Experienced Paediatric Dietitian
What is infant regurgitation/reflux and what are the symptoms?
Infant reflux is the passive flow of stomach contents that travel from the stomach up into the oesophagus. It is common in healthy infants younger than 1 year. The major proposed cause of reflux at this age is the unwanted relaxation of the sphincter that sits at the bottom of the oesophagus just before the stomach. When is it closed (not relaxed), it normally prevents the stomach contents coming back up into the oesophagus. Infants may regurgitate milk and may occasionally display signs of pain, irritability or coughing which may be worse after feed times.
Is it normal for babies to spit up after a feed?
Yes it is common/normal for babies to spit up. Often this can improve by 4-6 months of age, however in some babies this will take longer. The vast majority improve within a few months of walking age. It is also often reassuring to hear that in most situations, happy thriving babies that spill or vomit will not come to harm as a result of reflux.
When should I seek medical advice?
You should see your doctor if:
- Your baby’s irritability/crying/fussing is longer than three hours total (per 24 hours) on more than three days of the week
- If you feel your baby is at risk of dehydration – symptoms including: dry skin, reduced urine output, yellow smelly urine, hard poo
- If you feel your baby’s growth and weight gain is being affected by the amount of milk that is lost in vomits
Is my baby missing out on nutrients due to the regurgitation volume?
Often the volume that your baby regurgitates seems bigger than it actually is. If your baby is still growing well, then it is likely that they are still receiving everything that they need. If however your baby’s weight gain is not adequate, there is the possibility that they are losing too much milk and are not getting what they need. In this situation, seek medical advice.
How is infant reflux diagnosed?
Often reflux is treated without necessarily doing a clinical investigation. If your baby’s symptoms improve after treatment, they may be diagnosed with reflux. Clinical diagnosis may involve a 24hr pH probe. This is a thin tube which sits in the oesophagus for 24 hours and measures the amount of acid that comes from the stomach back up into the oesophagus.
Is reflux an allergy?
Clinically diagnosed reflux is not an allergy, however some allergies such as cow’s milk protein allergy in infants may cause very similar symptoms of vomiting, regurgitation and irritability. For this reason it can sometimes be confusing and difficult to determine whether it is actual reflux or a cow’s milk allergy reaction.
I’m breastfeeding – how can I thicken my milk?
To thicken breast milk, you will need to express some or all of your breast feeds and then thicken it in a bottle. Research suggests that this can help to reduce the amount of milk that is lost in vomits. Some good thickening options include regular baby rice cereal or corn based thickeners. These can be purchased from the supermarket or pharmacy. You may choose to alternate breast feeds and expressing. In this situation, you may choose to express/thicken for the times of day when your baby’s symptoms are most problematic. Expressing does not influence the quality or benefit of breast milk to your baby.
I’m using infant formula – how can I thicken it?
Infant formulae known as “AR” or “Anti Reflux” can be purchased in a pre-thickened consistency that is usually appropriate for most babies. These can be purchased from the supermarket or pharmacy. If your baby requires a slightly more specialised formula such as lactose free (LF) then you will need to purchase a thickener to add to the formula. Some good thickening options include regular baby rice cereal or corn based thickeners. These can be purchased from the supermarket or pharmacy.
What are the other ways to manage reflux?
Some find that smaller, more frequent feeds and being kept upright following feeds can help. In situations where more support is needed, pharmaceutical treatment generally involves trying to reduce the acidity of the stomach contents so that if/when stomach contents do come back up into the oesophagus, it is not as painful or damaging. Antacids act to neutralise or buffer the amount of acid present in the stomach whereas acid suppression therapy works to reduce the amount of acid actually produced in the stomach.
A dietary trial of removing cow’s milk products is also often suggested. This involves the mother removing all cow’s milk protein from her diet if breastfeeding, or if formula fed, choosing an alternative formula.
Will my baby grow out of this problem?
Babies with reflux will often improve after the first 6 months and continue to improve over the next few years of life. This improvement often relates to changes in feeding habits – more solid foods, growth and improved function of the lower oesophageal sphincter. Some babies with diagnosed reflux will need ongoing medical supervision and treatment to manage symptoms.
This article is written by an external expert. We advise speaking to a doctor or dietitian before altering or changing your normal feeding regimen.
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