Reflux In Babies: Understand What It Is And When You Should Be Concerned

Gastroesophageal reflux (GER) is the repeated return of gastric contents to the esophagus. And, according to Catherine de Almeida Cabral, pediatrician at Hospital Anchieta, Federal District (DF), is normal in babies, due to the immaturity of their digestive tract, common in this age group.

But, says the pediatrician, GERD is considered normal when there is no impairment in the growth and development of the baby. "And it can be considered a disease when it is associated with other signs and symptoms," he says.

Henrique Gomes, pediatrician and gastropediatrician at Santa Lucia Hospital, in Brasília, points out that in infants up to three months of age, reflux is normal. This is due to the development of the gastrointestinal system. Children in this age group, especially in the first month of life, have this system still in the process of maturation, thus, the occurrence of gastroesophageal reflux is more present at this time, as well as the higher incidence of other related manifestations, such as colic of the stomach. infant ?, highlights.

Gomes explains that gastroesophageal reflux can be classified as: physiological reflux and pathological reflux.

Physiological reflux: This is what happens most commonly in the first three months of life, and its occurrence is directly related to the maturation of the gastrointestinal system, bringing no harm to the baby in relation to weight gain or any other associated symptom.

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Pathological gastroesophageal reflux: may start in this age group, but in addition to the episodes of regurgitation, the baby also has irritability and / or low associated weight gain. This irritability is caused by the pain caused by the gastric juice in contact with the esophageal mucosa, and most often causes the intense crying of babies even during breastfeeding. Some patients may have associated respiratory and / or ENT symptoms.

A common concern is: Can reflux in the baby be a sign of serious illness?

Catherine explains that GER may be associated with specific conditions such as congenital esophageal stenosis, tracheoesophageal fistulas, pyloric hypertrophic stenosis, food allergies, among others.

Gomes points out that reflux, when pathological, is a condition that deserves special attention. "In addition to the discomfort caused by milk regurgitation, may lead the baby to have low weight gain, in addition to other non-gastrointestinal disorders such as recurrent otitis media, chronic cough or asthma," he explains.

The best way, then, is to be alert to the signs, knowing how to differentiate physiological (which may be considered normal) from pathological reflux, not hesitating to seek medical help in this second case, or simply in case of doubt.

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Symptoms: How to identify reflux?

It is important to know first what are the differences between regurgitation and reflux. Gomes explains that regurgitation is the return of food, in this case, milk, ingested. Regurgitation can be either a symptom of physiological or pathological gastroesophageal reflux. It is worth remembering the existence of hidden reflux, when there is no presence of milk regurgitation through the mouth, but may present pain on occasion or even other associated pathologies ?, says.

The gastropediatrician points out that regurgitation is also popularly referred to as "dolphin" until the sixth month of life, with a significant decrease in symptoms in the third month.

Catherine points out: Regurgitation can be defined as the return of small amounts of gastric or esophageal contents to the pharynx and mouth without effort. Is reflux the return of gastric contents to the esophagus?

Symptoms of physiological reflux

Catherine explains that when reflux is physiological, it is more common in the first months of life, with repeated regurgitation occurring without any other associated symptoms or conditions.

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Pathological Reflux Symptoms

Gomes highlights as main symptoms in this case:

• Intense crying during or after breastfeeding;
• Irritability;
• Changes in sleep;
• Associated respiratory and otorhinolaryngological symptoms (chronic cough, asthma, otitis media);
• Low weight gain.

What to do in case of reflux?

You can try some simple measures at home, such as holding the baby upright for 20 minutes after each feeding and raising the head of the crib slightly. Another alternative is to increase the frequency of feedings to decrease the amount of milk in each one.

But, it is worth mentioning, if reflux is associated with other symptoms, the ideal is to take the baby to the pediatrician as soon as possible. Any kind of treatment, after all, must be directed by a doctor.

Causes of Reflux in Babies

Catherine points out that the main cause is the immaturity of the gastrointestinal tract. "Remember that the mechanisms that prevent the return of gastric contents to the esophagus and mouth are still developing," he says.

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In pathological cases, reflux may be associated with specific conditions such as congenital stenosis of the esophagus, tracheoesophageal fistulas, hypertrophic pyloric stenosis, food allergies, among others.

Gomes points out that, in some cases, the exclusion of anatomical defects, such as pyloric hypertrophic stenosis, is necessary. "Other risk factors are prematurity and association with neurological diseases," he says.

Preventive measures: how to avoid the problem?

Catherine explains that parents can take the so-called anti-reflux measures, which are:

• Headrest elevation to 30 degrees. Tip: This can be done by adopting anti-reflective cushions or pillows.
• Wait a few minutes after feedings to put the baby in the crib even when he burps. Tip: Usually 10 to 15 minutes after breastfeeding is enough.
• Dietary Measures: Some foods may reduce sphincter tone, which is one of the anti-reflux mechanisms and / or increase gastric acidity. In such cases, fatty foods, citrus fruits, tomatoes and coffee should be avoided.

Gomes points out that foods that favor colic are also related to reflux in the first months of life, such as caffeinated, carbonated and excess intake of cow's milk and dairy products.

Backflow Treatments in Babies

Catherine recalls that in the cases of physiological GER, it is considered transient, and its reduction is expected around four to six months of age, with the introduction of solid foods and the adoption of a more upright posture, given by neuropsychomotor development.

Pathological gastroesophageal reflux, as Gomes points out, is treated with postural measures, changes in maternal eating habits, and specific drug treatment. • The pediatrician is qualified to give the necessary guidance and start drug treatment when this is the case. In some situations, the pediatric gastroenterologist is important for the follow-up of this patient ?, he says.

Catherine stresses that pathological reflux is treated with parental guidance, anti-reflux measures, dietary measures such as introduction of thickened infant formulas, early introduction of more solid foods, and medications for gastric emptying and protection and decreased regurgitation.

6 points to note and refer to

It is interesting to be prepared for a consultation with the pediatrician, noting the possible symptoms associated with the baby's reflux and also taking the questions to the doctor.

• Parents should inform their pediatrician about their concerns and anxieties about their baby's regurgitation and development. Routine consultation of the baby up to six months, which should be monthly, is an important point to diagnose GER disease, because the pediatrician assesses the baby's weight and growth and parental complaints?

In this regard, regarding the preparation of the parents and the moment of the consultation itself, Henrique Gomes advises:

1. It is important that the attending pediatric physician guides parents about the differentiation of physiological from pathological gastroesophageal reflux;
2. Parents should advise the attending physician if the baby is very tearful, if he is irritated during or after breastfeeding;
3. Parents should observe the baby's weight gain curve and always talk to the pediatrician about whether this gain is within the normal range;
4. Parents should note if the baby has persistent cough that is difficult to resolve, as well as recurrent respiratory or otorhinolaryngological infections;
5. They should watch if the baby regurgitates or vomits frequently;
6. They should also observe the baby's sleep pattern (if it is agitated, often awakened).

With parents' watchful eyes and routine "on-time" appointments, everything tends to go well, and even if the reflux is pathological, it will be treated as well as possible.

Gastroesophageal Reflux Disease | Children's National Medical Center (April 2024)