Infant reflux

What is reflux?

Reflux or gastro-oesophageal reflux (GOR) is when food (or milk) from the stomach comes back up the oesophagus (food tube), or into the mouth.

This is common in babies because the muscle at the top of the stomach is not yet strong enough to keep food down. In most babies, reflux causes no pain or problems with weight gain.

Reflux and crying are very common in the early months but are not necessarily related. Colic is when babies cry a lot or are unsettled for long periods of time. To find out more about colic and managing unsettled babies see:

• Crying and unsettled babies – colic fact sheet, The Royal Children's Hospital Melbourne
• Managing unsettled babies, Murdoch Children's Research Institute, The Royal Children’s Hospital Melbourne and Safer Care Victoria

Most babies who bring up milk are healthy and don’t need medical treatment.

Reflux in babies gets better with time as:

• They start to eat solids.
• They learn to sit up.
• The ring of muscle at the top of their stomach gets stronger.

Although it seems logical that reflux might cause babies to cry, studies show that reflux medications do not improve crying in most babies.

What is NOT a sign of reflux?

If your baby does any of these things, they could be upset, but they are NOT a sign of reflux:

• Goes red in the face.
• Pulls up their legs or knees.
• Arches their back.

What is ‘silent reflux’?

There is no proof that silent reflux exists. Silent reflux is used by some people to describe babies who don’t have the common signs of reflux.

Research shows there is no link between baby’s reflux and crying time.

Studies also show that if a baby doesn’t vomit, they are unlikely to have reflux.

Instead of silent reflux, these fussy or unsettled babies might be a high crier, which means they cry a lot.

You can talk about management strategies for your baby with your doctor or maternal and child health nurse.

What is gastro-oesophageal reflux disease (GORD) in babies?

Gastro-oesphageal reflux disease (GORD) is different to reflux. GORD is a medical condition that needs to be diagnosed by a doctor and affects small numbers of babies who have frequent vomiting AND other symptoms like:

• choking, coughing or wheezing during feeds
• vomiting up blood
• distress during feeds or refusal to feed
• poor weight gain or weight loss.

Some of these symptoms may also be a sign of a cow’s milk protein allergy.

If your baby has any of these symptoms, or you have any other concerns, discuss them with your doctor.

In babies with GORD, your doctor might prescribe medication to help treat these symptoms.

Treating GORD with medications

If your baby has reflux, but not GORD, there are no medications that can help.

Babies with GORD are sometimes given medications to help reduce stomach acid. There are 2 types of these medications:

• Proton Pump Inhibitors (PPIs) (such as Losec or Nexium)
• H2 Receptor Antagonists (H2RAs) (such as Zantac).

As with any medication, there are potential risks and side effects for babies. Discuss any concerns you may have with your doctor or nurse.

Potential risks of GORD medications

Taking medications for GORD means that babies may be at risk of the following compared to babies who do not take these medications:

• 3 to 6 times more likely to develop gastroenteritis (gastro) and pneumonia.
• 4 times more likely to not get enough nutrients from their food.
• Almost 2 times more likely to have a bone fracture later in life.
• 2 times more likely to get an infection that causes severe diarrhoea (known as Clostridium difficile infection).
• 1.5 times more likely to develop asthma as a child.

Treatment for reflux and crying in babies

Having a baby with reflux or who cries a lot can be challenging and worrying. Although there are no medications available, these strategies may help:

• Remember, if your baby is vomiting but is otherwise happy and growing well, there is no need to worry.
• Keeping your baby upright for 10 minutes after a feed may help.
• Use a diary to take note of how often your baby is crying and vomiting and when it is happening. That way you can keep an eye out for any changes and discuss any concerns with your doctor.

Where to get help

• Your GP (doctor)
• Your paediatrician
• Your maternal and child health nurse
• Maternal and Child Health Line (24 hours) Tel. 13 22 29