Infant reflux

Diagnosis

Your baby's health care provider will start with a physical exam and ask you questions about your baby's symptoms. If your baby is healthy, growing as expected and seems content, then testing usually isn't needed. In some cases, however, your health care provider might recommend:

• Ultrasound. This imaging test can detect pyloric stenosis.
• Lab tests. Blood and urine tests can help identify or rule out possible causes of recurring vomiting and poor weight gain.
• Esophageal pH monitoring. To measure the acidity in your baby's esophagus, the doctor will insert a thin tube through the baby's nose or mouth and into the esophagus. The tube is attached to a device that monitors acidity. Your baby might need to stay in the hospital while being monitored.
• X-rays. These images can detect problems in the digestive tract, such as a blockage. Your baby may be given a contrast liquid from a bottle before the test. This liquid is usually barium.
• Upper endoscopy. The doctor passes a special tube that has a camera lens and a light through your baby's mouth into the esophagus, stomach and the upper part of the small intestine. This tube is called an endoscope. Tissue samples may be taken for analysis. For infants and children, endoscopy usually is done under general anesthesia. General anesthesia is a combination of medicines that causes a sleep-like state before surgery or other medical procedure.

Treatment

For most babies, making some changes to feeding will ease infant reflux until it resolves on its own.

Medications

Reflux medications aren't typically used to treat uncomplicated reflux in children. But your child’s health care provider may recommend an acid-blocking medication for several weeks or months. Acid-blocking medications include cimetidine (Tagamet HB), famotidine (Pepcid AC) and omeprazole magnesium (Prilosec). Your child's provider may recommend an acid-blocking medication if your baby:

• Has poor weight gain, and changes in feeding haven't worked
• Refuses to feed
• Has an inflamed esophagus
• Has chronic asthma

Surgery

In rare cases, your baby may need surgery. This is only done if your baby is not gaining enough weight or has trouble breathing because of reflux. During the surgery, the LES between the esophagus and the stomach is tightened. This prevents acid from flowing back up into the esophagus.

Lifestyle and home remedies

To minimize reflux:

• Feed your baby in an upright position. Then, hold your baby in a sitting position for 30 minutes after feeding. Gravity can help stomach contents stay where they belong. Be careful not to jostle or jiggle your baby while the food is settling.
• Try smaller, more frequent feedings. Feed your baby a little bit less than usual if you're bottle-feeding, or cut back a little on nursing time.
• Take time to burp your baby. Frequent burps during and after feeding can keep air from building up in your baby's stomach.
• Put baby to sleep on the back. Most babies should be placed on their backs to sleep, even if they have reflux.

Keep in mind that infant reflux is usually little cause for concern. Just keep plenty of burp cloths handy as you wait for your baby's reflux to stop.

Preparing for your appointment

You may start by seeing your primary care provider. Or you may be referred immediately to a specialist in children's digestive diseases, called a pediatric gastroenterologist.

What you can do

When you make the appointment, ask if there's anything you need to do in advance. Make a list of:

• Your baby's symptoms, including any that seem unrelated to the reason for your baby's appointment.
• Key personal information, including major stresses, recent life changes and family medical history
• All medications, vitamins or other supplements your baby takes, including the doses
• Questions to ask your baby's doctor.
• Caregivers and how they feed your baby

Take a family member or friend along, if possible, to help you remember the information you're given.

For infant reflux, some basic questions to ask your doctor include:

• What's likely causing my baby's symptoms?
• Other than the most likely cause, what are other possible causes for my baby's symptoms?
• What tests does my baby need?
• Is my baby's condition likely temporary or chronic?
• What's the best course of action?
• What are the alternatives to the primary approach you're suggesting?
• My baby has other health conditions. How can I best manage them together?
• Are there restrictions I need to follow for my baby?
• Should I take my baby to a specialist?
• Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

• When did your baby's symptoms begin?
• Have your baby's symptoms been continuous or occasional?
• How severe are your baby's symptoms?
• What, if anything, seems to improve your baby's condition?
• What, if anything, seems to worsen your baby's condition?

What you can do in the meantime

Avoid doing anything that seems to worsen your baby's symptoms.