Gastroesophageal reflux (GERD) is the medical term for spitting up. It occurs when the stomach contents reflux or back up into the esophagus and/or mouth (the esophagus is the tube that carries food from the mouth to the stomach). Because the stomach naturally produces some acid, reflux is sometimes called acid reflux; other terms include regurgitation and spilling. Reflux is a normal process that occurs in healthy infants, children, and adults. Most infants have brief episodes, during which they spit up milk or formula through the mouth or nose. Uncomplicated reflux does not usually bother the infant, has a low risk of long-term complications, and does not usually require treatment. In contrast, a few infants with gastroesophageal reflux disease (GERD) are irritable, gain weight slowly, develop recurrent pneumonia, or spit up blood. Infants with these signs and symptoms usually require further testing and may require treatment. Although most infants with gastroesophageal reflux disease improve as they grow, some children have symptoms later in childhood. Some babies have a higher risk of getting GERD, including those who; were born prematurely (three or more weeks before the due date), are around cigarette smoke, or those with certain health problems, such as Down syndrome, cerebral palsy, or other problems with the brain and spinal cord. If the baby spits up a lot, but seems otherwise happy and healthy, he or she probably has what is called “uncomplicated” reflux. This is very common. Burping your baby often, and keeping him or her upright and calm after feeding, might help with the spitting up. If the baby has GERD, the symptoms might include; refusing to eat, crying and arching the back as if in pain, choking on spit-up, vomiting forcefully and not gaining weight normally. If a child is suspected of having gastroesophageal reflux disease, the first step in the evaluation is a complete medical history and physical examination. The need for further testing depends on what is found, and may include; laboratory testing (blood and/or urine tests), an x-ray study to evaluate how well the infant swallows and to evaluate the structure of the stomach or a procedure called upper endoscopy, to view the lining of the esophagus. Infants with gastroesophageal reflux disease are generally treated first with lifestyle changes, including avoidance of overfeeding and tobacco smoke, a milk-free diet (cow-milk free), and thickened feeds (thickening formula or expressed breast milk). Women who breastfeed are encouraged to continue doing so; an infant should not be switched to formula for the purpose of thickening the feeds. Breastfeeding may reduce the risk of reflux in infants. Infants may have fewer episodes of acid reflux if they can be kept upright and calm for 20 to 30 minutes after a feed (that is, carried on an adult’s shoulder, not placed in an infant seat). Parents should avoid over-feeding and allow the infant to stop feeding as soon as he or she seems to lose interest. Like all infants, those with acid reflux should be positioned on the back to sleep. There is no benefit of raising the head of the crib or placing the child to sleep in a car seat. Most babies with acid reflux do not need medicine. Plus, medicines do not always make the reflux better. But if one has tried the ideas above, and the baby is still having trouble with reflux, one’s doctor might suggest trying medicine. There are lots of medicines available for adults with acid reflux, but not all of them can be used safely in babies, and so your doctor will chose the most appropriate medicine for the baby after assessment. Dr. Ian Shyaka Resident in Surgery, Rwanda Military Hospital, iangashugi@gmail.com
