Gastroesophageal Reflux

What is it? Since the name is so long, we usually abbreviate this by calling it reflux or GER. Essentially, reflux is excessive spitting up. Each doctor may have his/her own definition of “too much”. Most babies will have a wet burp with every meal. Most babies can spit up a mouthful at one or two meals a day, and we may consider this acceptable. When the baby spits more than a mouthful more than twice a day, then we usually would consider that something we should treat.  How the baby is gaining weight will also be an important consideration when deciding to treat reflux. You may be wondering how we tell reflux from stomach flu or formula intolerance!

How reflux is different from Stomach Flu (viral gastroenteritis): With reflux, the baby is usually hungry after they spit, and they act well; with stomach flu, they are sick and not hungry. Reflux has nothing to do with the stools, but stomach flu almost always has diarrhea with it. Stomach flu often has a fever, while reflux never has a fever. Stomach flu only lasts a few days, while reflux may last several months (of course you will not know this in the first few days).

How reflux is different than formula intolerance: These two are actually quite similar, therefore we will have to decide which your child has after talking with you in detail. Formula intolerance often will have excessive gas, gas pain, and diarrhea - often with streaks of blood in it. When we think your child has reflux, we will often try different formulas anyway to make sure this is not part of the problem. Do not switch formulas without discussing this with us.

What causes it?  Your esophagus is the tube that carries food from the mouth to the stomach. At the lower end of the esophagus is a collection of muscles wrapped around the esophagus called the Lower Esophageal Sphincter (LES). This LES is supposed to keep the stomach contents in and prevent spitting or vomiting. The LES does not function well until approximately 8-10 months of life. Some kid’s LES simply does not function as well as others.

 

How do we treat it?   You and your doctor / nurse practitioner will decide which treatment to give. Do not change the treatment or try another step, unless we have instructed you to do so. The order of these steps is not necessarily the order you may try. You will notice that there are a lot more steps you can try when bottle-feeding. Breast fed kids do spit up much less often. For example, breast milk only takes 30 minutes to get past the stomach, while formula takes up to 2 hours. Of course, there are always exceptions.

What else can we do to help? There is definitely more we can do, but anything beyond that outlined here will either require a prescription, testing, or will require face- to-face discussion to ensure proper treatment.

 

When should I call the doctor?  There is a bowel disorder called Pyloric Stenosis that looks like reflux when it first appears. The pylorus is a muscle wrapped around the gut just past the stomach. This muscle keeps food in the stomach until the stomach can break down some of the food. In Pyloric Stenosis, the pylorus muscle grows so big that it won’t allow anything to pass. This usually occurs in first-born males, but can occur in any baby. Pyloric Stenosis usually shows up between 3 and 6 weeks of age as progressively worsening vomiting. The vomiting is projectile. Projectile is a word that frequently gets used incorrectly. In this case, when we say projectile, we mean shooting out of the mouth like a garden hose on full pressure stream that can shoot the vomitus several feet away from the baby. Many people will describe vomitus gushing out of the mouth as projectile, and this is not correct. With Pyloric Stenosis, eventually everything that goes in the mouth will come back out, and the baby will get dehydrated. If you think your baby has this, then call us immediately.

Copyright 2006 Joe Matusic, MD, FAAP, AME

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