If you have an infant, you know that spit up is a normal part of a baby's life. It's caused by reflux, but how do you know if your child has acid reflux?
Pediatric GERD (gastroesophageal reflux disease), is an increasingly common diagnosis. Doctors may prescribe acid suppressing medications if your baby vomits forcefully after eating, cries at meals, refuses to be fed, or fails to gain weight and thrive as a normal baby should.
Everyone – including all infants and children – has some degree of reflux, or the backwards movement of stomach contents into the esophagus. That's what has happened when we burp and get the aftertaste of the meal we just ate.
Unfortunately, your baby can't tell you if his reflux comes with acid or feelings of heartburn. But if he's having recurrent symptoms, you may want to take him to the doctor.
Understanding pediatric reflux
dailyRx spoke with Dr. John Stutts, a pediatric gastroenterologist at the University of Louisville School of Medicine. He said almost all babies have reflux.
“The question becomes whether they are having any detrimental side-effects. For example, the baby who spits up but is growing well, they're thriving - they just spit up and go about their business - we call that a 'happy spitter.' That's a patient who is not going to need a more extensive work-up, and probably will not need any medications.”
He said that the most common reflux resolves itself.
“The vast majority of the time, it is what we call physiologic reflux. Approximately 50 percent of babies outgrow their reflux by six months,” he said. “Approximately 80 – 90 percent outgrow by 12 months of age. There is a small percentage of children who will have reflux beyond their first year of life.”
Infants' reflux gets better with time because the muscle that holds their food in their stomach gets stronger as they grow, Dr. Stutts told dailyRx. The lower esophageal sphincter increases in tone from birth, and doesn't pop off as easily with pressure from the stomach.
Babies also get a boost from gravity as they start to hold themselves up. Gravity helps keep their food down, which is why babies should held upright during and after feeding.
Dietary changes contribute as well. Infants are less likely to have reflux after they transition to more solid foods, Dr. Stutts said.
However, a small fraction of infants who regurgitate their food have GERD.
Symptoms of pediatric acid reflux
Pediatric GERD is often diagnosed when other health issues have been eliminated, according to Dr. Eric Hassall, a pediatric gastroenterologist at the Sutter Pacific Medical Foundation. There's no single test or combination of tests that will definitively diagnose the disease.
Symptoms may include:
- Failure to gain weight or thrive
- Vomits forcefully, recurrent projectile vomiting
- Spitting up yellow or green fluid
- Resisting being fed
Dr. Stutts says that if a physician suspects acid reflux, they'll often order x-rays to look at the anatomy of the patient's upper gastrointestinal tract.
What they're doing is looking to see if the patient has any anatomical abnormalities. An obstruction of the gastric outlet, narrowing of the esophagus, or any obstruction that might prevent the normal flow of food could be the cause of GERD.
Patients who are likely to have chronic GERD, beyond their first year of life, may suffer from other diseases or have a family history of GERD.
Doctors may prescribe medications called H2 blockers or proton pump inhibitor (PPI), which aim to reduce gastric acid production.
Medication may be overprescribed
Use of PPIs among infants has grown quickly over the past decade. One formulation made for children saw a 16-fold increase in a period of six years. That has Dr. Hassall concerned.
“For most complaints that people think are reflux disease in infants, they're not,” he said. “They respond just as well to a placebo or changes in the diet.”
Last year, Dr. Hassall authored a paper published in the Journal of Pediatrics about the over-prescription of acid-suppressing medications in infants. He's worried that many infants are taking unnecessary medicine.
“All medications come with risks, and the basic tenet in prescribing medication is risk versus benefit,” he said. “If you're not going to get any benefit, why would you take the risk?”
He said many of the symptoms of GERD, such as unexplained crying, can be attributed to normal baby behavior.
“Infants have a limited range of responses to stimuli,” he said. Crying at meals might be due to constipation, gas, or reactions to their environment.
He estimated that roughly 1 – 3 percent of infants taking medications actually have acid reflux disease. The medicine works well if the baby does have the disease, but studies have shown that many infants respond equally as well to a placebo..
Dr. Hassall advised that if a child is unhealthy with symptoms of reflux, take him to the doctor and have the doctor do a detailed history before prescribing medications.