Acid Reflux In Infants - The Difference Between GER & GERD
There is nothing more distressing both for baby and parent than a bad case of acid reflux. It can lead to painful colic which is frequently accompanied by intense bouts of crying, vomiting and even a refusal to eat. That is just how unpleasant the symptoms can be.
While infant reflux can certainly be bothersome, it is an entirely normal process and thought to be related to a baby’s developing digestive system. Reassuringly, in most cases, it is absolutely nothing at all to be concerned about. Ordinarily, a bad case of reflux is simply down to the valve that keeps a baby’s stomach’s contents down where they belong still developing. As a result of which, milk, as well as acid, do have a propensity to come back up the digestive tract.
In most instances, by your baby’s first birthday, most of the episodic symptoms of reflux along with regurgitation should have dissipated, which is excellent news for baby and you.
Definition & Facts - GER Versus GERD
Gastroesophageal reflux, simply referred to as GER, occurs when contents from the stomach make their way back up the oesophagus resulting in heartburn. The burping, heartburn, and spitting up associated with GER are the result of acidic stomach contents moving backward into the esophagus. This can happen because the muscle that connects the esophagus to the stomach (the esophageal sphincter) relaxes at the wrong time or doesn't properly close. Many people have reflux regularly and it's not usually a cause for concern. But with GER, reflux happens more often and causes noticeable discomfort. After nearly all meals, GER causes heartburn (also known as acid indigestion), which feels like a burning sensation in the chest, neck, and throat. In babies with GER, breast milk or formula regularly refluxes into the esophagus, and sometimes out of the mouth. Sometimes babies regurgitate forcefully or have "wet burps." Most babies outgrow GER between the time they are 1 or 2 years old. But in some cases, GER symptoms last. Children with developmental or neurological conditions, such as cerebral palsy, are more at risk for GER and can have more severe, lasting symptoms.
Gastroesophageal reflux disease, shortened to GERD is a more serious and potentially longer-lasting condition that may prevent an infant from physically feeding and as such, requires immediate attention to remedy. Gastroesophageal reflux disease (GERD) is commonly called heartburn. This digestive disorder most often causes a burning and sometimes squeezing sensation in the mid-chest. In GERD, acid and digestive enzymes from the stomach flow backwards into the esophagus, the tube that carries food from your mouth to your stomach. This backward flow of stomach juices is called "reflux". These caustic stomach juices inflame the lining of the esophagus. If GERD is not treated, it can permanently damage the esophagus. A muscular ring seals the esophagus from the stomach. This ring is called the esophageal sphincter. Normally, the sphincter opens when you swallow, allowing food into your stomach. The rest of the time, it squeezes tight to prevent food and acid in the stomach from backing up into the esophagus. In most people with GERD, however, the esophageal sphincter does not seal tightly. It remains relaxed between swallows. This allows digestive juices to enter the esophagus and irritate the esophageal lining.
Definition & Facts - Reflux Versus Regurgitation
Frequently intertwined, reflux and regurgitation are in fact, different phenomena, although the physical effects experienced by your baby and the conventional treatments recommended are closely related. Gastroesophageal reflux, which we previously introduced as the non-threatening and commonly experienced condition abbreviated to GER, is where milk or food in older babies goes back up from the stomach and into the oesophagus or food pipe. You will also find this referred to as “silent reflux” as sometimes it can be tricky to detect as you will not always see the feeds being physically brought back up.
Regurgitation on the other hand also referred to as spitting up or “posseting”, is where the food or milk makes it way from the stomach, up through the food pipe and all the way into the mouth, typically landing on the shoulder of whoever has the honour at the time of holding the baby! It is differentiated from vomiting because there is no strain involved. Regurgitating is somewhat of an effortless process that’s more akin to a hiccup, so please do not get overly anxious if your baby is prone to regurgitating their milk.
While both reflux and regurgitation are distressing, they are entirely natural processes, and up to 30% of all healthy babies do experience reflux and regurgitation at least several times a day during the first year of their life as their digestive systems are still maturing.
As long as your baby isn’t displaying any apparent signs of discomfort or appears to be losing significant amounts of weight, there should not be any need for concern.
Possible Symptoms And Causes Of Reflux And Regurgitation
If your baby suffers from regular bouts of “posseting” you might be reassured to discover that there are several common reasons why this is occurring, all of which are non-threatening:
• A baby’s diet is predominately made up of fluids
• Babies spend a lot of their formative time lying down
• Their food pipes are short
• Their digestive systems are still going through a stage of maturing
• Babies have a tendency to take in too much milk or food in one sitting
Any one of the above or even a combination of those causes can lead to Gastroesophageal reflux (GER). They are all part and parcel of being a baby and hard to avoid so to a greater or lesser degree, reflux and regurgitation are going to feature in most parents lives. Other symptoms that accompany Gastroesophageal reflux disease (GERD) can include colic, vomiting and refusal to eat which is why a baby’s weight needs to be monitored closely to ensure that normal infant growth and development occurs.
Soothing And Reducing The Symptoms
The great news is that there are plenty of practical things you can do as a parent to make your child as comfortable as possible. Feeding little and often will certainly help prevent baby’s stomach from getting too full too quickly, while keeping them in an upright position after they’ve been fed will also help them to keep everything down. It’s also a good idea to dress your baby in loose clothing, especially around their tummy area, which will also help reduce the symptoms of reflux and regurgitation.
Here are some other top tips that you might want to try implementing:
• Avoid overfeeding - instead, go for little and often
• Be sure to burp your baby before, during as well as after feeding
• Check that the teat size isn’t too large and your baby isn’t feeding too quickly
• Consider switching to a specialist formula for the dietary management of GER
• Try and keep your baby upright for a minimum of 30 minutes post feed
• Dress your baby in non-restrictive clothing
Diagnosing GER And The Signs To Look Out For
The first signs of GER are likely to be seen from 3 weeks old, and symptoms can last up until a baby is 12 months of age. Your baby will be diagnosed as suffering from regurgitation if they regularly posset two or more times every day for a least three consecutive weeks. If there are no other signs of illness, for example, weight loss, feeding difficulties, vomiting or retching, then regurgitation is the cause.
However, if your child’s GER symptoms show no sign of improvement or appear to be coming back both frequently and with intensity, then it is worth getting them checked out for GERD. Tests to determine whether Gastroesophageal reflux disease is present may include an upper GI endoscopy, an upper GI series or on-going oesophageal monitoring.
Other troublesome symptoms to be aware of include:
• Constant or sudden crying
• Irritability or pain
• Waking up more frequently than usual
• An arched back after feeding
• Wet burps od hiccups
The peak time for experiencing symptoms of GER is between 4-6 months, and as already explained, in most cases, your baby should grow out of them by the time they reach their first birthday.
Diagnosing GERD And The Signs To Look Out For
In more severe cases, where reflux leads to inflammation of the digestive system, GERD could be the culprit. Feeding difficulties and failure to thrive syndrome may develop, and this is the point at which you should seek help from a healthcare professional. Treatment for GERD will depend upon the severity and range of symptoms present, as well as the age of the infant. It can include fundamental feeding changes, medicines or in extreme circumstances, surgery.
If your infant has been diagnosed with GERD, please do not be alarmed. As with GER, there are practical and actionable solutions which can be implemented. Simple and effective changes to their diet and nutrition may help, and your healthcare professional may advise feeding your baby with a higher calorie formula.
Written and edited by Mathilde Allemand