Gastro-oesophageal reflux (GOR/reflux) occurs when food and stomach acid flows back into the oesophagus (foodpipe), and sometimes out of the mouth. It is not yet understood why reflux causes complications such as pain or inflammation in one child but not another, but it is believed a combination of factors may contribute. Some factors that may contribute to reflux and its complications include the lower oesophageal sphincter (a band of muscle at the lower end of the oesophagus) relaxing at inappropriate times, increased pressure in the abdomen (e.g. from overfeeding, straining, crying, coughing, a slumped-over position or a seated position following feeds), food sensitivities, hereditary factors, and medical conditions that affect nerves or muscles.
For many children and their families, gastro-oesophageal reflux causes no real problems, and may simply be a nuisance until it is outgrown. Although there can still be family strains and anguish prior to diagnosis, this form can often be successfully controlled by simple remedies such as keeping the baby upright, thickened feeds, and/or reassuring the parents.
If your baby is happy, eating well and gaining an appropriate amount of weight, there may be no need for any treatment. However, there can be a more serious side to reflux in children. When the reflux causes complications or long term problems, doctors may diagnose this as gastro-oesophageal reflux disease (GORD). It persists despite simple lifestyle measures and can, at times, be a serious medical concern. Medical intervention is often necessary, which usually involves the child having medication and/or investigations, and further treatments may need to be established.
What Are The Symptoms Of Reflux?
The list below gives a general overview of some of the signs and symptoms that may be displayed. A baby with reflux will not necessarily display all of them, and the number of signs exhibited does not indicate the severity of their reflux.
If you suspect your baby or child may have gastro-oesophageal reflux, or you have any concerns, it is important to discuss this with your child’s doctor or child health nurse. Gastro-oesophageal reflux may not always be the cause of these signs and symptoms, and healthy children can reflux at times.
- Vomiting/regurgitating or possetting
- Appearing to be in pain e.g. back arching
- Repeated hiccups
- Hoarse voice
- Feeding problems – refusal to feed or only taking a small amount despite being hungry, comfort feeding/feeding frequently, pulling away and arching their back, crying/screaming during or after feeds
- Sleeping issues – catnapping, difficulty settling, frequent night waking (though some children who have reflux do sleep well at night), restless or easily disturbed from sleep
- Respiratory issues – choking, wheezing/coughing, recurrent chest infections
- Weight issues e.g. inadequate weight gain, weight loss, or huge weight gains
- Recurrent ear, throat or sinus infections
- Congestion, being ‘snuffly’ or appearing to have a cold
- Drooling or excessive salivation
- Gagging themselves (using their hand, fist or fingers)
If you suspect your child may have gastro-oesophageal reflux, or have any concerns, it is important to discuss this with your child’s doctor or child health nurse as there can be other reasons for their behaviour.
Hints For Managing Reflux
If your doctor has diagnosed your child with gastro-oesophageal reflux or gastro-oesophageal reflux disease, there are some strategies you can use that may help. If your child’s symptoms are severe or persistent, your doctor may also consider treatment with medication, or referral to a paediatrician or a paediatric gastroenterologist for further assessment. Keep in mind it is always important to talk to your doctor if you have any questions or concerns.
- Avoid exposure to tobacco smoke
- Feed your baby in an upright position if possible, and try to keep them upright for at least thirty minutes following the feed. Try to avoid the upright seated position or laying them flat during this time
- If you are comfortable with the idea, consider offering your baby a dummy or your clean finger to suck on. This may help some babies to settle
- Avoid vigorous movements or bouncing your baby
- The best time to lay your baby on the floor is when their tummy is empty i.e. before a feed
- Try to change your baby’s nappy before a feed. Avoid lifting their legs too high, and turn them to the side if possible
- Avoid any tight clothing around the waist, such as tight nappies, elastic waistbands.
- Avoid overfeeding ” if your baby vomits, wait until the next feed rather than feeding them again straight away (talk to your doctor or child health nurse to ensure your baby is taking appropriate amounts of food)
- Some reflux children may suffer from food sensitivities, and may need dietary restrictions (or the mother may consider an elimination diet e.g. avoiding all traces of foods such as cow’s milk and soy). If you suspect foods may be responsible for your child’s condition, it is essential to discuss this with your health care provider. Do not change your or your child’s diet before seeking medical advice. Your doctor may recommend a two week trial of hypoallergenic formula in formula-fed babies
- Minimise foods and drinks if they cause irritation or increase the risk of reflux e.g. spicy foods, citrus fruits, tomatoes and other acidic food, fatty foods and caffeine
- Thickened feeds may be effective for some infants, especially those who vomit. Talk to your doctor before introducing thickeners
- If your baby is under the age of twelve months, evidence from research studies does not support elevating the head of the bed to treat reflux. Additionally, sleeping your baby on their side or using positional devices is not recommended. It is important to always follow safe sleeping guidelines, available from SIDS and Kids
- Contact a reflux support organisation for further information and support. The effect on the baby AND the family can be stressful, and support groups can provide more detailed information and offer the emotional support you may need
Reflux and Effects on Families
Reflux is so common it is almost seen as ‘normal’, or even trivial, and many people do not seem to understand how difficult life can be for families, or understand the impact reflux can have on their lives. They may think of it erroneously as ‘just a bit of vomiting’, or ‘a behavioural issue’.
Many families say they:
- Have difficulty getting people to believe just how bad the vomiting and/or screaming really is
- Receive conflicting and confusing advice
- Become socially isolated
- Feel like failures as parents
- Have family and friends who just do not understand
Even when a baby is suffering from relatively uncomplicated reflux, families often need reassurance, and enjoy talking to someone who understands. For the families whose infants suffer complications, it is even more important that they can talk to other parents, and have the support, reassurance and understanding they need.
Reflux Survival Tips
- Do not expect that you have all the answers from the beginning ” it is a steep learning curve, and chances are you did not know much about reflux before you had your child.
- Children with reflux are not born with a manual, and there are generally no right or wrong way to handle a situation. Children are all individual, and what works for one may not work for another. It often takes time and involves a lot of trial and error before you find something that works for you and your family.
- Accept you are doing your best, and try not to be too hard on yourself.
- Try to focus on what you are doing right, not on what you feel is going wrong. You are not doing anything wrong; you just may not have worked out the best answers yet.
- It may help to accept that children with reflux can have very high needs. It may also help to realise that most people do not understand what you are going through or how to help.
- Remind yourself that this is NOT your fault.
- Believe in yourself and trust your instincts; reflux is a medical condition and not in your head.
- Look after yourself ” not only are you as important as your child, think about who will be there to look after them if you apart.
- There are many factors that are reported to flare a child’s reflux – hot humid weather, over-tiredness (vicious cycle, as being overtired may flare your child’s reflux, yet the reflux may disrupt sleep and make them overtired), change in routine, colds, infections, teething, vaccinations etc. Sometimes it can help to know that, so that any changes make more sense.
- Take each day as it comes, and just maybe it helps to know that life really can get better, no matter how hard it is right now. Remember though, if you are not coping, please ask for help, and seek medical guidance.
1. Craig, W. R., Hanlon-Dearman, A., Sinclair, C., Taback, S., & Moffatt, M. (2004). Metoclopramide, thickened feedings, and positioning forgastro-oesophageal reflux in children under two years (Review). Cochrane Database of Systematic Reviews (3), Issue 3. Art. No.: CD003502. DOI:10.1002/14651858.CD003502.pub2.