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Kerry asked...

How can I help my baby with acid reflux, silent reflux.

Tags: digestion

My daughter is 15 weeks old and has been treated for silent reflux since 4 weeks old with infant Gaviscon, but she still seems very unsettled and seems uncomfortable during and after feeds. In the past couple of days she has started refusing feeds and if taking a bottle will only take a few ounces at a time. Her GP says it will pass. Should I get a second opinion? What is the difference between GORD, acid reflux and silent reflux and are there other options to ease her discomfort?

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The answer

I am sorry to hear of the problems your baby is experiencing with silent reflux.

Reflux (or posseting) is when your baby brings up food shortly after eating. Acid from the stomach backtracks into the oesophagus, usually as a result of the oesophageal sphincter at the base of the oesophagus being weakened or not fully developed. Simply put, GORD is the condition and reflux is the symptom. The difference between acid reflux and silent reflux is the presence or lack of vomit. Symptoms most often start before the age of 8 weeks. Treatment is the same.

Signs of reflux

  • Spitting up milk during and after feeds on a frequent basis
  • Feeding difficulties- gagging, choking and refusing to feed
  • Persistent coughs or hiccups
  • Excessive crying or crying when feeding
  • Frequent ear infections
  • Possible weight gain issues
  • With silent reflux, your baby may not vomit but may still be swallowing the regurgitated food back into the stomach rather than expelling it out of their mouth. Often the only noticeable sign is hearing the baby repeatedly swallowing or crying from discomfort.

Causes of reflux

  • Immaturity of the oesophagus and stomach sphincter
  • Gastro-oesophageal reflux disease (GORD)
  • Food or milk allergies
  • Blockage or narrowing of the oesophagus
  • If your doctor thinks your baby could have a cows' milk allergy, they may suggest trying special formula milk that doesn't contain cow’s milk.

Very early on, babies with reflux can associate eating with pain and discomfort, becoming ‘fussy’ eaters or even refusing to feed. However, medication is not considered to be the first course of action. Some of the following management strategies may help if you haven’t already tried them.

Managing reflux

  • Feed your daughter in an upright position, keeping her head higher than her stomach for at least 30 minutes after a feed.
  • Avoid exposure to tobacco smoke.
  • Avoid over-feeding your baby – if she vomits, consider waiting until the next feed rather than feeding her again.
  • Avoid rough handling such as bouncing your baby after a feed.
  • Try to keep her calm.
  • If possible, try changing your baby’s nappy before a feed rather than after to avoid having to lift legs above her head.
  • Avoid tight clothing such as elasticated waist bands.
  • Discuss with your doctor the possibility of using thickened feeds, which can be helpful sometimes.
  • Burp your baby frequently during feeds.
  • Try feeding your baby smaller amounts more frequently.
  • Try using thicker milk formulas that are less likely to be brought back up – these are available to buy without a prescription, but only try them if advised to by a healthcare professional .
  • Elevate the cot mattress at one end so that the head is higher than the rest of the body as the baby sleeps.

Reflux usually is not a cause for concern but do seek professional help (again if necessary) if your baby is not gaining weight or is excessively irritable, especially if symptoms start after 6 months of age

When to seek medical help.

Talk to your doctor or midwife if your baby is:

  • Spitting up feeds frequently or refusing feeds
  • Coughing or gagging while feeding
  • Frequent projectile vomiting
  • Excessive crying or irritability
  • Green or yellow vomit, or vomiting blood
  • Blood in their poo or persistent diarrhoea
  • A swollen or tender tummy
  • A high temperature (fever) of 38C (100.4F) or above
  • Not gaining much weight, or losing weight
  • Arching their back during or after a feed, or drawing their legs up to their tummy after feeding.

As your daughter’s advocate, feel free to ask for a second opinion from another GP, a paediatrician or even a paediatric gastroenterologist who may assess her sucking and swallowing skills. They may also ask for an endoscopy or barium swallow.

Medication for reflux

Babies with reflux don't usually need to take any medication, but sometimes the following medicines may be offered if your doctor feels the problem is severe:

  • Alginates – these form a protective barrier over stomach contents, stopping them travelling up and irritating the oesophagus.
  • Proton pump inhibitors (PPIs) and H2-receptor antagonists – these reduce the level of acid in the stomach, so the stomach contents don't irritate the oesophagus as much Rarely, in severe cases, surgery may be needed.

Answered by the Health at Hand nurses  

Sources and further reading

GORD – NHS factsheet

Acid reflux – NHS factsheet

Reflux – NHS factsheet

Useful resources

http://www.gosh.nhs.uk/medical-information/gastro-oesophageal-reflux - Great Ormond Street Hospital

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