Let's talk about Reflux

Have you ever wondered if your baby has reflux?

What is a "normal" amount for a baby to "spit up"?

Have you been told to start solids early to help with reflux?

Does it always need to be treated?

If you have ever wondered any of the above, then you have come to the right place. We are going to dive in and discuss all things reflux today!

What is reflux?

Gastro-oesophageal reflux (reflux for short) is when milk (and food once bub is on solids) comes back up from the stomach into the food pipe (oesophagus) and sometimes the mouth. It isn't something you need to worry about most of the time and is actually very common for babies. This is because the muscle at the top of their stomach isn't strong enough to keep the tummy contents in and prevent milk from coming back up. As babies grown, are upright for longer and their tummy muscles get stronger, reflux tends to resolve on its own.

Reflux:

• is common and affects at least 40% of infants
• usually begins before 8 weeks of age, peaks at 4 months and resolves by 1 year of age for most children 
• Reflux can happen multiple times a day 

So in short- most babies will bring up milk, and even if it looks like a large amount, it is USUALLY nothing to be concerned about. Your standard reflux doesn't cause issues with weight gain or create pain and discomfort. 

When is it something to be concerned about?

Some babies have what is call gastro-oesophageal reflux disease (GORD), which is a little different. The vomiting is also accompanied by things like:

• choking, coughing or wheezing during feeds
• blood in their vomit
• distress during feeds or even refusal to feed
• vomiting can be very forceful 
• poor weight gain or weight loss
• have pain and discomfort in their chest or stomach, which will make them irritable, cry a lot or arch their back
• have disrupted sleep or be hard to settle

If you see signs of any of the above you should speak to your GP or paediatrician to get an assessment. It can also be useful to take a photo of the reflux or video of your baby vomiting if you can- so they can get a good idea of the volume, how your bub is behaving/presenting and how often it is happening.

If your child has blood in their vomit or it is green then you need to seek immediate medical support and should present to ED.

Should you start solids "early" to help with reflux?

There is currently very little evidence to support the advice that you should start solids early to help with reflux. It is important to follow the Australian recommendations around starting solids, and the current Australian Infant Feeding Guidelines state that:

It is recommended to introduce solids at around six months of age and not before four months.

Starting solids before your baby is meeting the signs of readiness can actually make reflux worse and even be unsafe.

The link between CMPA (cow's milk protein allergy) and GORD.

The symptoms of both CMPA and GORD overlap, and because there isn't a quick and easy way to diagnose either one, CMPA can often be mistaken as GORD. Some research also suggests 15-21% of babies with CMPA have GORD as well, meaning babies have both conditions. So if they have both, but only one is treated, symptoms might only partially resolve or not at all.

CMPA usually comes with some other symptoms including:

• diarrhoea
• mucous and or blood in stool
• constipation
• eczema

They often have the above, in addition to the symptoms that overlap with GORD which include being very unsettled, trouble feeding, can be issues with weight gain, vomiting/reflux and abdominal discomfort.

Does reflux need to me medically managed with medication?

No it doesn't.

Like with most medications, there are potential risks, as well as potential benefits. We also know that medication used to treat standard reflux doesn't often improve symptoms (so, if there are some risks but often limited benefits it shouldn't be prescribed lightly, so this makes sense!). As we said earlier, if bub is happy, feeding and growing well then there is usually no need to treat the reflux.

If however, it is presenting as GORD then your doctor may prescribe medication to help with this. Usually it is used short term and you have a review 2-4 weeks later to assess what is going on and your GP or paediatrician will closely monitor and support you.  It is important to discuss the risk and benefit of medication with your doctor so you feel confident and understand the treatment being offered.

Other ways we can help with reflux?

As a starting point, we often suggest:

• Keeping bub upright for about 20 minutes after a feed
• If you are bottle feeding- then paced feeding and feeding responsively so we don't over fill their tummies

There are definitely other things that can be done too, but it requires a 1:1 assessment and plan.

So where to from here?

If you are worried about your bubs reflux and feel like it is MORE than your usual reflux, you should always see your GP. It is then useful to see a paediatric dietitian to look at CMPA and if this too might be impacting your little one (don't start cutting out foods without support!). A dietitian can also guide you on when to start solids, paced feeding, spreading feeds out and the use of feed thickeners too. Especially if there are concerns about weight gain and feeding- a paediatric dietitian is essential to have on your Bub's team. 

References and Resources:

https://www.rch.org.au/kidsinfo/fact_sheets/Reflux_GOR_and_GORD/

https://raisingchildren.net.au/guides/a-z-health-reference/reflux

https://www.childrens.health.qld.gov.au/health-a-to-z/reflux

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7909757/

https://allergy.org.au/patients/food-allergy/cows-milk-dairy-allergy/

https://www.betterhealth.vic.gov.au/conditions-and-treatments/infant-reflux#

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