Reflux in babies and toddlers

All three of my children had reflux, or Gastroesophageal Reflux Disease to give it its proper title, in varying degrees.  Basically, the sphincter at the top of the stomach is weak when babies are born, and sometimes it is not strong enough to hold the contents of the stomach in, so when they burp (and very often also when they do not burp) everything in the stomach (including all that stomach acid) comes up too.  If left untreated, this condition causes pain and discomfort, in some cases a failure to thrive.

These are some of the symptoms of reflux, though they are not always all present, and those that are present do not appear all the time:

• Vomiting: anything up to 3 hrs after a feed or eating.
• Not wanting to eat or in the case of breastfed babies wanting to have milk often then crying at the breast.
• Weight loss or failing to gain weight: this is not always the case.
• Constant or sudden crying.
• Restlessness, drawing up of knees: you may well write this off as colic.
• Runny nose sometimes you will notice white deposits around the nose this is the milk coming back up into the nostrils.
• Coughing and/or gagging on feed.
• Bad breath.
• Smelly unsoiled nappies: you go to change a nappy believing it to be soiled, to find that it is only wet
• Abdominal pain: in babies this is usually shown by arching the back whilst screaming or drawing up knees to the stomach, sometimes babies eyes will roll into the back of their heads too and they can go rigid this can look like a fit and can be very scary but it is their reaction to the pain in their throats.
• Excessive salivation: dribbling

Because the symptoms can vary so much between children, it is often difficult to get a diagnosis and appropriate treatment.  The first point of call should always be your GP.  If you are unfortunate enough not to have a supportive GP, do not be fobbed off.  Visit another GP or keep going back until you are taken seriously.  Your GP may well prescribe a simple antacid (usually Infant Gaviscon) to make your child more comfortable.  However, this in itself will not stop the child from vomiting, so you may also be prescribed a milk thickener.

There is no need to stop breastfeeding just because your baby has reflux.  A lot of people believe that formula milk stops reflux.  It does not.  Formula is just heavier, and so will sit in the stomach better.  A formula fed baby with reflux will still have problems with acid, even if they are not being sick so much.  Breast milk, though lighter, is absorbed more quickly so your baby is more likely to get some nourishment before they vomit.  There are milk thickeners available that can either be added to expressed breast milk, or else given with a little water or formula midway through the breastfeed.

If your baby is putting on weight and has plenty of wet and dirty nappies, you may feel that you can cope with the vomiting as long as the discomfort has been eased, but if the vomiting is out of hand (and my eldest sometimes was sick 50 times in one day) you will usually be referred to a paediatrician.

The good news is that most babies will simply grow out of this condition as they get older and the ‘problem’ sphincter strengthens up.  There are also a few practical measures that you can take to try to help your child (and yourself).

• Avoid laying your baby completely flat, especially for long periods. Prop the head of their cot up by a few inches. The medical profession recommends an angle of about 30 degrees.  (It is better to prop up the legs of the cot itself than raise the mattress within the cot, as older children may then be able to climb out.).
• When breastfeeding try sitting your baby up a little or laying at an angle to keep their head raised above their stomach.
• Pop their head and shoulders on a cushion when changing a nappy.
• Avoid toys such as baby walkers that place pressure on baby’s tummy.
• Make sure waistbands are not too tight.
• If you do not object to them, a dummy may help, as the constant swallowing helps to keep everything down.
• If bottle-feeding, always take more than you need on outings in case the whole lot comes back up.
• Keep spare clothes for the baby and yourself in the car.
• Buy cheap muslin squares by the sack load.  Keep one on your shoulder, and place one under baby’s head whenever you put them down.  These are much easier to wash than carpets, sheets, sofas etc.
• When going on to solids give smaller, more frequent meals and keep a food diary to see if any particular food aggravates your child more.

Most importantly, do not despair! It is very hard being a new parent anyway, but if your child has bad reflux, it is easy for things to get on top of you.  Try to make time to look after yourself too, and talk to others who have been through the same experiences to remind yourself that you are not alone.

Remember that this will not last forever!

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