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Infant Acid Reflux

Introduction
Signs and symptoms
Causes
When to seek medical advice
Screening and diagnosis
Treatment
Self-care

Infant acid reflux is most likely after a feeding, it can happen anytime your baby coughs, cries or strains. And it's probably tougher on you than on your baby. Even when soaked in spit up, most babies who have reflux are happy and healthy.

Infant acid reflux typically resolves on its own by ages 12 to 18 months. In the meantime, changes in feeding technique - such as smaller, more frequent feedings, changing position or interrupting feedings to burp - can help keep reflux under control. In a few cases, medication or other treatments may be recommended.

Normal infant acid reflux doesn't interfere with a baby's growth or well-being. Contact your baby's doctor if your baby:

• Isn't gaining weight
• Spits up forcefully, causing stomach contents to shoot out of his or her mouth
• Spits up more than a tablespoon or two at a time
• Spits up green or brown fluid
• Resists feedings
• Seems hungry between feedings
• Has fewer wet diapers than normal or appears lethargic
• Has other signs of illness, such as fever, diarrhea or difficulty breathing
• Has a chronically hoarse voice

Some of these signs and symptoms may indicate more serious conditions, such as gastroesophageal reflux disease (GERD) or pyloric stenosis. GERD is a severe version of reflux that often causes pain, vomiting and poor weight gain. Pyloric stenosis is a rare condition in which a narrowed valve between the stomach and the small intestine prevents stomach contents from emptying into the small intestine.

Diagnosis of infant acid reflux is typically based on your baby's symptoms and a physical exam. Diagnostic tests are needed only if your baby's doctor suspects a more serious condition, such as GERD. In these cases, diagnostic tests may include:

• Lab tests. Your baby's doctor may do various blood and urine tests to identify or rule out possible causes of recurring vomiting and poor weight gain.
• Esophageal pH monitoring. To determine if irritability, sleep disturbances or other symptoms are associated with reflux, it may be helpful to measure the acidity in your baby's esophagus. The doctor will insert a thin tube through your baby's nose or mouth into the esophagus. The tube is attached to a device that monitors acidity. Your baby may need to remain in the hospital for the monitoring, which often lasts 24 hours.
• Upper GI series. If the doctor suspects a gastrointestinal obstruction, he or she may recommend a series of X-rays known as an upper gastrointestinal (GI) series. Before the X-rays, your baby may drink a white, chalky liquid (barium). The barium coats the stomach, which helps any abnormalities show up more clearly on the X-rays.
• Upper endoscopy. Your baby's doctor may use this procedure to identify or rule out problems in the esophagus, such as narrowing (stricture) or inflammation (esophagitis). The doctor will insert a special tube equipped with a camera lens and light through your baby's mouth into the esophagus, stomach and first part of the small intestine. Samples of any suspicious areas may be taken for analysis. For infants and children, endoscopy is usually done under general anesthesia.

Most cases of infant acid reflux clear up on their own. Treatment is typically limited to simple changes in your feeding technique - such as smaller, more frequent feedings, interrupting feedings to burp or holding your baby upright during feedings. If you're breast-feeding, your baby's doctor may suggest that you avoid cow's milk or certain other foods. If you feed your baby formula, sometimes switching brands helps.

For babies with severe reflux or GERD, more aggressive treatment may be needed.

• Medication. If your baby is uncomfortable, the doctor may prescribe infant doses of medications commonly used to treat heartburn in adults. Choices may include H-2 blockers, such as cimetidine (Tagamet) or ranitidine (Zantac), or proton pump inhibitors, such as esomeprazole (Nexium) or omeprazole (Prilosec). Although these medications are considered safe for use in infants and children with GERD, a 2006 study noted an increased risk of intestinal and respiratory infections in otherwise healthy children taking these medications.
• Alternative feeding methods. If your baby isn't growing well, higher calorie feedings or a feeding tube may be recommended.
• Surgery. Rarely, the muscle that relaxes to let food into the stomach (the lower esophageal sphincter) must be surgically tightened so that less acid is likely to flow back into the esophagus. The procedure, known as fundoplication, is usually reserved for the few babies who have reflux severe enough to interfere with breathing or prevent growth. Although surgery can reduce GERD symptoms, the complications are potentially serious - including persistent gagging during feedings.

Reflux happens. To minimize the mess, consider these tips:

• Keep it calm. Make each feeding peaceful and relaxed. Feed your baby before he or she becomes frantic.
• Sit up. Feed your baby in an upright position. Follow each feeding with 15 to 30 minutes in a sitting position. Try a front pack, backpack or infant seat. Gravity can help stomach contents stay where they belong. Be careful not to jostle or jiggle your baby while the food is settling.
• Try smaller, more frequent feedings. Feed your baby an ounce less than usual or limit nursing sessions to just one breast.
• Take time to burp. Frequent burps during and after each feeding can keep air from building up in your baby's stomach. Sit your baby upright, supporting his or her head with your hand. Avoid burping your baby over your shoulder, which may put pressure on your baby's abdomen.
• Check the nipple. If you're using a bottle, make sure the hole in the nipple is the right size. If it's too large, the milk will flow too fast. If it's too small, your baby may get frustrated and gulp air. A nipple that's the right size will allow a few drops of milk to fall out when you hold the bottle upside down.
• Thicken the formula. If your baby's doctor approves, add a small amount of rice cereal to your baby's formula. You may need to enlarge the hole in the nipple to make sure your baby can drink the thickened formula.
• Raise the head of the crib. Lying flat may aggravate reflux. Place your baby to sleep on his or her back, but elevate the head of your baby's crib 30 degrees.

Remember, reflux is usually little cause for concern. Keep plenty of burp cloths handy as you ride it out.