Reflux (or Gastroesophageal Reflux Disorder / GERD) is a shockingly common diagnosis in infants. There is a lot of controversy surrounding the diagnosis and treatment of this condition in this special population. My task here is not to fuel that fire, tell parents what choice is best for their specific situation, or replace medical advice. My goal is to provide a framework of understanding so that caregivers can feel confident and well-informed in their decision making process.
What is Gastroesophageal Reflux Disorder (GERD)?
GERD is a condition where the contents of the stomach are entering up into the esophagus. Depending on how far up the tract those contents go and how often, this can irritate the lining of the esophagus and cause a myriad of symptoms. Symptoms of reflux include spit-up or vomiting, a persistent cough or raspy noise, trouble eating (either refusal, fussiness during or after, choking, gagging, or inefficiency), GI distress, and poor weight gain. You do not need to have all of these symptoms for a diagnosis. Infants with reflux do not always spit up; this variation is sometimes called “Silent Reflux”. On the other hand, all kids who spit-up do not have GERD and a certain amount of spit up is very normal in infants! The persistence and severity or symptoms and the overall health of the child should all be taken into consideration whenever assessing for treatment.
What causes it?
There can be a few contributing factors reflux in an infant. An immature GI tract or low muscle tone at the gastresophageal sphincter (meaning the valve opens more readily than it should) are common culprits. Food allergies, sensitivities, and reactivities are also very common (with cow dairy protein being the most common of these, but certainly not the only possible food trigger). Structural disturbances such as the position of the stomach sphincter relative to the diaphragm (consider hiatal hernia) or excess tension at the diaphragm can also contribute. Autonomic nervous system regulation often plays a key role in balancing the appropriate amount and timing of digestive acids and enzymes. Poor feeding mechanisms (including tethered oral tissues, inefficient latch, weak suck reflex, or frantic eating patterns) can increase the amount of air coming in while feeding and cause additional irritation to the dynamics at play (which is sometimes called “Faux Reflux”). We will get into a few of these in more detail in a moment.
Why does it matter?
Severe and persistent exposure of stomach acid to the esophagus can cause a painful condition known as esophagitis. Regurgitation and vomit also pose potential choking risk. It can complicate asthma and other respiratory conditions. Imbalance in stomach acid, digestive enzyme production, and GI pH can have a major impact on nutrient absorption, microbial health, and immune function. Reflux symptoms can impacting both eating and sleeping behaviours. Plus, most baby’s with a true reflux are not too happy about it; we often see reflux as a dynamic component of our fussier babies, those with colic or dysautonomia (sympathetic overdrive). Needless to say, baby is not thriving at their best when struggling with GERD or concomitant conditions.
How do you diagnose reflux in an infant?
Although there are several invasive and non-invasive diagnostic tests used for GERD – including ultrasound, x-ray (barium swallow), pH monitoring, gastric emptying test, upper GI endoscopy, and lab tests – many of these are centred around ruling out other causes for symptoms and most commonly a diagnosis is made by your family physician or paediatrician based on history alone.
That was some great background information! Continue on to Part 2 to learn more about the Conventional Medical Management of Infantile GERD and to Part 3 to lean more about the Conservative Care Options for Infantile GERD.
If you are looking for references and additional resources, they are listed at the end of Part 3.