Infant Reflux

1 What is Infant Reflux?

Infant reflux refers to the passive spitting of food including milk soon after feeding in infants. This regurgitation of milk called ‘posseting’ is normal among infants and is usually a sign of underdeveloped food tube.

In most of the cases, the reflux stops by around 14-18 months of age. Infant reflux very rarely persists after 18 months of age.

In some cases, it may be a sign of gastroesophageal reflux or allergy, which is more worrisome. Reflux may occur several times a day, particularly after feeding.

2 Symptoms

Posseting or spitting up of food after feeding is the characteristic symptom of infant reflux. The spit up may be undigested milk or food, or partly digested food. The frequency of spit up varies with child, but it usually occurs after a feed.

In some cases, posseting may occur 1-2 hours after a feed. Frequency of spitting up is found to be more during 2-4 months. This condition is not of concern if the baby is gaining weight normally and is active. 

But if the child throws up green fluid, or has breathing difficulty, it is better to visit a doctor.

Spitting up that starts after 6 months, and spitting up blood are also of concern. Some children vomit forcefully, known as projectile vomiting, resulting in food content thrown out from mouth. Some of these symptoms may indicate gastroesophageal reflux disease.

3 Causes

Underdeveloped food valve is the root cause of infant reflux. As the valve present between esophagus and stomach is not matured, food flows back into the food tube.

As the baby grows, the valve remains shut and opens only during swallowing of food. It remains closed during other times and this keeps the food from moving back into the esophagus.

Chances of posseting is more common if

  • The baby is lying for most part of the time, particularly immediately after feeding
  • The diet is mostly liquid
  • The baby has premature birth

In some rare cases, infant reflux may be caused by conditions like GERD, esophagitis, pyloric stenosis, and intolerance to food.

4 Making a Diagnosis

Symptoms and physical examination help in the diagnosis of infant reflux.

If the baby is growing at a normal rate and does not have any other conditions, no other tests are recommended.

If needed, other tests including ultrasound, lab tests, esophageal pH monitoring, X-ray and endoscopy are used. These tests are usually suggested to differentiate infant reflux from other conditions.

5 Treatment

In most of the cases, infant reflux resolves on its own with time, without any treatment. Posseting may stop by the time the child is around 14 months.

Frequent feedings with small amounts helps to reduce reflux. This reduces pressure within the stomach, controlling the urge for reflux. Regurgitation can also be prevented by burping the baby every 1-2 hours after feeding.

Infants who are bottle fed should be allowed to burp often in between feeding, as they tend to swallow a good amount of air during feeding. In some cases, certain brands or formulas trigger reflux and hence changing the formula helps to reduce posseting. Infants may swallow more air if the nipple of bottle is more. Changing the size of bottle to an optimal one also is good in controlling reflux. 

If the baby is breast fed, eliminating dairy foods and eggs in mother’s diet may help to prevent reflux. 

Medications are generally not given to infants if they are having uncomplicated reflux. But, if the baby is not gaining weight, or refuses to feed, medications that block the production of acid in stomach may be recommended. Medications are prescribed if there is inflammation in the esophagus or if the child has asthma.

6 Prevention

Putting the infant to sleep on the side helps to prevent reflux.

Simple measures like frequent and small feeds, burping often, and changing the brand of formula are helpful in preventing regurgitation.

7 Alternative and Homeopathic Remedies

A few alternative and homeopathic remedies exist for infant reflux.

Nux vomica, natrum phosphate, and chamomilla are suggested homeopathic remedies for infant reflux.

Some of the alternate methods of treatment include

  • Orange oil
  • Roman chamomile
  • Gripe water
  • Probiotics

8 Lifestyle and Coping

Lifestyle modifications are necessary for your baby in order to prevent infant reflux.

Spitting up of stomach content is common among babies and is not of concern in most of the cases.

Simple remedies like frequent and small feeds, burping often, and changing the brand of formula are helpful in preventing regurgitation. Eliminating some food from mother’s diet, if the baby is breast fed, also helps to prevent reflux.

9 Risks and Complications

One of the common complications associated with infant reflux is GERD.

Infant reflux clears on its own when the baby is around 14 months old. It is of concern only if the baby is showing poor growth.

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