What is it about ?
Reflux is the flow of stomach contents to the esophagus and mouth. It can involve food or gastric (acidic) juice. Reflux can be normal and benign, certainly in small children (regurgitation).
It can also be a sign of a condition, such as a narrowing of the stomach outlet, gastroesophageal reflux disease (GERD), or a disease that affects the whole body (a systemic disease). These conditions require treatment because they can be accompanied by eating disorders and stunted growth.
What is its frequency?
Among children aged 3 months, 1 in 2 regurgitates milk more than 5 times a day. This phenomenon ends around the age of 12 to 18 months.
How to recognize it?
Benign reflux
Regularly, the child regurgitates part of the milk or food. This happens because the muscle ring (sphincter) between the esophagus and the stomach does not yet close properly or because the pressure in the belly increases suddenly, for example during heavy crying or sudden manipulation. There are no other symptoms, and growth and weight gain are perfectly normal.
Narrowing of the outlet of the stomach
Symptoms appear within the first 6 weeks of life. This is typically jet vomiting: after a feed or after having taken the bottle, the infant vomits the milk forcefully. Weight gain is slowed down and the child is not growing well.
Gastroesophageal reflux disease (GERD)
This variant seems at first glance to be normal reflux, but over time symptoms appear which indicate that it is a disease. Gastroesophageal reflux disease is more common in children with the following problems:
- Nervous system disorders;
- Birth defects of the stomach or esophagus;
- Prematurity;
- Serious respiratory tract problems, such as severe asthma.
The symptoms are varied:
- Weightloss ;
- Problems swallowing (swallowing problem);
- Refusal to eat;
- Intense crying;
- Irritability at mealtimes.
Food sometimes passes into the trachea, so there may also be respiratory symptoms, such as:
- Cough ;
- Shortness of breath;
- Wheezing ;
- Hoarseness.
Iron deficiency due to undernourishment can cause anemia.
Symptoms of an underlying condition
Sometimes parents think their child has reflux when they have another condition. Regurgitation and vomiting indeed have many possible causes. The following symptoms may suggest that the regurgitation or vomiting is caused by another condition:
- Onset of symptoms after 6 months of age;
- Vomiting of bile or blood;
- Persistent vomiting;
- Diarrhea;
- Bloated stomach ;
- Constipation;
- Growth retardation ;
- Presence of congenital malformations.
How is the diagnosis made?
If the doctor thinks that the regurgitation or vomiting is caused by another condition, he will refer the child to a pediatrician for further examinations. The pediatrician may perform an examination of the stomach and esophagus using a camera (gastroscopy) or a measurement of the acidity in the esophagus (pH-metry). A small probe will then be introduced into the child’s stomach through his nose.
What can you do ?
Benign reflux
With mild reflux, a few simple steps can help:
- Raise the head of the child’s bed a little;
- Distribute the diet over more frequent and lighter meals;
- Do not handle the child abruptly after feeding him;
- If necessary, thicken the milk a little;
- Optionally, try to start solid food earlier.
If that doesn’t work right away, wait a few weeks and try again. If symptoms worsen, see the doctor.
What can the doctor do?
In principle, no antacid is given before the age of 1 year. The effect of mild reflux is not well known. This is the reason why we let the pediatrician prescribe it for babies. The pediatrician will only recommend an antacid of the proton pump inhibitor type if his examination shows excessive production of stomach acid. Antacids can have side effects, such as an overgrowth of bacteria in the small intestine and negative effects on bone metabolism.
In the event of a congenital malformation, the advice of a surgeon will be sought.
Want to know more?
- Is your baby spitting up? When should she be given medication? here, Where to be found on this page of the FAMHP – Federal Agency for Medicines and Health Products
- Proton pump inhibitors (PPI) – CBIP – Belgian Center for Pharmacotherapeutic Information
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