Gastro-oesophageal Reflux

What is reflux?

Reflux is an extremely common condition affecting babies, it will probably affect 40% of babies under the age of 6 months. It is due to the muscles at the bottom of the oesophagus (gullet) being too relaxed and allowing passage of the stomach contents into the mouth and being sometimes vomited or posseted. This regurgitation is usually effortless, and harmless in the majority of babies. However, if it is associated with other symptoms such as pain, difficulty in putting on weight or distressed behaviour then it is termed gastro-oesophageal reflux disease (GORD) and may need treatment.

Who gets GORD?

Any baby can get GORD but it is more common in certain groups of children:

  • Premature babies
  • Babies with a neurological disability (such as cerebral palsy)
  • Babies with low birth weight
  • Babies with cow’s milk protein allergy

Both bottle and breast fed babies can get GORD.

When should I seek help?

Effortless regurgitation is usually harmless and doesn’t need any treatment.

Gastro-oesophageal reflux is suspected when there is a history of regurgitation with any of the following symptoms:

  • Distressed behaviour
  • Hoarseness or chronic cough
  • Unexplained feeding difficulties
  • Issues with growth
  • Pneumonia

You should speak to your GP or health visitor if you are concerned with your child and they have these symptoms.

Sometimes reflux/posseting may represent a more serious disease. This is rare but if your child has symptoms of reflux but also any of the following we advised you to seek immediate help from your GP, A+E or 111:

  • Frequent forceful vomiting
  • Bile stained vomit
  • Vomiting blood
  • Blood in stool
  • Abdominal Distention
  • Fever/ill child
  • Reduced conscious level
  • Lethargy/irritability

Who can I get help from?

The key health professionals trained to help children GORD are:

  • Health visitors
  • Family doctors (GPs)
  • Paediatricians

How is GORD diagnosed?

Usually this is done based on the history and examination of your baby. It is rare any further tests are needed.

However if the symptoms are severe and not responding to normal treatment then your  baby may have further tests including measuring of the acid in their stomach (pH monitoring),  endoscopy (a camera test) or a barium swallow (x-ray). These would be organised after seeing a paediatrician.

How is GORD treated?

Regurgitation of small amount of feeds without distress (posseting) is harmless and does not need treatment. Some children with mild symptoms of GORD who are growing normally may not need any treatment, just closer monitoring of their weight and symptoms by their GP or health visitor.

Sometimes raising the end of the bed at home can help symptoms, but your baby must be left on their back to sleep.

In breast fed babies, seeking advice from your health visitor or breastfeeding practitioner on breastfeeding and positioning can be helpful.

In bottle fed babies, it can be helpful to review the amount of milk that is being taken. It could be that your baby is having too much milk for their weight and age (overfeeding).  Sometimes having more frequent but smaller feeds can help with symptoms of GORD. We suggest you do this with the help of your health visitor or GP.

If these simple steps don’t help then we suggest talking to your GP who may suggest other treatments.

  • Thickening feeds. This can be done by either buying pre-thickened feed such as SMA Staydown® or Enfamil AR®, or using thickening agents such as Carobel®. We usually advise to try this for 3 weeks to see if it has any benefit.
  • If this doesn’t help your doctor may then prescribe Gaviscon® (alginate). This works by lining the stomach as well as thickening the feed, and shouldn’t be used with other thickening agents.
  • Both Gaviscon® and thickeners can cause constipation as a side effect and if this occurs whilst your child is on these medications, you would need to discuss it with your health visitor or GP.
  • If Gaviscon® doesn’t help, then there are medications that can be prescribed to help reduce the amount of acid that is being produced by the stomach. Usually ranitidine (H2 antagonist) or omeprazole (proton pump inhibitor) will be prescribed to help your child’s symptoms.

If despite these medications your child is still having significant symptoms then your GP will refer you on to see the paediatrician for further treatment.

How will I know my child is better?

The treatment above should reduce the symptoms of GORD that your child gets. They will be monitored by the GP, health visitor or paediatrician on a regular basis to review their symptoms and growth.

Most babies will grow out of GORD by the age of 6-12 months, usually when they start sitting upright.

Once a treatment is found that helps your child’s symptoms it is advised to review treatment every few months to consider a trial to stop the medication to see if the symptoms have subsided.