baby as well as scrubbing the couch and the floor. If you are feeling overwhelmed by the extra caretaking, ask for help from your spouse, friend or family member.

Infants and toddlers with GERD may need one of more treatments including:

Positioning:

Holding upright after a feeding
Frequent burping
Swaddling (a special way of wrapping a baby securely to reduce movement)
Sleeping on an elevated surface such as a wedge or hammock

Diet:

Small, frequent meals
Special formula (hypoallergenic, lactose free, thickened formula)
Special diet for breastfeeding mothers (May include eliminating foods that trigger digestive discomfort)

Medication:

The doctor may suggest using an over the counter or prescription medication to reduce or eliminate acid or improve motility. Several acid reducers have been approved for use with infants while medications to eliminate acid production, called Proton Pump Inhibitors are indicated for ages 1 year and older.

I always tell parents that the goal of treatment is to reduce pain and irritability so your baby can eat, sleep and play. Parents are often disappointed that the treatments do not eliminate the vomiting or help the baby sleep for 10 hours straight. Often, the treatments reduce vomiting and may increase sleep. Over time, it is hoped that the treatment will make your baby feel more comfortable and allow her to grow steadily.

The home care such as holding upright after a feeding, burping and swaddling are important treatments. However, parents report that it is exhausting to carry out the home care treatments, leaving little time for household chores. Parenting a baby with GERD does take extra time and effort. I know of many families who hire extra help or have a relative move in for a few weeks or months until the treatment settles the symptoms to a manageable level.

Long Term Outlook

Infants and toddlers with GER will often have a steady decrease in symptoms in a few months as the digestive system matures. Infants and toddlers have to grow into their digestive system since infants have a short esophagus. Also, an infant’s stomach works differently compared to an adult stomach and can’t stretch to accommodate a full liquid meal. Some doctors believe there is a decrease in GER symptoms as infants become more upright and eat baby food.

The good news is most infants and toddlers with GERD will respond readily to treatment and overcome many of the more worrisome symptoms seen in infancy such as crying, poor sleep and poor eating. While some babies with GERD outgrow the reflux, others will continue to have reflux symptoms beyond toddler hood.

Baby Nathan has GERD

Nathan was born pink and healthy at 7 pounds, 4 ounces. He nursed well during the first two weeks and seemed to be settling into a typical newborn eating and sleeping schedule. From 3 weeks of age to 8 weeks of age, Nathan started fussing during and after feeding, vomited 4-8 times a day and needed to be held constantly. This was very difficult for Nathan’s mom since she had a 3 year old son to take care of too. She talked to the doctor at the well check up and was given some home care instructions. The doctor instructed her to return in two weeks for a weight check since Nathan’s weight was poor. At the weight check, the doctor noted that he had only gained one ounce and was wheezing slightly. The doctor started Nathan on a medication to reduce acid and recommended a wedge for sleeping. By 5 months of age, Nathan was growing and only waking up once or twice per night. Nathan started vomiting again when baby food was introduced so the doctor recommended waiting a month and trying again. Nathan still vomits occasionally after a feeding and isn’t taking as much baby food as his brother but at a year of age, there is little evidence that his digestive system is causing him discomfort. Nathan’s mom and his doctor will continue to monitor Nathan’s growth and digestion as he gets older.