The return of stomach contents to the esophagus is called gastroesophageal reflux.
There Are Two Subtypes of Infancy Reflux
- Physiological reflux
In healthy babies, the stomach contents return to the esophagus. This condition is called ‘physiological reflux’.
- Pathological Reflux
If reflux is accompanied by some abnormal conditions, this is also called “pathological reflux”?
- What is Physiological Reflux?
Your baby had a complaint of vomiting, you took him to the pediatrician and the evaluating doctor told you that your baby had physiological reflux.
Reflux is a condition that can be seen as a part of the baby’s nutrition, starting from the newborn period, which is present in almost every baby.
It has been proven that in healthy infants, stomach contents return to the esophagus at least 30 or more times a day.
Returns of stomach contents sometimes reach the mouth and the mother sees and expresses this as vomiting. But sometimes it doesn’t go back to the mouth, it just comes to the lower part of the esophagus and comes back. If this situation is seen in a healthy baby, if it does not cause additional symptoms such as restlessness, inability to breastfeed, and inability to gain weight in the baby, this situation is called ”physiological reflux”.
In a baby with physiological reflux, the best option is to wait for the baby to grow up and take the simple measures that any mother can do, which I will suggest shortly. Physiological reflux is generally 6 months old and gradually decreases after the transition to complementary foods, and most of it ends at the age of 1 year.
What Causes Physiological Reflux?
Physiological reflux occurs in approximately 60% of infants. Among the reasons are the weak mechanisms that prevent the return of stomach contents between the stomach and the esophagus, and the fact that babies are fed with liquid foods.
How is Physiological Reflux Diagnosed?
Diagnosis of physiological reflux in general; It is put very easily by pediatricians. Physiological reflux can be easily said with the history taken from the family and the physical examination.
When to Worry About a Vomiting Baby? Is every vomiting baby a Physiological Reflux?
Of course no.
Physiological reflux is only one of the causes of vomiting in infants. Vomiting seen in physiological reflux has some typical features.
- Generally no more than a tablespoon
- In terms of content, it is either in the form of undigested milk that is newly sucked from the mother or slightly digested in the stomach.
- It is never yellow, bile,
- It’s never gushing,
- It comes out of the mouth easily, leaking from the edge of the mouth,
- There are no accompanying additional symptoms such as retching, restlessness, etc.
- Increases in certain positions, eg changing diapers or moving a lot
- Growth and development, ie monthly weight gain, height etc., are never affected in physiological reflux.
- There are no additional findings such as breast rejection, loss of appetite, sleep disturbance, colic,
How Can I Reduce Reflux?
- In babies with reflux frequently and in small quantitiesnutrition is a good option
- The baby should not lie down for at least 30 minutes after feeding: Stomach emptying takes an average of 30 minutes. After feeding, it takes an average of 30 minutes for the milk in the stomach contents to start digesting and then to start moving towards the intestines.
- Not gassing the baby after feeding increases reflux: Removing the gas by holding it upright on the lap without laying down after feeding is also a good option as it will provide a 30-minute waiting period.
- As a sleeping position, tilting with an angle of 30 degrees reduces reflux.: ready-made reflux beds can be preferred for this, or it is a good option to put a pillow under the bed and incline the bed.
- Avoid sudden movements.
- Do not grasp what you take in your lap by the belly
- Do not wear clothes that are tight on the waist and press on the stomach
- Feeding formula-fed infants with thickened reflux formulas is a good option.
- Do not do events such as changing clothes, changing diapers, and bathing immediately after feeding your baby.
- Physiolocal reflux gradually decreases with the initiation of additional food in the 6th month and ends at the latest 1 year old.
- Pathological Reflux
My baby has been diagnosed with reflux, how do I know if it is physiological reflux?
In physiological reflux, the baby grows well, is happy and pleasant, without any signs of disease. He just leaks breast milk or formula from the side of his mouth without gagging after feeding.
When should pathological reflux be considered?
Reflux should not be considered physiological in a baby with intense vomiting after feeding if one of the following conditions is present. An underlying cause should be sought. And if necessary, drug therapy should be started.
- If vomiting occurs with gagging or spitting
- If accompanied by excessive restlessness, crying spells and infantile colic
- There is breast rejection, so if the baby’s weight gain is impaired
- If he is restless while feeding, he gives up the breast and throws his head back
- If there is persistent hiccups: hiccups are a good sign of reflux in both infants and older children.
- If there is a delay in weight gain, growth and development: in some babies, vomiting is so intense that the baby vomits every time he sucks from the mother, and accordingly, weight gain slows down because he cannot get enough nutrition.
- Recurrent coughs: Reflux is one of the causes of cough and even recurrent bronchiolitis in infants. The return of the sucked milk to the esophagus affects the births through a reflex called the vagovagal reflex, and cough causes bronchiolitis attacks.
- Wheezing: One of the most important signs of infancy (infantile asthma) is wheezing from the chest (whesy infant). Pathological reflux should be considered in wheezing babies.
- Recurrent upper respiratory tract infection, recurrent otitis media: Since reflux weakens the defense mechanisms of the upper respiratory tract, upper respiratory tract infections, especially recurrent otitis media, are common.
Could there be an underlying disease in pathological reflux? Need an inspection?
Unlike adults, endoscopy is not a standard practice in infants with suspected reflux.
First of all, it is decided whether the existing reflux is physiological or pathological.
Physiological reflux does not require anything additional. Only monthly routine follow-up is done. The vast majority are reduced by switching to complementary foods.
Urinary tract infection, which may cause vomiting in infants with pathological reflux, should be ruled out.
Symptoms such as breast refusal, reflux, and inability to gain weight can be seen in all food allergies, especially cow’s milk allergy. And the main cause of reflux may be an underlying food allergy. Reflux can end with a diet made by the mother.