Reflux or spitting up is also called ‘gastroesophageal reflux disease’ (GERD) or ‘gastroesophageal reflux disease’ (GERD). Reflux occurs when stomach contents flow back into the esophagus during or after a meal. In a baby, the sphincter between the esophagus and the stomach is sometimes not yet formed properly, which is often the cause of reflux. More than half of all babies experience reflux in the first 3 months of life, but most stop spitting up between the ages of 12 and 24 months. With uncomplicated reflux, treatment is usually not necessary. It often helps to take a number of relatively simple measures. In more serious cases, medications can provide a solution. In very rare cases, surgery must be performed.
- What is gastroesophageal reflux?
- Reflux in Babies (Spitting Up)
- Symptoms of reflux in a baby
- Characteristics and complaints
- Types of reflux
- Pain complaints
- Examination and diagnosis
- Reflux treatment
- Milk thickeners
- Medication
- Surgical procedure
What is gastroesophageal reflux?
Reflux occurs when stomach contents flow back into the esophagus during or after a meal. The esophagus is the muscular tube that connects the mouth to the stomach. Muscles in the wall of the esophagus transport food to the stomach. At the transition from the esophagus to the stomach there is an annular sphincter muscle (sphincter), which opens to allow food to pass through, after which it closes again so that the stomach contents do not flow back into the esophagus.
Reflux in Babies (Spitting Up)
In babies it often happens that stomach contents flow back into the esophagus and mouth when the sphincter opens. This results in regurgitation or spitting up. Reflux can also occur when babies cough, cry, or are tense. This has to do with the fact that the sphincter between the esophagus and the stomach is sometimes not yet fully developed in children. The sphincter muscle will often develop further during the first year of life, causing the complaints to gradually disappear.Less common causes of reflux in babies are chronic constipation, food allergy (for example cow’s milk allergy) or a stricture in the esophagus.Unnoticed reflux Reflux is a phenomenon that occurs regularly in many babies, but sometimes it can go unnoticed.
Symptoms of reflux in a baby
Reflux is common in healthy infants. More than half of all babies experience reflux in the first 3 months of life, but most stop spitting up between the ages of 12 and 24 months. Only a small number of babies suffer from reflux to a serious extent. In that case it is called complicated reflux.
Characteristics and complaints
An infant with reflux may suffer from (some of) the following complaints:
- Frequent (inconsolable) crying after eating;
- Irritability;
- Making painful faces;
- Pull the head back;
- Frequent belching or frequent gagging, especially after meals;
- Choking or wheezing as the contents of the reflux enter the trachea and lungs;
- Wet burp or wet hiccups;
- Refusal to eat, or wanting to eat only limited amounts;
- Bad sleeping;
- Swallowing complaints and blood vomiting;
- Stunted growth or weight loss.
Types of reflux
A distinction is made between uncomplicated and complicated reflux. Uncomplicated reflux is the most common. The child regularly returns (large amounts of) food. If the child is not bothered by this and is growing well, then it is most likely uncomplicated reflux.
Pain complaints
As a result of the upward flow of acidic stomach contents, the esophagus can become irritated and eventually even inflamed, which causes pain in the child. As a result, these children often cry, eat less, are more irritable and sleep less well. In some cases, swallowing problems and blood vomiting also occur. When they eat less, growth retardation occurs. They can even lose weight. When the baby shows these complaints, this is called complicated reflux.
Examination and diagnosis
How is the diagnosis made? In many cases, in the case of uncomplicated reflux complaints, a physical examination of the baby is sufficient. Complicated and atypical reflux complaints can be demonstrated by esophagoscopy with biopsies. The esophagus is examined using an endoscope. At the same time, small ‘bites’ (biopsies) are removed from the mucous membrane. These biopsies can then be further examined. A 24-hour pH measurement can also be performed. A thin tube is inserted into the esophagus through the nose and the acidity (pH) in the esophagus is measured for 24 hours. Sometimes X-ray examination can also contribute to making the correct diagnosis.
Reflux treatment
With uncomplicated reflux, treatment is usually not necessary. Normally the complaints disappear during the first year of life, sometimes a little later.
Milk thickeners
When bottle feeding, it is possible to use ‘milk thickeners’, such as carob epithelium (nutriton), which reduces the return of food. What also helps is giving smaller feedings more often per day. It is also advisable to keep the baby upright for the first half hour after feeding, so that the stomach contents cannot flow back. Also make sure that he burps after feeding, so that less air remains in the stomach. This reduces the chance that it will spit up.
Medication
Complicated reflux must be treated with medications that accelerate the transport of food through the esophagus and stomach. These medications are also called ‘prokinetics’. This means that food reaches the small intestine more quickly and cannot flow back into the esophagus. Treatment with antacids such as Zantac can make the stomach acid less acidic. Although these medications do not remove the cause and the stomach contents can still rise into the esophagus, but because the stomach contents are less acidic, the esophageal wall is not irritated or damaged.
Surgical procedure
In very serious cases and in very exceptional cases, surgery can be performed.
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