Almost all babies have reflux for a few months. Reflux is essentially the stomach contents coming back up through the esophagus. In young babies, the esophagus is immature and the baby may spit up after almost every feeding. This rarely poses any bigger problem than that of laundry.
Contrary to popular belief, and a belief that some pediatricians still hold, breastfed babies do indeed have reflux and spit up after feedings. Some statistics on spitting up are:
– Half of all babies 0-3 months spit up within an hour or two of feedings
– Spitting up seems to peak between 2-4 months
– A lot of babies stop spitting up around 6-7 months
– Most babies do not spit up after one year
The rule of thumb is: if your baby is happy and gaining weight well, just be prepared with a burp cloth!
GERD (or Gastroesophageal Reflux Disease) is present in a small number of babies. Many times this condition goes under- or un- diagnosed or is not seen as a “problem” by pediatricians if the baby is still gaining weight. Many mothers are also unaware of the signs of reflux. If the baby doesn’t spit up often or much, but is fussy at feedings, arches and pulls back from bottle or breast, has spells of inconsolable crying, gags and chokes during feedings,and/or hiccups frequently – – – – -check with the pediatrician. Those are all signs of a condition called “silent reflux”. It is hardly silent, since it is characterized by a fussy baby, but refers to the fact that baby is not spitting up frequently or at all.
There are of course, signs of severe GERD in babies. Some of these include refusing breast or bottle; spitting up blood; breathing problems; and poor or no weight gain. But for this article, I will discuss the more borderline or difficult to diagnose cases of suspected reflux.
When GERD is suspected (in most cases, because the parent was adamant and prepared with a list of symptoms for the pediatrician) a trial of various reflux medicines is done before testing. Generally, reflux testing is reserved for severe cases that do not respond to medication, since the procedures are invasive and not always effective in babies.
There are two basic types of medication generally prescribed for reflux or GERD in babies.
One is a H2 Blocker. This does not lessen reflux episodes but will make the baby’s spit-up less acidic. Some common medicines in this class are cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac).
The next is a Proton Pump Inhibitor. These block the production of acid in the stomach. Some common medicines in this class are esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), and rabeprazole (Aciphex).
If the baby’s reflux symptoms decrease or disappear with one of these medicines, that baby is then considered to have reflux. As my daughter’s pediatrician said “it’s a diagnosis of symptoms” Your pediatrician will generally write for three refills at a time, because he or she will want you to reevaluate your child’s reflux symptoms every few months.
In the case of my youngest daughter, liquid Zantac has been the miracle cure for her reflux symptoms. She is breastfed. Since up to 70% of reflux cases are suspected to be linked to an intolerance of dairy products, I refrain from eating anything made with cow’s milk.
From day one, she choked and gagged and cried while nursing. She was having spells of inconsolable crying more than once a day by three months , an age when most babies are outgrowing their “colic.” She seemed to have a chronically stuffy nose. She arched and threw her head back frequently while nursing. And yet, she rarely spit up.
If it wasn’t for a friend of mine who had a daughter recently diagnosed with GERD, I would never have considered that possibility. When I discovered that many of her symptoms are associated with “silent reflux” I went to her pediatrician with a list of her symptoms. He immediately wrote a prescription for liquid Zantac and within two weeks, I had the happy, mellow, laid-back baby I had only gotten glimpses of earlier.
Most babies’ reflux symptoms lessen considerably by 6 months and are gone by one year. However, some babies do need to continue the medication for reflux between 12-24 months. In our case, my daughter’s symptoms persist at 11 months.
If you suspect your baby may have GERD, make a list of his or her symptoms and take it to your pediatrician. It can’t hurt.
