What is reflux?
Reflux, or gastro-oesophageal reflux, is a common problem in babies, especially premature babies. Reflux occurs when some of the partly digested milk or food in the stomach comes back up into the food pipe (oesophagus) and sometimes into the mouth. As the stomach contains acid that helps to digest food, the acidity can cause some discomfort and burning sensations within the food pipe. This can be painful for babies and they may become irritable during and after feeding times.
Why does reflux happen?
When food is taken through the mouth, it travels down the food pipe and into the stomach. There is a small band of muscle above the stomach opening (called the lower oesophageal sphincter). This band opens when food is about to enter the stomach and then closes so that food remains in the stomach. However in premature babies this band of muscle is weak and doesn’t close properly, so food can go back into the food pipe and into the mouth. This is known as reflux, when partially digested milk or food enters back into the mouth.
Symptoms of reflux can include:
- bringing milk back up with burping
- vomiting that often shows no clear pattern in terms of timing or amount
- fussiness, crying and restlessness
- refusing to feed and fighting the nipple/teat
- only taking small quantities of feed
- arching back during feeding
- choking or gagging
- changes to the baby’s skin colour.
More severe complications of reflux can include:
- chest infections
- poor weight gain
- feeding/eating difficulties
- inability to lie flat after a feed without discomfort
- becoming anaemic.
Treatment for reflux
Treatment depends on the severity of the reflux. Some babies on the neonatal unit can be managed by nursing them in different positions. Mild reflux tends to improve on its own and gets better when the baby begins to wean onto solids.
Ways to help your baby
- Giving your baby Kangaroo Care after a feed to allow the food to settle before laying your baby in a semi-inclined cot
- Changing your baby’s nappy before feeding makes vomiting less likely
- Feeding your baby with slightly smaller volumes of milk but increasing the frequency of feeds throughout the day
- Burping your baby more frequently.
Sometimes medications may be given to help. These may include feed thickeners, which are added to the baby’s milk to help reduce the effect of reflux. Thickeners work by making the feed more solid once it is in the stomach and this makes it harder to bring back up. Infant Gaviscon is an example of this. Other medications may help to lower the acid production in the stomach and to speed up food passage through the stomach.
Reflux is often worse when a baby is lying flat on their back, so it can help if you keep your baby’s head gently raised during the day. The most important time is after a feed; at this time you should hold your baby upright for as long as you can.
If your baby suffers from reflux during the night, try making the head end of the cot slightly higher by standing it on something stable (a couple of books perhaps), so that your baby’s head is slightly raised. However, you should not put anything directly under your baby’s head, and never use a pillow with a baby under 12 months old.
Most babies will grow out of reflux naturally. If it does not pass and medications do not improve the situation, then further investigations may be required. These could include an acidity probe test or a contrast swallow. Your doctor will advise you about any tests.