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 Infant Reflux

Gastro-oesophageal reflux in Infants

How to Treat and Prevent Infant Reflux?

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Normal Presentation 

  • Some reflux – regurgitating or vomiting of feeds – is normal in babies

  • Reflux is very common. It affects at least 4 out of 10 of babies younger than 1 year.

  • Usually no tests or treatments are needed.

  • It tends to start before the baby is 8 weeks old.

  • Babies can bring up milk 6 or more times a day.

  • It normally happens less often as the baby gets older.

Check if your baby has reflux 

Reflux usually starts before a baby is 8 weeks old and gets better by the time they're 1.

Symptoms of reflux in babies include:

  • bringing up milk or being sick during or shortly after feeding

  • coughing or hiccupping when feeding

  • being unsettled during feeding

  • swallowing or gulping after burping or feeding

  • crying and not settling

  • not gaining weight as they're not keeping enough food down

  • Sometimes babies may have signs of reflux but will not bring up milk or be sick. This is known as silent reflux.

 

When to seek medical advice

  • The vomiting becomes more forceful, as 'projectile vomiting' contact your GP or 111 out of hours immediately.

  • If your baby brings up milk that is green, yellow‑ish green or if it looks as though it has blood in it, contact your GP or 111 out of hours immediately.

  • If your baby, won't stop crying (high pitch cry after vomiting), arching their back during or after a feed, or drawing their legs up to their tummy after feeding, stops putting on weight, or if reflux is still a problem in a baby older than 1 year.

 

Causes

  • It's normal for some babies to have reflux. It usually just occurs because a baby's food pipe (oesophagus) is still developing. It normally stops by the time a baby is a year old, when the ring of muscle at the bottom of their oesophagus fully develops and stops stomach contents leaking out. In a small number of cases, reflux can be a sign of a more serious problem, such as:

  • gastro-oesophageal reflux disease (GORD) – a long-term form of reflux where stomach contents are able to rise up and irritate the oesophagus

  • a cows' milk allergy – this can also cause a rash, vomiting and diarrhoea; many babies will eventually grow out of it and can be treated by removing cows' milk from their diet.

  • a blockage – rarely, reflux may occur because the oesophagus is blocked or narrowed, or there's a blockage in the stomach and small intestine.

 

Medication

  • Babies with reflux don't usually need to take any medication, but sometimes the following medicines may be offered if your doctor feels the problem is severe:

  • Alginates – these form a protective barrier over stomach contents, stopping them traveling up and irritating the oesophagus

  • Proton pump inhibitors (PPIs) and H2-receptor antagonists – these reduce the level of acid in the stomach, so the stomach contents don't irritate the oesophagus as much.

Feeding advice

  • Your midwife or health visitor may want to check how you feed your baby and suggest some changes to help with their reflux.

  • These changes might include:

  • burping your baby regularly throughout feeding.

  • giving your baby smaller but more frequent feeds.

  • holding your baby upright for a period of time after feeding.

DHD Reviewed 2021 National Health Service 2023. National Health Service Choices 2.3.23 https://www.nhs.uk/conditions/reflux-in-babies/

National Institute for Excellence in Health and Care (NICE) 1.3.2019 Gastro-oesophageal reflux disease in children and young people: diagnosis and management

https://www.nice.org.uk/guidance/ng1/ifp/chapter/Medicines-to-reduce-acid-production2018 surveillance of gastro-oesophageal reflux disease in children and young people: diagnosis and management (NICE guideline NG1)

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