Most moms know the feeling of getting your little one all dressed up and ready to go, just to have them spit/vomit milk all over everything just before you leave.
Ever wondered why or how to help them?
Gastro-Esophageal Reflux (GER) is a normal occurrence in healthy babies where the contents of the stomach push back into the oesophagus (swallowing tube) and is then swallowed back (“silent reflux”) or spit/vomited up.
Most babies (40-60%) struggle with some degree of reflux because of their immature gut, fluid diets and the fact that they are mostly lying flat. Symptoms of reflux can start in the first few days of life and is usually outgrown by 12-18months.
These babies are often irritable after feeds, can arch their backs, sleep for shorter stretches and want to feed often as the milk soothes their throats. Most babies with reflux grow well, feed well and do not have any danger signs.
These babies are often referred to as “happy spitters” and do not need any specific medicine.
Your baby may have Gastro Esophageal Reflux DISEASE (GERD) if he:
- Is failing to thrive (not gaining weight, not reaching developmental milestones)
- Refuses feeds
- Has signs of esophagitis (this is painful inflammation of the oesophagus)
This is not normal and should be treated.
So how can we treat a baby with reflux?
As a mom I know we will try anything to help our babies, but as a paediatrician I want to help you understand what has been proven to work and what is safe for your baby.
General management for all babies with reflux
- Upright positioning (90°) for 20-30min after feeds. Babywearing keeps your hands free and keeps baby happy and safe. “Reflux pillows” that elevates baby’s head has not been proven to make a big difference. A rocker or car seat can worsen reflux due to the scrunched-up position and increased pressure in the stomach.
- It helps to give smaller feeds more frequently. The total volume of formula for the day can be divided by 12 to give two hourly feeds.
- Breastfeeding moms can feed on demand, but try to soothe baby in other ways if the previous feed was less than 2 hours ago. Remember breast milk has a protective effect against reflux.
- Thickening of feeds. Studies have proven that thickening expressed breast milk can decrease the episodes of vomiting.
- There are several brands of formula milk that offer an anti-reflux formula that is a thicker milk and helps to reduce symptoms of reflux.
- Avoid exposure to tobacco smoke as this can worsen the symptoms of reflux.
Specific medications for Reflux
- Proton Pump Inhibitors (PPIs) are used to suppress the amount of acid formed in the stomach. It will NOT decrease the number of reflux episodes or the amount of vomiting, but it could make your baby more comfortable if there was inflammation and pain due to the acid. If your doctor prescribes this medication, it is important to decide after 2 weeks if it is really helping, and to reassess after 3 to 6months if it is still necessary. Remember that stomach acid is very important for your baby’s digestion and immune function, and suppressing it does have risks.
- Antacids such as Gaviscon® have been shown to provide some relief in the symptoms of reflux and it is safe to give for short periods (less than 2 weeks).
I know it can be scary if your baby vomits all the time, and it creates mountains of washing, but take heart! These days feel long, but the years are short and before you know it your child will be waving goodbye on their first day of school (without vomiting all the milk from their morning porridge.)
Red flags in a vomiting baby
Please see your doctor ASAP if you see any of these symptoms:
- Recurrent projectile vomiting (when the vomit hits the other side of the room)
- Yellow bile or blood-stained vomiting
- Distension or pain of the stomach
- Constipation or diahroea
- Any seizures, abnormal movements or abnormal head size
- Recurrent lung infections
From as far back as I can remember I wanted to work with children and this dream was realized when I qualified as a Paediatrician at the University of the Free State in Bloemfontein. In 2017 our beautiful baby boy, Eran, was born and he made me a Mom! It was the perfect mix of theory and practical experience. I have a passion to help other parents understand more of the what, why and how of these tiny humans by explaining paediatric topics from a mother’s perspective on my blog “Pediatrics & Playdough”.
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