Infant acid reflux: how do you know if your baby has GORD, and how is it treated?

Gastroesophageal reflux, happens because of too much relaxed muscle between the oesophagus or so-called gullet and the stomach As a consequence, the food the baby has taken, milk through the products, will get mixed with acid from the stomach, then will go up in the gullet or oesophagus

It will cause pain and discomfort The baby will be screaming Gastroesophageal reflux is more prevalent, is more common in babies who have other problems For example, with those with cow's milk protein allergy, cerebral palsy Those babies who have problems with the lower end of the gullet

Gastroesophageal reflux happens in one in two babies And sometimes it becomes as a disease leading to poor weight-gain, extreme vomiting and poor growth We know that baby has got the gastroesophageal reflux going back looking at the baby's behavior particularly after feeds When the baby regurgitates the milk they have taken, the milk may smell acidic But on the other hand, we know that in the same age baby may present with the sign of colic or milk allergies

But the behavior of the baby with colic is completely different, because those will draw up legs, they scream and stop, whereas gastroesophageal reflux is more continuous Those babies who vomit, who regurgitate are more likely to be suffering gastroesophageal reflux other than colic Gastroesophageal reflux is caused by relaxation of the muscle between the gullet, also called the oesophagus in the stomach And we know that this is very common in babies because they are very young With age this matter becomes stronger and there shall be no milk going from the stomach into the gullet

As a consequence, we have to think about strategies to put in place to make sure that what they eat is more thickened On the other hand, make sure that we play with the position of the baby Upright position would decrease the chance of the milk going from the stomach to the gullet The diagnosis of a gastroesophageal reflux is straightforward for paediatricians It's based on pattern recognition on good history taking from the information given by parents about the baby behaviour around feeds and after feeds

The baby will be regurgitating, will be vomiting, will be vomiting with acidic smell and babies will be screaming in pain after feeds So, based on that we can make a diagnosis, but in some cases, we end up doing a pH study which involves putting a probe in the gullet and measuring the period, the degree of acidity in the gullet to demonstrate that the acid has gone from the stomach into the gullet In very rare cases, in some centres they do endoscopy In other centres, they do barium swallow studies But these are very unusual tests as the majority of babies will gastroesophageal reflux are recognised on clinical grounds

Majority of babies with gastroesophageal reflux do not need treatment The management of the condition is mainly making sure that we minimise the chance of the milk going from the stomach into the gullet And that will include positioning the baby Make sure the baby is upright, or you sleep on the back because that's safer The other step of management without medication would be to make sure that the milk is thickened

That again will decrease the chance of milk going from the stomach to the gullet as it is less liquid In some babies, we recommend that on top of positioning, thickening, the baby get some special amount of milk reduced So, the volume they are getting every, for example, three hours is reduced to two hours Which means that volume being low, the content in the stomach is lower than what the stomach can hold As a consequence, the milk will not go back into the stomach

In rare cases, then we need to give some medication And medication given for gastroesophageal reflux: we start with the simple one: Gaviscon, which the mainstay is to improve the lining of the gullet in the stomach When this does not work, then we have to think about giving medication to reduce acidity in the stomach And in those cases, we give ranitidine, in some situations, we give omeprazole These tend to work because it is increasing the acidity

It means that even if you had some reflux, the amount of harm particularly of pain-causing screaming is reduced

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