IN THIS ISSUE
GASTROESOPHAGEAL REFLUX

by Wendy Mackey

Is your baby a "happy spitter"? Many healthy infants experience involuntary vomiting two to three times a day. Although spitting up is normal in babies, some seem to spit up with every meal. This can become frustrating for the parents, not to mention messy. The medical term for this phenomenon is gastroesophageal reflux. It is defined as an involuntary movement of stomach contents back into the esophagus, the tube that connects the mouth to the stomach. Although gastroesophageal reflux can occur anytime during the life cycle, it is a very common problem in babies, occurring in up to three percent of all newborns.

The majority of children with gastroesophageal reflux have the physiologic type. Physiologic gastroesophageal reflux generally occurs in infants less than six months of age who have frequent regurgitation/vomiting due to an immature lower esophageal sphincter. This means that the muscles at the bottom of the esophagus are weak and underdeveloped. Consequently, the muscles do not stop the food from coming back up. These muscles become stronger with age and most children are symptom free by eight to ten months of age.

Gastroesophageal reflux is considered harmful when it interferes with the child's growth and development. Its treatment depends on the severity of the disease, the presence of complications and the age of the child. Management strategies for physiologic gastroesophageal reflux are conservative and are often limited to thickening formula, refining feeding schedules, adjusting feeding volume and repositioning the baby during feedings.

  • Thickening of the formula is usually accomplished by adding rice cereal (1-6 teaspoons per 4ounce feeding). The cereal increases the caloric density, decreases vomiting and discomfort and increases the sleep time following feedings.
  • Smaller more frequent feedings, every two to three hours while the child is awake, is another strategy. Avoid overfeeding and ensure appropriate burping.
  • Therapeutic positioning involves keeping the infant in a 30-degree upright position or holding her vertically for a minimum of thirty minutes following the feeding. These positions work because gravity keeps the food away from the esophageal sphincter in the stomach. Not only do these positions decrease gastroesophageal reflux, they facilitate digestion. Placing the child in a seated position should be avoided because it actually increases the intra-abdominal pressure and changes the position of the lower esophageal sphincter, thereby increasing the incidence of gastroesophageal reflux.
  • Change in formula . Although, a change in formula may be helpful in some situations, the incidence of actual formula intolerance is very low. Formula intolerance, when it does occur is accompanied by diarrhea, abdominal cramping and occurs with every feed.

These conservative interventions should decrease the incidence of gastroesophageal reflux, while allowing physiologic maturation of the stomach and the sphincter muscles. Most children are treated with this conservative regimen initially unless they have complications of gastroesophageal reflux. The most severely affected may need medication, and a small fraction of children will require surgery. 

Although physiologic gastroesophageal reflux can be frustrating for caregivers, it is a common condition that responds well with basic interventions. Time, patience and lots and lots of "spit rags" may be all you and your "happy spitter" need to get through those trying months.

Family Resources for GER: International Foundation for Functional Gastrointestinal Disorders 
Phone: Toll Free 888-964-2001
www.iffgd.org or www.aboutkidsgi.org

About the Author: 
Wendy Mackey resides in Guilford, CT with her husband and two young children. She works part-time at Yale-New Haven Children's Hospital as a Clinical Nurse Specialist in Pediatric Surgery and Trauma.

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