Decode infant acid reflux with Meri Sehat. Learn causes, symptoms, and gentle remedies for your baby's comfort.

Acid Reflux (Infants)

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Overview

Acid reflux is a common and normal condition in infants characterized by the backward flow of food or acidic stomach juices into the esophagus.<a href="#accordion">[1]</a> 
&nbsp;

Gastroesophageal reflux (GER), also called acid regurgitation, is a common condition in infants, with 70-85% of cases presenting in the first 2 months. There may be one or more episodes every day.<a href="#accordion">[3][4]</a> The numbers decline, and the condition almost always disappears by the time they turn 2.

In one study, infants with gastroesophageal reflux disease (GERD) were more likely to have acid reflux episodes associated with transient lower esophageal sphincter relaxations as compared to normal infants.<a href="#accordion">[2]</a> 
&nbsp;

There are two main types of acid reflux in infants &ndash; physiological reflux and pathological reflux.<a href="#accordion">[5]</a>

<ul>
	<li>Physiological Reflux: This type of reflux is considered normal and usually resolves on its own as the infant&#39;s digestive system matures. It does not interfere with the infant&#39;s growth or development.</li>
	<li>Pathological Reflux: Pathological reflux, also known as gastroesophageal reflux disease (GERD), is a more severe and long-lasting form of acid reflux. It causes distress or discomfort and requires medical intervention. 
	&nbsp;</li>
</ul>

Sign and Symptoms

The signs and symptoms of acid reflux in infants can vary, but common characteristic symptoms include:

<ul>
	<li>Discomfort and irritability after feeding</li>
	<li>Poor <a href="https://merisehat.pk/article/is-your-asthma-due-to-your-mothers-gestational-weight-gain">weight gain </a></li>
	<li>Feeding difficulties, eating only small amounts or refusing to eat </li>
	<li>Coughing and choking</li>
	<li>Wet hiccups or wet burps 
	&nbsp;</li>
</ul>

Causes

The exact causes of acid reflux in infants are not fully understood, but several factors can contribute to its development.<a href="#accordion">[6][7]</a>

<ul>
	<li>Immature Lower Esophageal Sphincter (LES): LES is a ring of muscle at the bottom of the esophagus, responsible for preventing the backflow of stomach contents into the esophagus. In infants, the LES may be underdeveloped or weak, making it easier for stomach acid to enter the esophagus.</li>
	<li>Delayed Gastric Emptying: Infants have a slower rate of gastric emptying compared to older children and adults. This can contribute to the accumulation of stomach contents and increase the likelihood of reflux.</li>
	<li>Hiatal Hernia: A hiatal hernia occurs when a portion of the stomach protrudes through the diaphragm into the chest cavity. This anatomical abnormality can weaken the LES and increase the risk of<a href="https://merisehat.pk/disease/acid-reflux-infants"> acid reflux</a>.</li>
	<li>Food Allergies Or Intolerances: Some infants may experience acid reflux as a result of food allergies or intolerances. Common culprits include greasy, highly acidic foods.</li>
	<li>Position During Feeding: Feeding in a reclined or supine position can increase the likelihood of acid reflux in infants. 
	&nbsp;</li>
</ul>

There are no specific screening tests or procedures recommended for routine screening of acid reflux in otherwise healthy infants.<a href="#accordion">[8]</a>

Colic babies or those who are unusually irritable may be screened by a doctor. Additionally, evaluation is necessary if:

<ul>
	<li>Symptoms appear for the first time in infants 6 months of age or older</li>
	<li>Symptoms worsen with time (e.g., vomiting blood, not gaining weight, or recurrent pneumonia)</li>
	<li>Symptoms do not improve by 18-24 months of age 
	&nbsp;</li>
</ul>

Diagnosis

The diagnosis of acid reflux in infants is primarily based on a combination of clinical evaluation, medical history, and the presence of characteristic symptoms. Diagnostic tests may be performed in cases where the symptoms are severe or persistent, or when complications are suspected. 
&nbsp;

<ul>
	<li>Clinical Evaluation: A healthcare provider will assess the infant&#39;s symptoms, feeding patterns, growth, and overall well-being. They will also inquire about the frequency and severity of regurgitation, spitting up, and other associated symptoms.</li>
	<li>Medical History: A detailed medical history will be obtained, including information about the infant&#39;s birth, feeding habits, and any previous treatments or interventions.</li>
	<li>Symptom Assessment: The healthcare provider may use standardized questionnaires or scoring systems to assess the severity and impact of the infant&#39;s symptoms. These tools can help determine the need for further diagnostic tests or interventions.</li>
	<li>Diagnostic Tests: In cases where the infant&#39;s symptoms are severe or persistent, further diagnostic tests may be performed to confirm the diagnosis and rule out other problems. These tests may include 24-hour impedance-pH monitoring, upper GI radiology study, upper endoscopy, and biopsy.<a href="#accordion">[9]</a> 
	&nbsp;</li>
</ul>

Treatment

The treatment of acid reflux in infants aims to alleviate symptoms, promote normal growth and development, and prevent complications. The treatment approach may vary depending on the severity of symptoms and the presence of underlying conditions.[9] 
&nbsp;

