Gastro-esophageal reflux is also known as possetting, regurgitation and ‘spitting up’. It is, not surprisingly, very common – babies are taking large amounts of milk into small stomachs to fuel rapid growth and the contents of the stomach are sometimes moved back into the gullet (esophagus) or mouth.
It can be caused by how the baby is fed. Incorrectly made infant formula or feeding too quickly can both contribute. Reflux should not usually be a cause for concern and has usually disappeared by the time the baby is 12-15 months of age.
If it persists beyond 18 months – 2 years it may need treatment. Stomach contents contain acid and whilst this tends not to be a problem in the stomach it can damage the delicate lining of the esophagus. There is also a danger that feed may go into the lungs and cause infections.
Symptoms include frequent vomiting and excessive crying as well as insufficient growth, poor sleep and refusing to feed. Ear, chest and sinus infections and constant coughing may also be signs.
Winding baby thoroughly in the middle as well as the end of the feed may help as may giving smaller but more frequent feeds. It is important to point out to parents that the overall amount of food given per day should not change.
Holding an infant upright for 20 minutes after feeding may also help with baby’s digestion. For mothers feeding infant formula, it is necessary to ensure that the instructions for making up feed are followed correctly.
Feed thickeners may also help. For mothers who are breastfeeding, this can be mixed with expressed breast milk and given by spoon either before or during a feed. It can also be mixed with cooled boiled water. For babies being bottle fed, the doctor should be able to recommend an appropriate formula like Ronalac AR.
Some babies may need medication such as antacids as well as thickened feeds.
Parents should be advised that in some cases, excessive parental anxiety is thought to make esophageal reflux worse.