Acid Reflux: Managing Symptoms in Infants with Severe Cases of Gastroesophageal Reflux

It is not uncommon for newborns and young infants to spit up some of the contents of their stomachs after a feeding, and typically minor regurgitation does not present any health problems. By the time an infant reaches 3-4 months of age, approximately 60-70% will experience a reflux episode during at least one feeding in a 24 hour period.

The diagnosis of a severe case of gastroesophageal reflux takes into account the number and severity of reflux episodes, as well as complications that are associated with extreme acid reflux such as failure to thrive, esophageal stricture formation, erosive esophagitis, and the development of chronic respiratory disease. The American Academy of Pediatrics estimates that less than 1% of infants have severe cases of reflux, but severe cases require immediate medical care and the supervision of a pediatrician.

In addition to suffering health complications from severe cases of gastroesophageal reflux, infants with this condition typically present very malcontent dispositions. An infant with reflux may cry often and be difficult to soothe; it is believed that this is due to the pain caused by stomach acids entering the esophagus. Sleeping can be difficult for an infant with reflux, and constantly regurgitating food or refusing to breastfeed or drink from a bottle can result in a diagnosis of failure to thrive if the child is not gaining weight and growing properly.

Pediatricians recommend several things to help manage the symptoms of esophageal reflux in infants. One method is to feed smaller amounts, more frequently. A smaller amount of milk can digest faster, decreasing the likelihood of a severe reflux episode. A pediatrician may recommend a change in formula for formula-fed babies; hydrolyzed protein formulas are cow’s milk based, but the ingredients in the formula are already partially broken down in order to help a baby with reflux digest the milk faster so there is a higher chance of nutrients being absorbed. After a feeding, it is recommended that infants with reflux be held in an upright position as long as possible to reduce the chance of a reflux episode.

Infants require many hours of sleep in order to grow and develop properly, but a severe case of gastroesophageal reflux can prevent a baby from getting the sleep that he or she needs. Many babies with severe reflux sleep better or more soundly when they are propped up at an incline. This position helps keep stomach acid from rising past the lower esophageal sphincter and causing pain in the throat. To safely create an inclined sleeping surface for an infant a wedge can be placed under the edge of a crib mattress to slightly elevate one side. Pillows and blankets should never be used to prop up a sleeping infant as they are a suffocation hazard.

In very rare cases of severe infant esophageal reflux, surgery may be necessary to repair damage to the esophagus. The procedure typically used is called fundoplication, and prognosis after the surgery is considered excellent.