Gastroesophageal Reflux Disease (GERD) in Infants: Understanding and Managing the Condition
What is GERD (Gastroesophageal Reflux Disease) in infants?
Gastroesophageal Reflux Disease (GERD), commonly experienced as acid reflux, is a condition that can cause discomfort in infants from their earliest days. According to the American Family Physician Journal, gastroesophageal reflux is defined as “the passage of stomach contents into the esophagus with or without accompanied regurgitation (spitting up) and vomiting” and is a normal physiologic process in infants. It's interesting to note that regurgitation typically peaks at 4 months of age, affecting up to 40% of infants. However, this usually decreases significantly by 12 months.
Identifying GERD in Infants
It's crucial for parents to differentiate between normal reflux and GERD, a more severe form of the condition. Symptoms of GERD in infants include:
Poor weight gain
Persistent vomiting
Feeding refusal or prolonged feeding times
Fevers
Arching of the back
Painful swallowing
Distress during feeding
These symptoms necessitate a clinical evaluation for an accurate diagnosis. GERD is most commonly observed in infants aged 4-6 months.
What Causes GERD in Infants?
Gastroesophageal Reflux Disease (GERD) in infants is primarily caused by the immaturity of the gastrointestinal system, specifically the lower esophageal sphincter (LES). The LES is a muscle at the junction between the esophagus and the stomach, and it acts as a barrier to prevent stomach contents from flowing back into the esophagus. In infants, this muscle is often underdeveloped, leading to more frequent episodes of reflux. Here are some key factors contributing to GERD in infants:
Underdeveloped Lower Esophageal Sphincter (LES): The primary reason for GERD in infants is the immature LES, which may not close properly, allowing stomach contents to flow back into the esophagus.
Lying Position: Infants spend most of their time lying down, which can make it easier for stomach contents to reflux into the esophagus, especially after feeding.
Diet and Feeding Habits: Overfeeding, feeding too quickly, or consuming certain types of formula or breast milk (if the breastfeeding mother eats specific foods) can contribute to reflux symptoms.
Gastrointestinal Motility Disorders: Some infants may have conditions that affect the movement of food through the gastrointestinal tract, thereby exacerbating reflux.
Neurological or Developmental Disorders: Infants with certain neurological or developmental disorders may have a higher incidence of GERD due to factors affecting muscle tone and gastrointestinal functioning.
Genetic Factors: There can be a genetic predisposition to GERD, making some infants more likely to develop the condition than others.
Food Allergies or Intolerances: Sensitivities to certain components in breast milk or formula can cause or worsen reflux symptoms.
Hiatal Hernia: Although less common in infants, a hiatal hernia (where part of the stomach pushes up into the chest cavity) can contribute to the severity of reflux.
How is GERD Different from Regular Infant Reflux?
Understanding the distinction between Gastroesophageal Reflux Disease (GERD) and regular infant reflux is essential for parents to identify when to seek medical advice. While infant reflux is a common condition, GERD is a more severe form of reflux that requires attention. Here are the key differences:
Frequency and Severity of Symptoms: Regular infant reflux involves the occasional spitting up of milk or formula after feeding, which is generally not painful or distressing to the baby. GERD, on the other hand, is characterized by more frequent and severe symptoms. These can include persistent vomiting, irritability during or after feeds, and signs of discomfort or pain.
Impact on Health and Development: Infants with GERD may experience poor weight gain due to difficulties in feeding or excessive vomiting. In contrast, babies with normal reflux typically continue to gain weight and develop normally despite the occasional spit-up.
Level of Discomfort: GERD often leads to noticeable discomfort in infants. This could manifest as crying during or after feeds, arching the back as if in pain, and apparent distress during swallowing. Regular reflux, while it may cause some fussiness, usually does not cause significant or consistent pain.
Response to Feeding Changes: Regular reflux might improve with minor adjustments in feeding techniques, like burping the baby more often or keeping them upright after feeds. GERD symptoms might not respond as readily to these simple measures and may require more specialized treatment or dietary changes.
Association with Other Symptoms: GERD can be associated with additional symptoms such as coughing, choking, or wheezing, indicating that the reflux is causing irritation beyond the esophagus. Regular infant reflux typically doesn’t cause such respiratory symptoms.
