Infant reflux

DEFINITION

Infant reflux (sometimes called infant acid reflux) is the condition where the contents of the stomach are spit out, usually shortly after feeding. Spitting up (infant reflux) becomes less common as a baby gets older, and it’s unusual if it’s still occurring after 18 months of age.

In a small number of cases, reflux can be a sign of a more serious problem, such as gastroesophageal reflux disease (GERD), an allergy or a blockage.

CAUSES

Infant reflux is related to a number of factors, often in combination with one another.

In infants, the ring of muscle between the esophagus and the stomach — the lower esophageal sphincter (LES) — is not yet fully mature, allowing stomach contents to flow backward. Eventually, the LES will open only when baby swallows and will remain tightly closed the rest of the time, keeping stomach contents where they belong.

Babies are lying flat most of the time, which makes reflux more likely. Moreover, their diet is completely liquid, also favoring infant reflux. Sometimes air bubbles in the stomach may push liquids backward. In other cases, your baby may simply drink too much, too fast.

Although infant reflux most often occurs after a feeding, it can happen anytime your baby coughs, cries or strains.

In a small number of cases, the symptoms of infant reflux are caused by something else. Among the possibilities:

• Allergic gastroenteritis is an intolerance to something in food, usually a protein in cow’s milk.
• Gastroesophael reflux disease (GERD) is a more severe condition where the reflux is acidic enough to actually irritate and damage the lining of the esophagus.
• Eosinophilic esophagitis is a condition where a particular type of white blood cell (eosinophil) builds up and injures the lining of the esophagus.
• Obstruction is a blockage or narrowing in the esophagus (esophageal stricture) or between the stomach and small intestine (pyloric stenosis).

SYMPTOMS

Spitting up and vomiting are the main symptoms of infant reflux. As long as your baby is healthy, content and growing well, the reflux is not a cause for concern. Your child will in all likelihood outgrow it.

While your baby may act fussy or seem to be uncomfortable, it is very unusual for the stomach contents to be acidic enough to irritate the esophagus or throat, as happens with acid reflux.

When to see a doctor

Contact your baby’s doctor if your baby:

• Isn’t gaining weight
• Spits up forcefully, causing stomach contents to shoot out of his or her mouth (projectile vomiting)
• Spits up green or yellow fluid
• Spits up blood or a material that looks like coffee grounds
• Refuses food
• Has blood in his or her stool
• Has difficulty breathing
• Begins vomiting at age 6 months or older

Some of these signs may indicate more-serious conditions, such as gastroesophageal reflux disease (GERD) or pyloric stenosis. In GERD, the reflux contains stomach acid which damages the lining of the esophagus. Pyloric stenosis is a rare condition in which a narrowed valve between the stomach and the small intestine keeps stomach contents from emptying into the small intestine.