Gastro-oesophageal reflux (GORD or GERD in the US) in babies is caused by the muscle between the stomach and the oesophagus (food pipe) being weak, allowing milk to return up the oesophagus after feedings. This milk contains acid from the stomach and causes heartburn-like pain.

In most children, as the body develops the muscle strengthens and the reflux stops by itself once the child is crawling or walking, usually by a year old.

Unfortunately, the symptoms with reflux can vary drastically between one baby and another. Some babies will scream with every feed, whilst others will feed all the time to try to soothe the pain (especially breast-fed babies as breast milk is a natural antacid).  Some babies will not gain or lose weight, others (because of the comfort feeding) gain normally, or even more than average.

Frequent vomiting is a major symptom, but some babies don't vomit at all (called 'silent reflux').

 

If you notice your child is;

 

Mild reflux

Moderate to severe reflux

Some children are called 'happy-chuckers' where there is frequent vomiting and mild irritability but does not require treatment.

However, others do require treatment of some kind. The following list is from my experience with my son and friend's babies and may alter depending on your child's physiology.

 

1.         Easy tips to try – elevating your baby’s cot/crib by putting two tin cans at the head end, or a pillow UNDER the mattress at the head end. You may need to put towels either side to prevent the infant from rolling down the bead and getting stuck. There are companies that sell special slings to hold babies upright when sleeping.

2.         Keep baby upright when feeding and for 20 minutes (or more) after each feed to allow the milk to go down properly.

3.         Some babies with reflux prefer to sleep on their tummies. As this goes against all current advice preventing against SIDS (Sudden Infant Death Syndrome), this MUST be discussed with your doctor before you make this decision. I invested in a breathing monitor to put my mind at rest when my baby was sleeping on his tummy.

4.         The first prescribed treatment is usually Gaviscon - either adult or infant. The adult version can neutralise some acid and coats the oesophagus to help protect from the acid. The infant version just acts as a raft over the milk to try to keep it down. Can be very effective in immobile children, tends to reduce effectiveness as the infant becomes mobile, can cause constipation.[1]

5.         Many doctors will tell you to add cornstarch or rice cereal to your baby's bottle (if you are formula feeding) to thicken the milk and keep it down. This only works for some babies and in young babies may cause a stomach upset. There is a formula (In Israel, Enfamil AR) which has rice in it to thicken it instantaneously. Some parents have found this helps.[2]

6.         A better thickener I have found is Carobel[3]. Unfortunately this is only available in the UK from the company Cow & Gate and needs to be ordered for delivery to a local pharmacy. In my experience only large pharmacies are willing to do this (Boots for example). It is expensive as well but in our case worked amazingly and was worth every penny. It is a powder that is added to either the bottle or given on a spoon before a breast-feed. [4] It is listed in the Kosher Food Guide (published by the London Beth Din) and is also suitable for use on Pesach.

7.         It is worth noting that many babies have reflux due to a cow's milk protein or soy protein intolerance. (60% of infants with cow’s milk intolerance have been shown to develop soy protein intolerance).[5]This is not a true allergy and therefore cannot be tested for (except via an exclusion diet) and is thought to involve elements of the immune system not normally associated with allergies. It is worth trying your child on a hypoallergenic formula such as Neocate or Nutramigan if their reflux is severe. Breastfeeding mothers should eliminate all dairy and soy from their diets for a minimum of 3 weeks to determine if this is the cause of your child's reflux.[6]

8.         The main medication prescribed for reflux is Zantac (ranitidine)[7]. This causes acid reduction of up to 70%. In our son, this was all we needed, although it is important to get the dosage right as it changes with your child’s weight. As with all medications, side effects exist, and it is important to weight these up against the benefits. Personally, our son had no side-effects and within a few days a happy baby emerged from a screaming, non-sleeping nightmare!

9.         If there is no improvement with Zantac after 3 days maximum, even slight (full improvement only occurs after the damage to the oesophagus has healed – up to 3 weeks), return to your doctor and ask for Losec/Prilosec (omeprazole)[8]. Losec blocks 100% of acid production in the gut. There is NO research of the use of Losec on infants which makes doctors very reluctant to use it, and your child will have to be suffering quite a lot before your doctor will prescribe it.[9] In addition, paediatricians usually do not have permission to prescribe Losec and you will have to be referred to a gastro-paediatrician. Some countries require a pH-probe (by showing a low/acidic pH in the gut) and/or a scope of some kind to show ulceration. Losec is made for adult use and therefore comes in either capsules which are opened or tablets which are crushed for use in infants. The side effects are stronger.

10.       There are also motility agent/prokinetc drugs (e.g. domperidone) that cause the stomach to empty faster, preventing vomiting and enabling weight gain. Again, these are strong medications and are usually only prescribed in children that are not gaining weight.

There are many, many, websites providing information and support for parents of children with reflux.  On our forum there is a reflux topic for us Jewish mothers to complain about the vomit on our clothes!

Here are some relevant links;

http://infantrefluxdisease.com/

http://www.infantreflux.org/

http://www.momswearingpuke.com

http://www.livingwithreflux.org/

http://www.cryingoverspiltmilk.co.nz/

http://www.babycentre.co.uk/baby/health/reflux/

I have tried to reference as much as I can on this article. If, however, you find information that contradicts anything I have written, please email info@jewishwomensnet.com and I will endeavour to correct the error.