I had only just begun to thank my stars at about the 1 month mark, that my daughter was not giving us much trouble at all – no colic etc., when something more sever struck. At about the 6 weeks of age my daughter was diagnosed with GERD (Gastroesophageal Reflux Disease), also commonly referred to as acid reflux. She had to be put on medication for about 4-5 months and we had take a lot of precautions during that time. Here’s all the information I gathered and our journey.
What is GERD or Reflux?
It is the upward movement of the stomach contents into the food pipe (esophagus), and sometimes into or out of the mouth.
Don’t all infants spit up? How is GERD/Reflux different?
Yes, to varying degrees, all infants spit up one or more feeds during the day, especially in the earlier days. When this is not accompanied by any other discomfort or symptoms, spitting is absolutely normal and you should not worry.
What are the symptoms of GERD/Reflux?
A combination of one or more of the following symptoms would indicate that your baby has GERD/reflux:
- Frequent or recurrent vomiting: One clear indicator between a spit up and vomit in babies is that the vomit will resemble curdles milk in appearance and will have that distinct stench. Spit up is mostly odorless.
- Frequent throaty noises that may sound like cough or like your baby is trying to clear his or her throat.
- Esophageal noises: Even 30-60 minutes after a feed, you will notice sometimes the sound of liquid going up and down your baby’s throat or food pipe not necessarily resulting in throwing up.
- Frequent and fussy feeding: Because of the constant discomfort your baby may demand very frequent feeds (as frequent as every 45-60 minutes), cluster feeds (feeding continuously every 5 minutes for about 3-4 hours). He/she may also be very uncomfortable during the feeding resulting in shrieks, high pitched crying and arching of the back.
- Extreme gassiness or colic
- Poor weight gain
What causes GERD/Reflux?
GERD/Reflux in babies is caused due to an under-developed esophageal sphincter (that is, the valve connecting the food pipe to the stomach). This is aggravated by the fact that babies remain in horizontal stationary position almost throughout the day.
How is Reflux/GERD diagnosed?
Since babies can’t really communicate, and so many symptoms of GERD/Reflux could just be normal new born symptoms or may indicate a less serious condition such as colic or just gas, it is difficult to diagnose it. Also, sometimes the reflux is silent (which means that there is no vomiting as the baby swallows the acidic contents back). This is where the mother’s instinct comes into the picture. You need to observe your baby very carefully for these symptoms for atleast a period of 2 weeks. Note down the frequency of the occurrence of the symptoms so that your doctor has enough data/statistics to diagnose. In very severe cases, your doctor may prescribe tests such as pH probe, ultrasound, endoscopy etc.
How is Reflux/GERD treated?
Doctors usually prescribe an antacid such as Zantac. The dosage is based on the weight of the baby. However, under no circumstance should you give any over the counter medication on your own, as it exposes your baby to life threatening risk.
Apart from the medication, doctors advise the following:
- If you are breastfeeding your baby, feed on demand or every 1-2 hours. Frequent nursing helps the baby relieve the bad taste and discomfort. Also, due to reflux, babies are not able to drink too much at one go. The medication also makes the breast milk more easily digestible making the baby hungry sooner.
- If you are formula feeding, and the baby is throwing up often, you are advised to mix rice cereal in the bottle to help the feed settle down. The ratio is prescribed by the doctor. Do not do this if your doctor has not specifically advised you for it.
- During feeding (breast or bottle), the baby should be positioned such that the head is elevated from the rest of the body.
- Frequent burping – after every 2-4 ounce of formula or 5-10 minutes of nursing is a must.
- After feeding, place the baby in a reclining baby chair (such as a bouncer without it being on) or a car seat for at least 30-45 minutes. Do not place the baby completely upright as that places pressure on the stomach and that is not advisable.
- Elevate the bed of the baby (using a crib wedge) so that the baby is more comfortable during sleep time.
- Try not causing any stress during feeding as that increases reflux. If your baby is used to the breast, try not to force a bottle, or don’t change bottle type or formula type.
- Give your baby lot of tummy time as that position strengthens the valve.
How long does it take to cure Reflux/GERD?
Most babies take medication for a period of 3-6 months. The dosage is first increased (as the baby weight increases) and then slowly decreased till the baby is no longer dependent on it. Most babies outgrow reflux/GERD once they start moving around and having solids. My daughter outgrew her need for medication at about the 6th month mark. If GERD/reflux continues in babies beyond 12-18 months or occurs only after the 6th month mark, doctors say that the reasons maybe different from infant reflux and require a different kind of diagnosis and treatment.