Gastroesophageal reflux is a backward flow or reflux of stomach contents into the esophagus. Everybody has some reflux. In infants, it causes "spit up." Warren Bishop, MD, pediatrician and director of the division of gastroenterology at University of Iowa Children's Hospital located in UI Hospitals and Clinics, talks about pediatric gastroesophageal reflux:
Is gastroesophageal reflux common in newborn babies?
It is very common. The majority of infants, in fact, have gastroesophageal reflux. It approaches 60 to 70 percent.
Aside from what we all know as 'spit up' what other symptoms might a baby have who has gastroesophageal reflux?
Fortunately, most babies who spit up have no other symptoms and those infants have what we call physiologic reflux or normal infant reflux. But if complications happen due to the reflux, then we get concerned. Examples of those other symptoms might be trouble gaining weight or evidence of an inflamed esophagus due to acid injury. A baby who has that might be extremely fussy, for example. Or you might even see blood in the spit up. And finally, if a child is having any breathing symptoms-wheezing, pneumonias, excessive coughing, we might consider that those symptoms might be a complication of the reflux and those would be a cause for concern.
Do babies generally outgrow gastroesophageal reflux?
I think probably most of our listeners could answer that question and the answer is yes. Babies spit up but people who are older generally don't and the reasons for this are really quite simple. A baby's diet is 100 percent liquid, so it sloshes up easily. Most young infants are in a horizontal position-they're lying down or sitting up just slightly in a car seat, for example. So gravity isn't helping very much and a baby needs to take a huge amount of calories per day. They take around three to four times the calories per pound that an adult does. And as a result, they're filling up their tanks with basically a liquid bag that wants to come back up. And that gets better as they get older and that's why babies stop spitting up.
When should a parent be concerned about their child's gastroesophageal reflux ?
There's really two pieces of advice I would give parents about when to be concerned. The first is that if the child is having one of those warning symptoms that I described (either not gaining weight, being very fussy, seeing blood in the regurgitated milk, or having some kind of significant trouble with breathing) those should immediately cause concern and the parent should seek good medical advice. The other time when a parent might become concerned is if the spitting up persists beyond the usual age that an infant would outgrow this. And I usually tell people that would be 12 to 15 months of age.
How is gastroesophageal reflux diagnosed?
Well, in fact, no special tests are necessary in the majority of infants. The simple fact that they're spitting up, tells us that stomach contents are moving upward from the stomach and appearing in the mouth, so we know they have reflux.
Sometimes the diagnosis is a little more difficult if, for example, a child isn't actually spitting up but maybe having a lot of respiratory symptoms--might be coughing, might have pneumonia-and we're concerned that reflux might be a factor. Those children need special tests, perhaps an X-ray is often done in which a child drinks some barium and we watch how it moves through the system. The other possibility is to do a special test that uses an acid sensor in the esophagus to tell us how often a child is having regurgitation.
What is the treatment for these pediatric patients?
Well, in fact, for the infants with the normal infant reflux, the best treatment is nothing more than a towel on the shoulder. These children do not need medication, they're not sick, and they're going to outgrow this. And it's just a normal part of infancy.
If complications begin to become present, then we need to consider some medical therapy or even in severe cases, surgery can be considered. But that's truly uncommon. The vast majority of infants who spit up need nothing. We do have medications that reduce acid production in children who are having fussiness and very often that can be quite helpful until they outgrow their symptoms.
And finally, there are some older children who really have gastroesophageal reflux disease similar to what adults have and those children do clearly benefit from medications. If a child's having life-threatening symptoms, we might consider surgery to stop their reflux entirely.
If a child has this reflux, are there specific things parents can do when feeding their child to prevent or lessen symptoms?
That's a very good question and I would say to a limited extent, yes there is. Parents frequently receive advice that I consider somewhat dangerous including limiting feedings, for example. And it's certainly true that if you don't feed a child, they won't reflux. But that child also will not gain weight.
Parents sometimes receive advice from a loved one or perhaps even from a medical professional advising them not to give more than a certain number of ounces per feeding, or a certain number of feedings per day. The problem arises when a child spits up half of the feeding and doesn't get a replacement amount, the child won't gain weight well. Thickening feedings in infants--thickening the formula with added baby rice cereal--is known to reduce the amount of reflux. But that should only be done under the advice of a medical professional.
The bottom line is that children who have reflux really should be fed when they're hungry and you really shouldn't worry about it causing problems. It's much better that child be given enough calories and grow normally.
Is UI Children's Hospital involved in any gastroesophageal reflux disease in children research?
There's always research going on. We're currently interested in possible complications of some of the medical therapies and we actually have a grant proposal in to look at the effects of long-term acid-suppressing drug use in children. We've participated through the years in studies of some of these medications that look at the proper dose and their safe use in children.
I think the main thing for parents to know now is that there really are some truly effective therapies available. We're able to offer those; we're able to offer the latest is diagnostic testing when children need that. But we also take a very commonsense approach and try not to overdo those things in babies who are otherwise healthy. |
