Our little girl has been suffering from reflux for some time now. She even had to be admitted to hospital. What is it, how do you recognize it, and what are the treatment methods.
What is it?
Reflux is the backflow of stomach contents into the esophagus. As soon as we swallow food, it enters the esophagus. The esophagus is a muscular tube between the oral cavity and the stomach. The wall of the esophagus contains muscles that actively transport food to the stomach. There is a sphincter at the transition from the esophagus to the stomach. This sphincter must ensure that stomach contents do not flow back into the esophagus.
As soon as food enters the stomach, it is mixed with gastric juice. Gastric juice contains aggressive hydrochloric acid. The stomach itself has a thick mucous membrane layer, which protects the stomach wall against hydrochloric acid. However, the esophagus does not have such a thick protective layer. If stomach contents enter the esophagus, the esophagus can be damaged by the aggressive gastric juice. This can eventually cause esophagitis.
Reflux is the backflow of stomach contents into the esophagus. Reflux is quite common in babies. This is usually because the sphincter between the esophagus and the stomach is sometimes not fully developed in children. The sphincter will usually develop further during the first year of life. This usually reduces and disappears the complaints.
There are two forms of reflux:
- With ‘normal reflux’ children spit up regularly
- With ‘hidden reflux’, stomach contents also rise, but the baby does not spit them out. For example, stomach contents then reach the throat and then sink back down again. Some children ‘ruminate’ their food in this way.
Possible causes
Reflux in babies usually occurs because the sphincter between the esophagus and the stomach is not yet fully developed. A sudden relaxation of the sphincter muscle can also be the cause of feeding back in babies.
The sphincter muscle cannot yet perform its function sufficiently. This means that stomach contents can flow into the esophagus. This mainly happens just after feeding and/or when your baby is (almost) lying flat. Reflux can also be caused by being too busy with your baby shortly after feeding.
Less common causes of reflux include:
- Chronic constipation. Due to blockage in the intestine, the intestine presses on the stomach. This increased pressure will cause stomach contents to flow up into the esophagus more quickly.
- Food allergy. Due to an allergic reaction, food is not well tolerated. The most common food allergy in babies is cow’s milk allergy.
- A narrowing in the esophagus
Complaints
Reflux can occur in different ways; from mild complaints to very serious. That is why a distinction is made between:
Uncomplicated reflux
This is the most common form of reflux. The complaints consist of regularly giving back (sometimes large amounts of) food. If your child does not seem to be bothered by this and is growing well, it probably has uncomplicated reflux. Treatment is usually not necessary, and the symptoms disappear during the first year of life.
Complicated reflux
As a result of the upward flow of stomach contents, the esophagus becomes irritated and inflamed over time. This causes pain in your child. These children often cry a lot, are easily irritated and sleep poorly. Sometimes swallowing problems and vomiting of blood also occur. Because the inflammation can be painful, these children often eat poorly. This can cause growth retardation or weight loss. Complicated reflux must be treated with medication.
Atypical reflux
In addition to the normal reflux complaints, these children also have completely different complaints. This is because atypical reflux causes stomach contents to enter the airways. Complaints that may arise as a result are: breathing problems, bronchitis, asthma, laryngitis and apnea. Apnea is the sudden temporary loss of breathing. This form of reflux is not common.
How is the diagnosis made?
The doctor can often make the diagnosis by asking questions and by physically examining your child. If in doubt, or if your child does not respond to a certain treatment, the following tests can be performed:
24-hour pH measurement
The doctor inserts a thin tube into the esophagus through the nose. A measuring instrument is attached to the end of this tube. This measures the acidity (pH) in the esophagus, just above the sphincter and the transition to the stomach. This instrument measures for 24 hours how often and for how long it is too acidic in the esophagus.
X-ray examination (swallow photo)
During this examination, contrast fluid is introduced into the esophagus or drunk. This contrast agent ensures that the esophagus is visible on an X-ray. Abnormalities of the esophagus (and stomach) can be demonstrated in this way.
A visual examination of the esophagus (esophagoscopy)
During this examination, the doctor inserts a thin tube through the mouth into the esophagus. This thin, flexible tube is also called an endoscope. The endoscope has a small camera and a light so that the doctor can get a good look at the inside of the esophagus. If necessary, the doctor can also look into the stomach with the endoscope. The examination is therefore also called a gastroscopy.
The above examinations are quite stressful for a baby. Doctors will therefore only perform these tests if there is doubt about the diagnosis. The diagnosis can usually be made on the basis of the pattern of complaints. In that case there is no point in conducting further research. Certainly not if research is also taxing.
Therapy
The treatment depends on the severity of the complaints. This treatment can be divided into different phases. The doctor will start with phase one, and move on to subsequent phases if necessary.
1. Initially the doctor will give you general advice and try to reassure you. Reflux in babies is a common phenomenon. In the vast majority of cases it is not serious and the complaints disappear on their own. If the symptoms do not improve, or if your child clearly suffers from reflux, it is wise to go back to the doctor.
The general advice for reflux is:
- Keep your baby upright for the first half hour after feeding
- Try to give smaller feedings, more often per day
- When bottle feeding, thickening the food can help. You can do this by using, for example, locust bean gum.
3. Treatment with medications that accelerate the transport of food through the esophagus and stomach. These medications are also called prokinetics. The most commonly prescribed drug is domperidone. By using prokinetics, food enters the small intestine more quickly and cannot flow back into the esophagus.
4. Treatment with medications that make the stomach acid less acidic. These medications are also called antacids. Antacids do not treat the reflux itself. Antacids only ensure that stomach acid is less acidic. The stomach contents can therefore still rise into the esophagus. Because the stomach contents are less acidic, the esophageal wall will not be damaged. Antacids are mainly prescribed to treat or prevent esophageal damage. There are different types of antacids. The doctor will prescribe this depending on the severity of the complaints.
If the above treatments do not help (sufficiently), you can discuss the following with your pediatrician:
- Your child’s position in bed. There is a lot of discussion about the correct position for a baby in bed. It may help to raise the head of the crib so that your baby lies slightly at an angle. The most effective position against reflux appears to be the prone position. However, it is also known that prone position is a risk factor for cot death. It is therefore wise to discuss this carefully with your pediatrician. This advice must be reviewed for each child.
- In very serious cases, surgery can be performed. There are various anti-reflux operations that can reduce the symptoms. These operations are only done in exceptional cases. A pediatric surgeon can tell you about the options.