Infant Reflux Disease – Is It Over Diagnosed?

Spitting up, gassiness, fussiness, and sleepless moments – these are signs many parents worry about when it comes to their infant’s health.

While they are often very typical behaviours for newborns adjusting to life outside the womb (which requires eating and digestion), some parents and healthcare providers jump to a diagnosis of infant reflux disease.

This is also known as GERD/GORD (gastro-esophageal reflux disease/gastro-oesophegeal reflux disease).

Reflux, which is when food/liquid comes up into the esophagus, is often confused with the medical problem GERD.

Reflux doesn’t require ongoing medical treatment, whereas GERD often requires medication and occasionally surgery.

The problem with confusing typical infant reflux (commonly referred to as ‘spit up’) with GERD, is that a child who only has reflux might be subjected to unnecessary medication or procedures.

Is Infant Reflux Disease Over Diagnosed?

A new study from Jefferson University in the US found only 10% of the study participants actually had GERD, confirmed by an abnormal MII-pH study.

An MII-pH study measures the movement and volume of gas, liquid, and solids through the esophagus, and the level of acid in the esophagus.

Although it was only a small study of 58 participants, the number of those who exhibited behaviours of reflux, but did not actually have reflux disease, was quite significant. Only 6 participants actually had GERD, as opposed to reflux.

This suggests that many infants (upwards of 90%) are being incorrectly diagnosed and treated for a health issue they don’t have.

Is Reflux Normal In Infants?

Babies and a bit of spit up seem to go hand in hand. Nearly 73% of one month old infants experience reflux, and by 5 months around 50% still experience some. Typically, babies outgrow reflux by 12 months, with only about 4% of babies still experiencing it after that.

Why is reflux so common in babies?

There are several reasons. Their diet is purely liquid for about 6 months, and their esophagus is shorter than that of an adult. Also, their muscle tone is immature, before they become more mobile and able to sit up, and they spend a good deal of time lying down.

While it is upsetting to see, some spitting up, fussing, and gas are typical in infants. It’s certainly important to address any health concerns with your baby’s doctor, but often reflux is a typical part of infancy.

How Can You Tell The Difference Between Normal Reflux and GERD?

Some doctors will diagnose GERD based on reported symptoms. This study, however, suggests the importance of testing, so as to get a true diagnosis before treating reflux with medication or surgery.

Spit up alone doesn’t mean GERD. And surprisingly to some, GERD can occur without visible spit up. This is sometimes referred to as silent reflux/GERD and occurs when stomach contents (including acid) enter and rise up in the esophagus, but do not enter the mouth and exit as spit up. This is also what an older child or adult would experience as heartburn.

If your baby is a bit fussy after feeds, but doesn’t seem to be crying in pain, it’s probably just normal newborn fussing. Digestion is a new sensation, and can be a bit uncomfortable for a baby who has spent 9 months in the womb without ingesting anything. If your baby seems to cry in pain after multiple feeds in a day, it’s possible she is experiencing GERD.

If your baby is spitting up, even after every feed, but in small amounts that aren’t affecting her growth, it’s possibly just a frustrating laundry problem. If she’s crying and spitting up large volumes following the majority of feeds, and is experiencing weight problems, she might have GERD.

If your baby isn’t spitting up, but is in pain after feeds, and difficult to settle, silent reflux could be the problem. As single symptoms, silent reflux, frequent coughing, gagging, gurgling and hiccups, can be common newborn behaviours, and not necessarily a medical concern. If these are accompanied by frequent cries of pain, especially with fussing at the breast or bottle, and refusal of some feeds, it’s possible your baby has GERD.

You can read more about infant reflux and GERD in BellyBelly’s article Reflux In Babies – 10 Common Questions Answered.

How Can I Be Sure My Baby Is Properly Diagnosed?

This study found that it’s important to be sure a baby really has GERD, as most babies diagnosed with GERD are offered medications or even surgical procedures. An MII-pH study will determine whether your baby is experiencing reflux, or whether she genuinely has GERD.

Reflux can be uncomfortable, messy, and quite frustrating, but it isn’t dangerous to your baby. The reason GERD requires treatment is that if there is frequent reflux of acid it can damage the esophagus. This is also quite painful for babies, and can lead to a refusal to eat, which, as well as large volumes lost via spit up, could cause weight and growth problems.

Some doctors diagnose GERD based only on symptoms, rather than on the MII-pH study, which requires a bit of extra training, or a referral to another doctor.

The MII-pH Study Came Back Normal, So What Can I Do For Reflux?

A normal MII-pH study probably indicates your baby isn’t having serious acid or reflux disease concerns. However, even typical newborn reflux can leave some babies feeling unwell. If you think the results are incorrect, or you believe there’s another possible health concern, it’s important to discuss it with your baby’s doctor.

If, however, you are confident your baby is experiencing normal infant reflux, there are several things you can do to help:

• Small frequent feeds are better than spaced out, large volume feeds
• Practise laid back breastfeeding if you think your milk flow is affecting her spit up
• Keep baby upright for 20-30 minutes after a feed (babywearing is excellent for this!)
• If bottle feeding, practise paced feeding, and pause to burp a few times throughout the feed
• Don’t encourage baby to finish a bottle after she shows signs of being satiated, and don’t encourage ‘top ups’ (breast or bottle) to prolong time between feeds

Currently there is a small amount of evidence suggesting a link between aerophagia (swallowing air) induced reflux and tongue and lip tie. More research is needed before any more definitive conclusions can be drawn. For more information, you can read some research here.

Recommended Reading: Sometimes reflux, and even GERD, is the result of a cows’ milk protein allergy. Read more in BellyBelly’s article Cows’ Milk Protein Sensitivity In Babies – 8 Facts.