Gastroesophageal reflux in infants

Definition

Gastroesophageal reflux is the movement of stomach contents up the esophagus toward the mouth, rather than down through the digestive system (peristalsis).

Causes, incidence, and risk factors

In infants, a small amount of gastroesophageal reflux is normal. Persistent reflux with frequent vomiting, and subsequent irritation of the esophagus is indicated by unrelenting crying and discomfort. Reflux associated with weight loss or reflux that causes breathing difficulty is considered abnormal.

Symptoms

• Excessive vomiting during the first few weeks of life
• Extremely forceful vomiting
• Chronic cough
• Wheezing
• Apnea or breath-holding spells
• Slow growth
• Excessive crying as if in pain
• Weight loss

Signs and tests

There may be a history of episodes of aspiration pneumonia.

Tests that may be performed include:

• X-ray of esophagus (esophagogram using a radio-opaque dye)
• pH probe monitoring of esophagus (see esophageal pH monitoring)

Treatment

If your baby has reflux problems, prop him or her upright for one to two hours after feeding. This can be helped by use of a reflux board. When the infant begins to eat solid food, thickened foods are preferable to thin foods. Sometimes medications are used to help reduce symptoms, including antacids or Reglan (a prescription medication that improves peristalsis).

Expectations (prognosis)

The majority of infants outgrow this condition. In unusual cases, reflux may persist into childhood and can cause varying degrees of esophageal damage.

Complications

• Esophageal irritation and inflammation
• Esophageal stricture (scarring and narrowing)
• Pneumonia caused by stomach contents passing into the lungs

Calling your health care provider

Call your health care provider if your baby is vomiting frequently, especially if the vomiting is forceful or if other symptoms of reflux occur.

Prevention

Avoid allowing your baby to sit in a slumped position after meals.

Illustrations

Digestive system

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