If tears and discomfort usually follow your infant’s spit-ups, his digestive system may be the culprit.

When Seema Rai’s 6-week-old baby boy, Nikhil, started throwing up after every milk feed and crying incessantly, she started to worry

She recalls, “I initially thought it was colic but he was constantly regurgitating his milk, and a lot of it, so I was worried he wasn’t getting enough nutrients. He also fussed a lot, especially when I would put him on his back and would only sleep on me or if carried.”

A trip to Nikhil’s paediatrician confirmed that her infant had gastroesophageal reflux disease (GERD), a more serious case of acid reflux. It’s a non-life threatening condition, but to the new parents, it was still of some concern.

“It was the first time my hubby and I had even heard of GERD and that infants could have it,” says Seema. “We started researching a lot and speaking to the right doctors, so that we could manage it well for our son.”

Nikhil eventually outgrew his GERD when he was 6 months old, but Seema wants to stress that a baby’s condition is not as straightforward as that of an adult’s. Two National University Hospital experts, Associate Professor Marion Aw and Dr James Huang, tell SmartParents more about this condition.

What’s the difference between reflux and GERD?

AP Marion Aw Reflux refers to the reverse movement of stomach contents back up into the food pipe. This is a normal occurrence in both children and adults, and often happens transiently after meals. In babies, this may be more obvious and manifests as regurgitation or vomiting of milk after milk feeds.

GERD is used to describe the situation where the reflux is associated with complications or worrying symptoms; these include symptoms of pain or discomfort, or poor weight gain.

What causes reflux/GERD?

AP Marion Aw Reflux is very common in babies, almost all of them have it. This is because the junction or angle between the food pipe and stomach is not as tight as it is in older infants and children. Many babies would regurgitate (“spit up”) after milk feeds or when they burp. They are otherwise happy, and don't seem to mind it at all.

GERD, on the other hand, is not as common. This occurs when reflux is associated with complications, such as inflammation of the food pipe ― also known as oesophagitis. This results in pain and discomfort for the baby and usually manifests as vomiting after feeding, Symptoms include pain and discomfort ― the baby cries and fusses, starts to refuse milk feeds, or the spit-up contains blood streaks.

How is it treated?

Dr James Huang It is important to first provide reassurance to the parents that reflux is a benign condition. Simple treatments for reflux include positioning the child in a head-elevated position for about 20 to 30 minutes after a feed and giving smaller, but more frequent feeds. If the child is age-appropriate for weaning (more than 4 months), the milk can be thickened with cereal. If your child has GERD, he’ll be prescribed medications such as acid-suppressants. If the mum is breastfeeding, she doesn’t need to change her diet to manage her baby’s reflux. If formula feeding, pre-thickened formulas may help.

When should the condition be taken seriously?

AP Marion Aw Babies will typically grow out of spitting up after a feed at about 6 months of age. In addition, at this time, solids are introduced (puréed foods/rice cereals), which are harder to spit up after feeding compared to milk. So, even if the baby has a tendency to regurgitate, the solids “stay down” better. If the baby is happy, feeding well and putting on weight, there is no concern and no need for medications.

Most children will also outgrow GERD. However, if there is a structural problem with the food pipe, or an underlying neuromuscular problem ― an issue with the nerves or muscles in the body ― then it might not resolve by itself. If the vomiting is associated with a lot of crying, fussing, arching, turning away from a milk feed and decreased feeding, then this would be cause for concern. If this is allowed to go on for a period of time without treatment, the child will refuse feeding and his weight gain will be affected.

Get to know our experts…

Associate Professor Marion Aw, head and senior consultant, division of Paediatric Gastroenterology, Hepatology and Nutrition, National University Hospital.

Dr James Huang, consultant, division of Paediatric Gastroenterology, Hepatology and Nutrition, National University Hospital.

Photo: iStock

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