Reflux in the baby
definition
Reflux is made up of the terms re (Latin again / back) and flux (from Latin fluere = to flow) and describes a reflux of parts of the stomach contents into the esophagus. The esophagus and stomach are separated from each other by a sphincter. This is permeable for food and beverages, which are transported from the mouth via the esophagus to the stomach. In the other direction, the muscle is blocked and prevents stomach contents or stomach acid from getting back into the esophagus.
Almost all babies have occasional reflux. However, it is only referred to as a disease when the child suffers from the consequences.
causes
Reflux is a relatively normal occurrence, especially in newborns and especially in premature children. With the obligatory pork belly after a meal, mostly air is burnt, but there can also be a little stomach content. Between the esophagus and stomach there is a sphincter muscle that is supposed to prevent the stomach contents from flowing back into the esophagus.
This muscle cannot always be controlled in a fully controlled manner, especially in the first few weeks and months. Sometimes it relaxes momentarily after a meal or it doesn't close completely. This allows stomach contents to flow back. In addition, in very young babies, the angle at which the esophagus enters the stomach is very small. This also promotes reflux. This usually grows out within the first few months.
The baby's drinking behavior can also influence reflux: if the child drinks very quickly and hastily, too large amounts are often swallowed, which then work their way up again. Pathological causes can be faulty wiring or damage to the nerves. Causes in the area of the lungs are also conceivable, as they change the pressure conditions in the baby's chest and thus possibly promote reflux.
Read about this too Pyloric stenosis in the baby
diagnosis
The suspected diagnosis of reflux in babies is initially made based on symptoms. The first examination that follows such a suspected diagnosis is the ultrasound. Any anatomical anomalies present can be identified. A 24-hour PH-Metry is also often used, in which the acidity in the esophagus is measured over 24 hours. If reflux occurs, acidic chyme flows into the esophagus. This process can be measured with the examination. A 24-hour impedance measurement can also be used to measure the speed and pressure of the reflux.
How can I tell if my child has reflux?
Children with reflux often experience chest pain immediately after meals. Usually they express this by crying and screaming. The symptoms worsen especially when lying down. Most of the time, the children vomit regularly after meals or have to cough more often because parts of the stomach contents that have run back get into the windpipe.
Read more on this topic: Vomiting in the baby
Depending on the severity of the reflux, the children refuse to eat because it causes them pain. Alternatively, they drink particularly greedily because they are very hungry. Hiccups are also not uncommon in children with reflux. Since the symptoms occur particularly when lying down, the children often have problems sleeping. You sleep little during the day but are very tired. They also find it difficult to fall asleep and stay asleep at night.
Children with parts of the food getting into the windpipe get hoarseness as well as coughing. The acidic gastric juice can attack the unprotected vocal cords and lead to small inflammations there. This makes the children hoarse and they can also get a sore throat.
In the worst case, stomach acid also ends up in the lungs and causes pneumonia there.
You can also read our topics here: Pneumonia in babies or pneumonia in children
What can be signs of this?
The signs of reflux disease are many: coughing, vomiting, hiccups, crying, and screaming are common after meals. The disease becomes worrying if milk is vomited more than five times a day, if the baby refuses to eat and / or does not gain weight.
Difficulty swallowing and frequent coughing as well as recurring infections in the lungs should also be clarified. If there is blood in the vomit, it indicates that the esophagus has already sustained more serious damage. In this case, a doctor should be consulted.
Pain after meals
In the case of reflux, chyme flows from the stomach back into the esophagus, especially immediately after meals. The food ingested is mixed with the stomach acid in the stomach. This is primarily intended for digestion, and it should also kill potential pathogens. If the acidic chyme gets back into the esophagus through reflux, minor injuries can occur there. The esophagus is not adequately protected against the strong acid. These small injuries can become infected and bleed. When the baby eats food again, these infected and open areas in the esophagus can cause pain.
Bad breath
The bad breath often felt in babies with reflux is caused by stomach acid. In the stomach, the absorbed milk is mixed with the stomach acid and digested. If this mixture comes back up the esophagus due to reflux, you can smell the sour component of the chyme. The chyme may also be vomited. In that case, the vomit also smells sour.
Concomitant symptoms
Symptoms associated with reflux are initially pain, nausea and vomiting. These symptoms result directly from the gastric contents that have flown back and make their way up the esophagus. On its way, the chyme mixed with gastric acid attacks the mucous membrane of the esophagus and damages it. This can lead to infections and bleeding. Often the half-digested mixture does not just end up in the mouth, from where it is vomited. Part of it often ends up in the windpipe, causing lesions similar to those in the esophagus. This is reflected in the increased number of infections of the respiratory tract (such as bronchitis in babies). A tendency to pneumonia is also not uncommon.
If the sour chyme also lies on the vocal cords, it can cause hoarseness and painful inflammation there. Due to the often painful experience of eating, babies often refuse it after a while. This makes them gain weight more slowly or not at all. Another accompanying symptom is the noticeable tiredness of the infants. Reflux leads to complaints, especially when lying down, which is why the children often sleep very poorly and little.
Shortness of breath
Difficulty breathing can be an expression of an infection in the lungs and airways. This occurs in connection with reflux, when acidic stomach contents rise through the esophagus into the larynx and there also enter the trachea. The trachea and the smaller, branching airways are not adequately protected against gastric acid and can therefore easily suffer minor injuries that can become inflamed.
If chyme settles in the lung tissue, it can also lead to an infection there and thus trigger dangerous pneumonia.
