Acid Reflux & GERD

Reflux, Spitting Up, & GERD (Gastroesophageal Reflux Disease)

It’s pretty likely your baby spits up; about half of babies do. And it can be frustrating, wondering whether your baby is crying because of spitting up, or from something else entirely.

Particularly for a baby who cries much of the time, it can be hard to tell if he is experiencing pain related to feeding. After all, he cries when he’s feeding, but he also cries when he’s not feeding.

What Is Spitting Up?

All babies are born with immature digestive systems, and some spitting up (and even sometimes a lot of spitting up) is normal. There is a ring of muscles near the bottom of the esophagus that acts as the ‘gatekeeper’ between the stomach and upper esophagus. This ring of muscles is called the lower esophageal sphincter, or LES.

In adults and children, the LES allows food to pass into the stomach, and then makes sure the food stays there. In babies, however, the LES is not yet fully developed, and may allow some of the stomach contents to come back up the esophagus.

In most infants, this process is relatively harmless and is just a normal part of being a baby. In many cases, babies may not even notice that this is happening. It does not appear to be painful for babies (we’ve all seen babies who spit up without missing a beat in their peek-a-boo game). These babies are sometimes called happy spitters.

Babies generally begin spitting up shortly after birth, and may continue to spit up until around their first birthday or even later. It usually is significantly better by 6-8 months.

What Is Reflux?

Generally speaking, reflux is just another name for spitting up. It can however, be used to refer to a more serious condition called Gastroesophageal Reflux Disease, or GERD.

Gastroesophageal Reflux Disease in Babies (GERD)

Since you came to this site, chances are you do not have a ‘happy spitter’. Your baby may spit up after nearly every meal, appear to be in pain during and after feedings, may have difficulty feeding, or frequently even refuse to eat.

In this case, your doctor may start to investigate the possibility of GERD.

Symptoms of GERD in Infants

As with many conditions, your baby may exhibit many of these symptoms, or only a couple. Please be sure to consult with your physician if you are concerned.

GERD is frequently evidenced in both the respiratory and gastrointestinal systems.

Respiratory Symptoms of GERD

If your baby is suffering from silent reflux (where stomach contents are regurgitated but then re-swallowed), the respiratory symptoms may be the only indication you have of GERD:

• Frequent cough
• Wheezing
• Recurrent croup
• Asthma
• Sinusitis

Gastrointestinal Symptoms of GERD

• Frequent vomiting or spitting up
• Difficulty feeding, or refusal to eat
• Failure to gain weight (and possible diagnosis of failure to thrive; FTT)
• Gagging or choking

Other Symptoms of GERD

• Disturbed sleep
• Frequent crying or fussiness
• Seizure-like movements of the head or neck, known as Sandifer’s Syndrome (rare)

How Do You Know if Your Baby has GERD?

If your baby’s spitting up appears to be severe, and your doctor strongly suspects GERD, he or she may order a series of tests to confirm the diagnosis, including:

• Barium Swallow, or Upper GI Series – An X-ray that will show if there are any obstructions or narrowing of your baby’s esophagus, stomach, or upper intestine.
• Upper GI Endoscopy – A thin tube that allows your doctor to see the esophagus, stomach and upper intestine.
• pH Probe – A long, thin tube is swallowed, the tip of which is positioned just above the stomach. This probe will help indicate if stomach acid is coming back up the esophagus.

Your Baby’s Fussiness May Be Due to GERD….But More Likely Isn’t

A study was done in 2007 that followed 44 infants who had been diagnosed with persistent regurgitation; 42 of these were being treated with anti-reflux medications. The infants underwent esophageal PH testing to determine if they really did have GERD (most physicians will not actually test for GERD in infants, but will simply prescribe an anti-reflux medication like Ranitidine, more commonly referred to as Zantac).

Of the 44 infants tested, only 8 met the criteria for GERD. That means that 36 infants were being unnecessarily treated with anti-reflux medication. For the babies who did not have GERD, the anti-reflux medication was stopped. The vast majority improved or did not experience a worsening of their symptoms.