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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