Treating Reflux in Infants

Reflux in babies — when stomach contents enter the esophagus — is a common problem, especially in premature babies. This happens when the lower esophageal sphincter (LES) — the muscle at the top of the stomach — becomes weak, relaxed, or underdeveloped.

For most babies, reflux is mild and does not require treatment. Simple strategies can help improve problems like spitting up and discomfort. Reflux symptoms usually resolve spontaneously by the time the child is 12 to 14 months old, when the LES is stronger and well-developed.

However, some cases are important enough to warrant treatment. Infants with gastroesophageal reflux disease (GERD) — severe infant reflux — may require medication and, less commonly, surgery.

This article discusses various treatment options for reflux in babies, including things you can do at home to reduce reflux and help your baby feel better. It also explains why your baby may have gastroesophageal reflux rather than reflux.

stay-at-home strategy

Whether your baby’s reflux is mild or severe, there are some strategies you can try at home that may help reduce symptoms:

  • Smaller, more frequent feedings: If your baby is less full, they are less likely to spit up. Feeding your baby small amounts more frequently may reduce spitting up and reflux symptoms.
  • Burp your baby: Burp your baby frequently during and after feedings to prevent air from building up in their stomachs, which can push their contents up.
  • Stay upright after feedings: Keeping your baby upright for about 30 minutes after each feeding can help reduce reflux symptoms. Placing your baby in a semi-upright position on a swing or rocker after feedings can also help.
  • Change your baby’s formula: If your baby’s reflux symptoms are caused by a food allergy, switching to a special infant formula with a different protein composition (such as soy or hypoallergenic formula) may help.
  • Change your diet: If you’re breastfeeding, your baby may be reacting to the foods in your diet. Milk protein is a common culprit; breastfed infants who are sensitive to cow’s milk protein may experience gastroesophageal reflux symptoms. If you are advised to try eliminating dairy from your diet, be patient. It may take up to two weeks to see results.
  • Formula thickeners: Studies show that thickening infant formula with infant cereal can reduce GERD symptoms within one to eight weeks. Add 1 teaspoon rice cereal for every 2 ounces of formula or use pre-thickened formula.

According to the American Academy of Pediatrics (AAP), infants should not be introduced to foods other than infant formula or breast milk until they are 6 months old. This includes thickening formula unless your pediatrician advises otherwise.

You may also have heard that raising the head of the crib can reduce GERD symptoms while they sleep. However, the AAP said this was “ineffective in reducing gastroesophageal reflux”. It also recommends against this strategy due to the risk of sudden infant death syndrome (SIDS).

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If your baby has a higher risk of dying from GERD than SIDS, your doctor may recommend raising the head of the crib. Otherwise, the only safe way to put your baby to sleep is to lie down without a blanket or pillow.

Swallowing problems may be due to GERD

drug

At-home strategies may be sufficient to improve mild cases of infant reflux. If this is not the case, medication may be required. Signs that your baby may need treatment include:

  • Breathing problems caused by inhaling backflow of milk
  • coughing, choking, or wheezing
  • poor growth
  • refusal to eat due to pain
  • severe pain

Your baby’s pediatrician may also prescribe medication if your baby’s esophagus becomes inflamed and damages the lining of the esophagus, a condition called Esophagitis.

Medications sometimes used to treat reflux in infants include antacids, H2 blockers, and proton pump inhibitors (PPIs). Sometimes, over-the-counter (OTC) preparations are available. Or your baby’s pediatrician may recommend a prescription. The first drug your baby tries may work, but be prepared to trial and error to find the one that works best.

How to Diagnose GERD

Antacid

OTC antacids suitable for treating reflux in infants include Mylanta, Maalox, and Tums. Although Mylanta and Maalox can be given to babies over 1 month old, Tums are not recommended for babies younger than 1 year old.

Regular use of antacids may help babies with mild gastroesophageal reflux symptoms. However, there are some risks you should discuss with your pediatrician before giving antacids to your baby. If you use one of these, be sure to strictly follow the dosage instructions.

There is growing evidence that babies who take high-dose antacids are at a higher risk of developing rickets, a condition in which children’s bones become weaker and weaker.
Maalox and Mylanta are known to have laxative effects at high doses and may cause diarrhea in infants.

how to use them

Mylanta comes in liquid form that you can mix with water or infant formula. Your pediatrician may occasionally recommend an antacid in chewable tablet form, which you’ll need to grind into a fine powder and mix into your baby’s formula.

If your pediatrician recommends antacids for your baby, they will instruct you on the appropriate dose. For example, while Mylanta can be taken up to 3 times a day, your pediatrician may recommend a different dosage, depending on your baby’s weight, age, and other factors.

In general, antacids should not be taken for more than two weeks. If your baby’s reflux symptoms do not go away within two weeks of starting antacids, be sure to read the label carefully and call your pediatrician.

