There’s nothing quite as distressing as a crying infant. While babies are known to test their parents’ patience with their crying, uncontrollable crying or an overly unsettled baby can signal an underlying problem.
If you have a baby who cries a lot, fusses during feeding and spits up more than usual, you may be wondering whether your little one has reflux. Dr Noel Friesen, a paediatric registrar at Sydney Children’s Hospital Randwick, explains that for infants below the age of one, reflux is very common.
What is reflux?
“Reflux is the regurgitation of stomach contents into the oesophagus (food pipe) which may or may not go up to the oral cavity,” Dr Friesen says.
“The cause of reflux is due to the infant’s short oesophagus, a small stomach and an immature valve between them which transiently opens and closes. As the infant grows the anatomy changes and the backflow of stomach contents becomes less frequent,” he explains.
Studies show that around 50 per cent of all babies from birth to age three months will have at least one episode of spitting up per day. In some infants this can be more but is often nothing to worry about, Dr Friesen says.
“If a baby spits up a lot but is otherwise happy and healthy — gaining weight normally, feeding well and not excessively unsettled — then this baby is said to have uncomplicated reflux,” Dr Friesen explains. Generally these infants do not need any investigations.
What is GORD?
Reflux becomes GORD (Gastroesophageal Reflux Disease) when there are physical complications associated with the reflux, including failure to gain weight normally, inflammation of the oesophagus and respiratory compromise such as recurrent pneumonia.
Some symptoms which may be present in infants with GORD include:
- Food refusal
- Choking on spit up
- Not gaining weight normally
- Blood loss in the stool
- Back arching and crying in relation to feeding
- Forceful vomiting
If your baby exhibits any of the above, or seems unusally unsettled, it is essential that you take them to your GP or paediatrician for a review. Many cases of uncontrollable crying have other underlying causes such as ear or bladder infections that need to be investigated.
How is reflux diagnosed?
You will need to visit your doctor or GP to determine whether your child has reflux. Generally, your child’s health history and an examination is enough, especically if vomiting is the only symptom.
Special tests such as X-rays, nuclear scans, endoscopies or oesophageal pH studies may be required if your child has any complications associated with their reflux or if GORD is suspected.
If your baby is generally happy, healthy and gaining weight at an appropriate weight it is probably best to just wait out the vomiting stage. Most babies stop vomiting once they begin to walk and spend more time upright — generally around 12-18 months.
While the vomiting stage can be exhausing and feel endless, the worst it is likely to do is cause an extra load of washing or two for you each week. To lessen the load, Dr Friesen suggests keeping your baby well burped and quiet after feeding.
“There is some suggestion that burping during feeding and limiting activity after feeding reduces spitting up,” he says. If the vomiting is really borthering you, try to keep your baby upright for 30 minutes after each feed to give the meal time to digest.
If your baby is suffering from symptoms of GORD, treatment with an appropriately prescribed medicine or a change in diet may be required. It is, however, important to get informed medical advice before making any changes, explains Dr Friesen.
“Thickening of formula, changing formula, changing of maternal diet and medication are all interventions which should be discussed with your doctor,” he says.
Where to get help
Caring for a baby or child who suffers from reflux can be extremely stressful and exhausting. Organisations such as the Reflux Infants Support Association (RISA) provide a wealth of information, tips and support to families with children diagnosed with reflux. Your local community nurse can also provide support. See your Blue Book for details.