Reflux in babies affects around four in ten under-one-year-olds. While nine in ten babies grow out of it by their first birthday, 10 per cent of those affected continue to struggle.
WHAT IS REFLUX?
Reflux is when a baby brings up milk or vomits during a feed or shortly after eating, which can happen more than six times a day for some. It tends to start before a baby is eight weeks old.
When reflux happens, a small amount of acid in the stomach can come back up towards the throat. This can irritate the lining of the oesophagus, causing discomfort or pain. Other symptoms include:
- coughing or hiccupping when feeding
- being unsettled during feeding
- swallowing or gulping after burping or feeding
- crying and not settling
- not gaining weight.
Reflux happens because the muscles at the base of the food pipe have not fully developed, so milk can come back up easily. As they grow, babies’ muscles strengthen and they should grow out of any problems.
Reflux is often simply known as ‘posseting’ or ‘regurgitation’ because you can usually see the milk coming back up after a feed.
Rishil Patel, a paediatric registrar, says it doesn’t much matter what it is called. ‘The term “reflux” can colloquially be used more or less interchangeably with bad posseting. If an eight-week-old baby is struggling with sleep and vomiting milk, we would call it reflux.
‘There is a blurred line between posseting and reflux, but if the baby is otherwise healthy and isn’t losing lots of weight, then it doesn’t make a huge difference practically what we call it as the management is very similar.’
Sometimes babies may have signs of reflux but will not bring up milk or be sick. This is known as silent reflux.
ITS EFFECT ON BABIES
Babies do not necessarily have to see a doctor if they have reflux so long as they are happy, healthy and gaining weight. However, babies with reflux may cry, be hard to comfort, arch their backs, or fuss over or refuse feeds.
Reflux can also affect sleep, especially for babies with silent reflux, who can take a long time to settle and, once asleep, often wake up quite suddenly. Dr Patel says, ‘The big thing with reflux is the impact on the child and family. As with many common problems, it is difficult to give a hard and fast rule on how much to intervene, but the best treatment is always dealing with the source of the problem – so, implementing changes in feed amounts or feeding patterns should hopefully see an improvement in sleep.’
TREATMENT
Small practical changes are likely to be recommended initially by a health visitor or GP. Tips include:
- holding the baby upright during feeds and for as long as possible after feeding
- giving formula-fed babies smaller feeds more often
- having a breastfeeding assessment with a professional
- making sure the baby sleeps flat on their back rather than their side or front
If there is nothing else wrong, managing reflux is key. ‘The first thing to do is not treat but manage reflux,’ Dr Patel explains. ‘But you need to do this over a few months, you cannot help overnight. If nothing improves after a few months, it may require medication.’
This stage may involve the prescription of medicines to reduce the amount of acid produced by the stomach, an alginate to stop as much acid escaping the stomach, or simply adding a thickener or using a thickened feed for bottle-fed babies.
In very rare or severe cases, surgery may be needed to strengthen the muscles.
ITS EFFECT ON OLDER CHILDREN
For the one in ten children who experience reflux after their first birthday, Dr Patel recommends a medical review.
‘That first consultation will be less about reflux and more to just check that there’s nothing else going on,’ he says. ‘It is important to ensure the diagnosis of reflux is correct, and then trial different feeding methods and, after that, certain medications, which often need periods of weeks or months before an assessment of their success. It is impossible to say how long reflux will carry on for, or predict the likelihood of growing out of it.’
If reflux causes discomfort or pain on a regular basis, or if it causes other problems, such as poor growth in babies, healthcare professionals call it gastro-oesophageal reflux disease (GORD). This term tends to be used when the disorder becomes long-term, or chronic, after a baby has suffered from reflux for more than 12 to 14 months or an older child shows symptoms more than twice a week for a few months.
Dr Patel explains that this term is generally only employed after the one-year mark. ‘Because young children usually grow out of reflux, we usually apply the term GORD [gastro-oesophageal reflux disease] to an older child because there might be more to it then. It is much harder psychologically for families to hear their baby has gastro-oesophageal reflux disease, a formal-sounding diagnosis with fancy words in, and then they suddenly don’t have it any more even though nothing has been done.’
MANAGING IT IN AN EARLY YEARS SETTING
In an early years setting, communication between parents and practitioners is vital in flagging reflux. It is also important to be able to spot the difference between posseting, or bringing up milk after a feed, and projectile vomiting, when the vomit is expelled with such force that it lands some distance away. If a baby projectile vomits or brings up milk that is green or yellowish-green, or if it looks as though it has blood in it, a GP’s advice should be sought.
‘I would always want any child who a parent, carer or teacher is concerned about to be seen by a trained medical professional as soon as possible,’ explains Dr Patel.
‘However, if a child is known to suffer with reflux, it would be sensible to know how that usually manifests, such as the timing and size of vomits, and to have a discussion with the parents about what they would consider “normal” for their child and when they would be concerned.
‘Overall, reflux is a tricky topic for parents, infants and carers, both in diagnosis and management. It can usually be managed in the community, but just because it is common doesn’t mean it isn’t tricky. There is no great easy fix.’
CASE STUDY: Lydia Fraser-Davies, a pharmacist from Cardiff, has a six-month-old son with reflux
‘After weeks of Jacob screaming and being told “babies just cry” by my health visitor, I found out he had reflux at ten weeks old. I initially thought it was colic as Jacob was never sick. We only found out by chance at my post-partum check-up, because Jacob just would not settle and the GP said his cry sounded painful, so I searched the internet and realised “silent reflux” was a thing, and that a baby can still have acid rise even when he’s not being sick.
‘Jacob had all the symptoms. He would be very upset during and after feeds. I would hear a few strange gulp sounds and he would start screaming. He would only settle if we were walking and he was upright in the baby carrier.
‘I don’t know what I would have done if I didn’t have a clinical background. Every time Jacob went ballistic, I would try to remind myself that the GP said, “Every baby has reflux to some degree and their tubes just need to develop”, but when Jacob started hyperventilating from crying so much in pain, I just knew I had to push for medication.
‘He had a personality change overnight. My upset, screaming, very tiring little guy became my smiley, happy boy who could actually sleep for longer than two hours. He would finally have happy awake time and I could start playing and reading with him.
‘After my maternity leave, I wouldn’t be opposed to putting Jacob in nursery now he’s stable on medication. If his reflux was still horrible, I would be reluctant to expect nursery staff to have to deal with it. I’m not sure they have the time to be constantly settling him or wearing him in a baby carrier.’