<ul>
	<li>Lifestyle Modifications: Simple lifestyle changes can often help manage mild cases of acid reflux in infants. These may include burping the baby before and after feeding, avoiding overfeeding, and keeping the infant in an upright position while feeding and for at least 30 minutes after it.</li>
	<li>Dietary Modifications: In some cases, modifying the infant&#39;s diet can help reduce acid reflux symptoms. This may involve switching to a hypoallergenic formula or eliminating certain foods that trigger GER symptoms. Thickening the infant&#39;s formula with cereal, for instance, can also help reduce reflux.</li>
	<li>Medications: Medications may be prescribed to infants with moderate-severe acid reflux symptoms. Commonly used medications include proton pump inhibitors (PPIs) and H2 blockers to reduce and block the production of stomach acid respectively.</li>
</ul>

Note: They should be used under the guidance of a healthcare provider because the use of medication in infants is controversial, and more research is needed to assess the safety and efficacy of these interventions. 
&nbsp;

<ul>
	<li>Surgical Intervention: This is an option in rare cases where medical management fails or complications arise. The most common surgical procedure for acid reflux in infants is fundoplication, which involves wrapping the upper part of the stomach around the lower esophagus to strengthen the sphincter. 
	&nbsp;</li>
</ul>

While most cases of acid reflux in infants are mild and self-limiting, severe or untreated acid reflux can lead to complications.<a href="#accordion">[8]</a>

<ul>
	<li>Irritation or damage to the esophagus</li>
	<li>Recurrent pneumonia</li>
	<li>Asthma </li>
	<li>Dental erosion and tooth decay</li>
	<li>Sleep disturbances</li>
	<li>Laryngitis 
	&nbsp;</li>
</ul>

Several risk factors can increase the likelihood of developing acid reflux in infants.

<ul>
	<li>Neuromuscular disorders, such as cerebral palsy and muscular dystrophy </li>
	<li>Neurodevelopmental disorders, such as Down&rsquo;s syndrome</li>
	<li>Preterm birth</li>
	<li>Previous esophagus surgery </li>
	<li>Cystic fibrosis</li>
	<li>Obesity </li>
	<li>Family history of reflux 
	&nbsp;</li>
</ul>

Some preventive measures that can help reduce the risk or severity of symptoms include:<a href="#accordion">[10]</a>

<ul>
	<li>Ensuring proper feeding techniques, such as holding the infant in an upright position during feedings, burping frequently, and not jostling the baby</li>
	<li>Trying smaller and more frequent feedings</li>
	<li>Dressing the infant in loose-fitting clothes</li>
	<li>Ensuring the infant&#39;s head elevated during sleep and placing them on their backs to sleep</li>
	<li>Avoiding the infant&rsquo;s exposure to tobacco smoke 
	&nbsp;</li>
</ul>

key points

<ul>
	<li>Acid reflux is a common and normal condition in infants characterized by the backward flow of food or acidic stomach juices into the esophagus.</li>
	<li>There are two main types of acid reflux in infants &ndash; physiological reflux and pathological reflux.</li>
	<li>The signs and symptoms of acid reflux in infants include fussiness, poor weight gain, feeding difficulties, and choking.</li>
	<li>The causes of acid reflux in infants can include an immature LES, delayed gastric emptying, hiatal hernia, food allergies or intolerances, and position during feeding.</li>
	<li>Treatment options for acid reflux in infants include lifestyle modifications, dietary modifications, medications, and surgical interventions.</li>
	<li>Complications of acid reflux in infants can include dental issues, recurrent pneumonia, laryngitis, and irritation or damage to the esophagus.</li>
	<li>Risk factors for acid reflux in infants include preterm birth, family history, obesity, and previous esophagus surgery.</li>
	<li>Preventive measures for acid reflux in infants include proper feeding practices, avoiding overfeeding, dressing the infant in loose-fitting clothing, and avoiding the infant&rsquo;s exposure to tobacco smoke.</li>
</ul>

[1] Pediatric reflux disease. Yale Medicine. October 28, 2022. Accessed November 15, 2023.

[10] Infant reflux. Mayo Clinic. January 24, 2023. Accessed November 15, 2023.

[2] Omari TI, Barnett CP, Benninga MA, et al. Mechanisms of gastro-oesophageal reflux in preterm and term infants with reflux disease. Gut. 2002;51(4):475-479. doi:10.1136/gut.51.4.475

[3] Definition &amp; Facts for Ger &amp; Gerd in infants - NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed November 15, 2023.

[4] Reflux in infants. MedlinePlus. Accessed November 15, 2023.

[5] Acid reflux in infants: Causes, symptoms, and treatment. Medical News Today. Accessed November 15, 2023.

[6] Acid reflux / gerd. UCLA Health. Accessed November 15, 2023.

[7] Steven M Schwarz M. Pediatric gastroesophageal reflux. Practice Essentials, Background, Etiology and Pathophysiology. July 21, 2021. Accessed November 15, 2023.