Sleep disorder
The sleep disorder in babies suffering from reflux arises from the anatomical structure of the esophagus and stomach. In an upright position, food finds its natural way into the stomach following gravity and remains there. If the baby is put down to sleep, the food can flow back. This is usually prevented by a sphincter between the esophagus and the stomach. However, this is not yet fully functional in many infants. Therefore, reflux occurs much more frequently when lying down, and the children feel pain.
If the children are fed immediately before they go to sleep, there is a lot of food in the stomach, which makes the problem more pronounced.
Treatment and therapy
If no alarm signs (such as blood in the vomit, failure to thrive, frequent pneumonia or respiratory infections, etc.) can be detected in the babies, conservative treatment for reflux is usually appropriate. This consists of training the parents in the following behavior: The food should be thickened so that it flows less easily back into the esophagus. Avoid placing the baby on the prone. Feeding late or at night is also unfavorable.
While sleeping, the baby's upper body should be slightly elevated so that gravity keeps the stomach contents in the stomach as much as possible.
It is also known that passive smoking increases reflux, so smoking in the vicinity of the child should be avoided. The reflux can also be treated with medication. Proton pump inhibitors and drugs that work against the H2 receptor in the stomach reduce acid production, which means that the gastric contents flowing back are less likely to attack the esophagus.
In exceptional cases, an operation may be necessary. However, this only applies if there are anatomical anomalies that will not go away on their own and can cause permanent problems.
Which drugs are used?
The most commonly used drugs for reflux are proton pump inhibitors (PPIs for short for proton pump inhibitors). The proton pumps in the stomach ensure that the stomach acid becomes particularly acidic. If drugs are used against these pumps, stomach acid is still produced, but it is less acidic and therefore less damaging to the esophagus. Among the PPIs, omeprazole is the most commonly used drug for children.
H2 receptor antagonists (drugs that inhibit the H2 receptor) also counteract acid production. Nocturnal acid production in particular is inhibited. During the day, they are less effective than PPIs. The drug group of prokinetics (pro = for, kinetics = movement) is based on a different mode of action. These drugs are mainly used for nausea and vomiting. They strengthen the stomach's own movement, which it needs for digestion. This allows the food to be digested better so that it leaves the stomach for the intestines more quickly. In order for the drugs to work properly, they must be given in acid-proof form. Therefore, the tablets must not be crushed or otherwise crushed.
Can Osteopathy Help?
Osteopathy is a manual form of therapy. It is based on the fact that a therapeutic effect is created with the hands through touch and pressure at different points. Osteopathy is primarily designed to activate the body's self-healing powers.
In the case of reflux symptoms, the base of the baby's skull is particularly in focus. This is where many cranial nerves emerge that control swallowing and sucking in babies. During the treatment, particular attention is paid to relieving tension and improving the mobility of the bones, so that possible irritation of the nerves is eliminated. Another starting point is the diaphragm (the large respiratory muscle). The esophagus passes through a hole in the diaphragm just before it opens into the stomach. Therefore, tension in the diaphragm can also trigger increased swallowing difficulties and reflux. This respiratory muscle should be relaxed through practiced hand movements and thereby cause less reflux.
The specific mode of action of the osteopathic therapy is still not scientifically explained. Studies, however, confirm a positive influence of osteopathy on children with reflux symptoms.
homeopathy
With the help of homeopathically effective globules, reflux symptoms can be alleviated in babies. Depending on the child's behavior, different preparations are suitable for this: Silicea is often used when the child has severe swallowing problems and vomits immediately after drinking. If the baby has stomach pains in particular, which can be accompanied by nausea and vomiting, the use of Magnesium phosphoricum is recommended.
Aethusa cynapium is recommended for gushing vomiting. If the vomiting is also accompanied by hypersensitivity in the baby, Nux vomica is the drug of choice. Cuprum metallicum is best when the infant drinks particularly quickly.
How long does the reflux last?
Mild reflux is not entirely normal in babies in the first few months of life, but it is not a cause for great concern at first. The problem usually subsides after a few weeks to months, as certain anatomical structures mature and the interaction of the various nerves and organs becomes more coordinated. The main cause for concern is when additional symptoms such as difficulty breathing, vomiting blood, and failure to thrive appear.
If the symptoms do not improve after about half a year, a doctor should be consulted again. It is different with children who have an anatomical anomaly. This may have to be treated surgically. After that, however, it is often possible for the symptoms to go away. In the first months of life, the symptoms can usually be adjusted conservatively, in more severe cases also with medication, so that the babies can develop undisturbed.
What is the influence of breastfeeding and baby food?
Breastfeeding and baby formula both have an impact on the baby's reflux. In general, it can be said that neither one nor the other variant can completely avoid the symptoms. Children who eat baby formula tend to suffer from reflux more often. The baby food is probably a little less well tolerated than natural breast milk. In addition, the bottle is usually used to feed in somewhat larger quantities. As a result, the food stays longer in the stomach and thus increases the symptoms of reflux.
Conversely, a strong milk ejection reflex on the part of the mother can lead to the children drinking particularly quickly. As a result, they accidentally swallow a lot of air and have to burp it again after the meal. Belching, in turn, promotes reflux, since the sphincter between the esophagus and stomach has to be opened.
Does the mother's diet while breastfeeding affect reflux in babies?
The mother's diet during breastfeeding then has an impact on reflux in the baby if the baby has a food intolerance. Everything that the mother ingests can also get into the breast milk and thus be fed to the baby. For example, infants often suffer from cow's milk intolerance. If the mother drinks a particularly large amount of cow's milk while breastfeeding, the babies will also get a lot of it and may react to it with an irritated stomach. Similar relationships can also be found with other intolerances.
Alcohol consumption and smoking by the mother also have a negative effect on reflux symptoms. The child absorbs the ingredients through breast milk and is therefore more likely to suffer from reflux.
