What is ‘reflux’?
Infant reflux is a common condition affecting up to 20% of babies. It usually starts before a child is 8 weeks old and fortunately rarely continues beyond 12 months (in most cases there is significant improvement by 3-4 months). It is not usually serious and is not thought to have any long-term effects on the child. However, it can be extremely distressing for both the infant and their parents, who often feel helpless when dealing with a child who is distressed during and after feeds. This can contribute to a difficulty in bonding with the child, fatigue and unhappiness.
What are the symptoms?
- Bringing up milk or vomiting shortly after feeds.
- Coughing or hiccupping.
- Being fussy and unsettled during feeds.
- Excessive crying.
- Poor growth/weight gain.
Causes
Reflux occurs when milk in the stomach flows back up into the oesophagus (food pipe). It happens to some babies and not others. It is more common in premature babies. One of the common causes may be the sphincter (ring of muscle) at the lower oesophagus not maturing just yet. If your child has symptoms such as weight loss, persistent vomiting or blood in the vomit, they should be seen urgently. Reflux may be linked to food allergies/intolerances. It seems to be equally prevalent in breastfed and formula-fed infants.
Diagnosis
In most cases we can make the diagnosis based on the history and a physical examination of the baby. If more worrying symptoms are present (such as weight loss), we may arrange further tests.
Treatment
At Osler Health, we give the following advice, monitoring the progress over 2-4 weeks:
- Sit upright for 30 minutes after feeding.
- Reduce the volume of feed (often difficult to gauge if breast feeding) – we are aware that overfeeding is one of the most common causes of vomiting associated with reflux.
- Use a thickening agent (cumbersome if these babies are breast fed).
- Consider anti-regurgitant formula (not relevant for children who are exclusively breast feed).
If these measures fail, we sometimes recommend trying a medication to improve things. Traditionally in Singapore, a proton pump inhibitor such as omeprazole, or a H2 antagonist such as ranitidine are used to reduce the acidity of the stomach contents. Both medications can have side effects in some children, and can sometimes be difficult to obtain in liquid form.
Gaviscon Infant sachets
At Osler Health we are able to offer Gaviscon Infant. This comes in easy-to-use sachets based on a seaweed alginate which acts as both a feed thickener and mild antacid. It may have a better safety profile than the other medications, and seems to work as effectively. It is widely used in many other countries and does not tend to cause side-effects.
If you would like to find out more or have any concerns about your child, make an appointment to see one of our experienced family doctors today. We have two clinics:
– Raffles Hotel Arcade: 6332 2727
– Star Vista: 6339 2727