Do not mix aspirin and baby

Make sure that any medicines you give your baby do not contain aspirin or bismuth subsalicylate. Use of these drugs in children has been linked to a life-threatening condition called Reye’s syndrome, which causes swelling of the brain and liver failure.

H2 blocker

Histamine (H2) blockers block the hormone histamine to reduce the amount of acid the stomach produces. Doctors also prescribe them because they help heal the lining of the esophagus.

Prescription H2 blockers such as Pepcid (famotidine) are considered safe and have been widely used to treat reflux in infants and children. They do carry a small risk of side effects, including abdominal pain, diarrhea, and constipation. Some studies also suggest that long-term administration of H2-blockers to infants may disrupt the protective effects of their gut lining and increase the risk of certain bacterial infections.

how to use them

Over-the-counter H2 blockers such as Tagamet (cimetidine) and Pepcid are available in liquid and tablet form at your local pharmacy. These over-the-counter medications are not recommended for children under 12, so if a pediatrician recommends an H2 blocker, your baby will need a prescription.

H2 blockers begin to work quickly and can reduce a baby’s symptoms in as little as 30 minutes. Your doctor will determine the correct dose for your baby when prescribing the medicine.

infection risk

H2 blockers and PPIs reduce the amount of stomach acid in the baby’s stomach. Because stomach acid helps protect the body from infection, babies are at higher risk for pneumonia and gastrointestinal infections when taking these medicines.

proton pump inhibitor

Proton pump inhibitors (PPIs) are generally considered more effective than H2 blockers in reducing stomach acid. Prescription-only PPIs include Nexium (esomeprazole), Prilosec (omeprazole), Prevacid (lansoprazole), and Protonix (pantoprazole). Although you can find some proton pump inhibitors over the counter, such as Prilosec, they are generally not recommended for children younger than 1 year old.

PPIs should be considered with caution because they have more long-term side effects than H2 blockers, including liver problems, gastric polyps, and reduced immunity to bacterial infections.

how to use them

Doctors usually prescribe PPIs for 4 to 8 weeks. Your doctor will consider your baby’s age, weight, and other factors when determining the dose. To get some PPIs in liquid form, you’ll need to find a pharmacy that can synthesize or mix your own.

Power agent

In the past, power agents like Reglan have been used to speed up digestion, empty the stomach faster and prevent reflux. These drugs are no longer used in babies due to serious side effects.

review

Antacids, H2 blockers, and PPIs may be considered when your baby does not improve with nonpharmacological strategies. While over-the-counter versions of some of these drugs are available for infants to ingest, this is not the case. Follow your pediatrician’s instructions.

Infant reflux surgery

In rare cases, when GERD symptoms are life-threatening, a condition called fundoplication can be executed. Your pediatrician may recommend it if:

  • GERD lasts well beyond the first year of life and does not improve with treatment.
  • Your baby will have recurrent aspiration pneumonia due to stomach contents being sucked into the airways.
  • Your baby has an apnea episode where they cannot breathe completely or partially for more than 20 seconds during reflux.
  • They develop an irregular heart rhythm called bradycardia.
  • Their airways are damaged, leading to a chronic lung disease called bronchopulmonary dysplasia.
  • Your baby is not developing properly due to malnutrition.
  • Your baby’s esophagus is unusually tight (esophageal stricture) due to inflammation, a condition that increases their risk of choking.

During fundoplication surgery, the top of the stomach is wrapped around the esophagus, tightening the LES and making it harder for food to flow out of the stomach.

While it can be an effective solution for children with severe reflux who do not respond to medication, fundoplication is a major surgical procedure with many possible complications. This program may not work for some children.

What is Gastroesophageal Reflux Disease (GERD) Surgery?

Work with your pediatrician

Reflux can be difficult to manage and sometimes frustrating. Many families try multiple remedies before finding one that works for their baby, but after a few months that remedy stops working.

This situation can test your patience, so keep your lines of communication open with your pediatrician. It can help keep track of the interventions you try and how your baby responds to them. Also, note any changes in their diet or routine, as they can also affect their symptoms.

If your baby has gastroesophageal reflux disease, consider consulting a pediatric gastroenterologist, a doctor who specializes in children’s digestive health issues.

generalize

Reflux symptoms usually improve on their own by the time most babies are 14 months old. When symptoms are mild, feeding the baby small, frequent meals, keeping him upright after feedings, and other strategies may be sufficient. If your baby is diagnosed with GERD, your pediatrician may recommend antacids, H2 blockers, or PPIs. While effective, they carry a risk of side effects that you and your pediatrician should consider. Surgery may be considered when GERD symptoms cause complications.

VigorTip words

It’s not uncommon for babies to spit up within an hour or two of feeding. It’s also normal to be unsure if your baby is spitting up normally, especially if you’re a first-time parent. Between 70% and 85% of babies regurgitate part of their food at least once a day during the first two months of life. If this sounds like your baby, try not to panic, although you may have to find a way to supplement your baby’s nutritional needs.