Need for Medical Intervention: While regular infant reflux is mostly managed with home care and often resolves as the baby grows, GERD may require medical intervention. This can include medication to reduce stomach acidity, changes in feeding practices, or even specialized formulas.
When Should Parents Seek a Specialist’s Opinion for GERD?
Recognizing when to seek a specialist's opinion for Gastroesophageal Reflux Disease (GERD) in infants is critical for ensuring timely and effective treatment.
Persistent and Severe Symptoms: If symptoms of reflux such as vomiting, fussiness during feeds, or refusal to eat persist despite trying home remedies or general pediatric advice, it may indicate GERD that requires specialized care.
Poor Weight Gain or Weight Loss: If the infant is not gaining weight appropriately or losing weight, this could be a sign of severe GERD impacting the child’s nutritional intake.
Respiratory Problems: Occurrence of respiratory issues like chronic coughing, wheezing, or breathing difficulties associated with feeding times could suggest that the reflux is affecting the baby's respiratory system.
Feeding Difficulties: Persistent refusal to eat, prolonged feeding times, or significant distress during and after feeding are signs that the reflux is more than just a mild issue.
Evidence of Pain or Discomfort: If the baby shows signs of pain, such as excessive crying, arching the back, or apparent discomfort during or after feeds, it could indicate that the reflux is causing significant irritation or pain.
Blood in Vomit or Stool: The presence of blood in vomit or stool is a serious symptom that requires immediate medical attention, as it could indicate complications from GERD.
No Improvement with Initial Treatments: If the symptoms of GERD do not improve with initial treatments suggested by a regular pediatrician, such as dietary changes or positioning strategies, further evaluation by a specialist is necessary.
Other Underlying Health Conditions: Infants with other health issues, especially neurological or developmental disorders, might require a specialist’s care in managing GERD, as their condition could complicate standard treatment approaches.
Treatment Approaches for Infant GERD
Treatment typically starts with conservative measures, such as smaller, more frequent feeds to decrease reflux episodes. Alterations in breastfeeding mothers' diets or changes in formula can also help mitigate symptoms.
The Role of Physical and Occupational Therapy in Managing GERD
Occupational and physical therapists can play a pivotal role in managing GERD in infants. Their expertise is particularly valuable in strategizing positioning to minimize discomfort. Infants with GERD may show intolerance to positions like prone (tummy time), sidelying, or supported sitting. Since GERD often coincides with muscular torticollis and is prevalent in the crucial developmental phase of 4-6 months, it can potentially delay milestones like rolling, playing with toys, or sitting unassisted. For instance, sitting positions may increase intra-abdominal pressure, causing discomfort and leading to back arching.
Therapists can suggest alternative positions and modifications to enhance comfort and support developmental progress. Research indicates that prone or modified prone positions can lessen GERD symptoms. Similarly, a left side lying position is beneficial. However, it is essential to always place babies on their backs for sleeping to reduce the risk of Sudden Infant Death Syndrome (SIDS), as recommended by the American Academy of Pediatrics.
Seeking Professional Help
If your infant is showing signs of GERD or you’re seeking guidance on managing their symptoms, reach out to healthcare professionals like Tiny Transformations for an evaluation and skilled recommendations. Early intervention can significantly improve your infant’s quality of life and support their developmental journey.
Sources:
Baird, D. C., Harker, D. J., & Karmes, A. S. (2015). Diagnosis and treatment of gastroesophageal reflux in infants and children. American Family Physician. Link
Bercik, Deborah PT; Diemer, Susan PT, PCS; Westrick, Stephanie PT, DPT; Worley, Sarah MS; Suder, Ryan OTR/L, BCP, PhD. Relationship Between Torticollis and Gastroesophageal Reflux Disorder in Infants. Pediatric Physical Therapy 31(2):142-147, April 2019. DOI: 10.1097/PEP.0000000000000592
Eric C. Eichenwald, et al. Diagnosis and Management of Gastroesophageal Reflux in Preterm Infants. Pediatrics July 2018; 142 (1): e20181061. 10.1542/peds.2018-1061
van Wijk MP, et al. Effect of body position changes on postprandial gastroesophageal reflux and gastric emptying in the healthy premature neonate. J Pediatr. December 2007;151(6):585-90, 590.e1-2. doi: 10.1016/j.jpeds.2007.06.015. PMID: 18035135.