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Infant Acid Reflux Disease

All babies reflux or spit up food in the first year of life. But one in three babies will develop significant symptoms. When symptoms develop it’s considered infant acid reflux disease (GERD; GastroEsophageal Reflux Disease). Since it’s so common, doctors may suggest, “they will outgrow it”. We hear Moms cry for help all the time and know how frustrating it can be. Especially when you’re watching your baby suffer, cry non-stop, refusing to eat or worse. It’s not acceptable to allow an infant to suffer in pain. It affects everything from development to weight gain and the possibility of changes in the esophagus that may lead to the future likelihood of lifetime GERD.

What are the symptoms?

Common/Moderate

1. Spitting up with crying. Crying is often from the acid in the spit up. Small to large amounts projectile in nature. Parents may call this vomiting, however, vomiting involves retching.
2. Back arching. While feeding the acid refluxes in the esophagus, the infant arches the back instinctively to try and relieve the pain.
3. Recurrent Hiccups or wet burps. Due to acid and/or pressure affecting the nerves near the esophagus and the diaphragm. Wet hiccups occur when there’s spit up during hiccupping.
4. Irritability during feeding. Screaming or crying suddenly while feeding is due to acid causing esophageal irritation and causing pain.
5. Refusal to eat, difficulty swallowing. Caused by acid coming back into the esophagus
6. Gagging or choking. Caused by reflux coming into the esophagus and moving up into the upper esophagus.
7. Difficulty sleeping. As the infant is lying, gravity works against them. Acid moves into the esophagus and is painful.
8. Not gaining weight. Due to above symptoms. In fact, an aversion to feeding can be learned and can be challenging to unlearn. Parents attempt to get enough ounces into their infants including feeding during sleeping. This is good for baby; however, a physician think the baby is gaining weight and assume reflux isn’t bad.

Severe symptoms

1. Purple baby syndrome – Can be frightening and very serious. The infant has trouble breathing, they stop breathing and the lips and face turn purple or blue because the oxygen is not moving throughout the blood. This can lead to what is known as an Apparent Life Threatening Event (ALTE).
2. SIDS (sudden infant death syndrome). Consider an ALTE but the infant doesn’t spontaneously start breathing on their own. This is SIDS.
3. Asthma Like symptoms. If an infant has asthma like symptoms the first thing to consider is acid is the cause. Acid vapor can move up from the esophagus, cause sufficient inflammation and lead to apnea and asthma like symptoms. If your child has these asthma symptoms is also possible your child could be suffering from silent reflux which is a different kind of acid reflux. Check out this article for more information on silent reflux
4. Recurrent ear infections. Acid is refluxed up to where the Eustachian tube drains into the esophagus. This acid then inflames the tissue and with the resultant swelling the normal flow of secretions from the middle ear can’t occur. Bacteria then overgrows and causes infection in the middle ear. Treating with antibiotics (without treating the reflux) leads to bacteria that are resistant to antibiotics.
5. Laryngomalacia. Can be congenital (at birth) or develop soon after. Either way, reflux plays an important role. Significant control of infant acid reflux can lead to a reduction of inflammations, which can improve symptoms.
6. Coughing without a cold, noisy breathing, wheezing. These symptoms occur when the acid affects the upper esophagus and airways. Along with recurrent ear infection and sinusitis aka – Extra Esophageal manifestations of reflux, ENT-related manifestations, or LPR (LaryngoPharyngeal Reflux). These symptoms can be more difficult to control as very few reflux events are required to keep symptoms from continuing.
7. Sandifer’s Syndrome. Isn’t dangerous! The problem is it’s mistaken for seizure or a neurological disease. Extensive neurological studies may be undertaken and seizure medicine may be unnecessarily started.

There are many other symptoms related to GERD. This is why it is important to have a list to report to your physician. This is why the Infant Acid Reflux Questionnaire is very helpful because it allows you to follow the progress of your baby when you make changes to diet, formula, and medicine. (A reflux diary).

Treatment

H2 blockers can develop tolerance (also called tachyphylaxis). The H2 blocker, which was working, just seems to stop working. Increasing the dose or changing to another H2 blocker won’t help.

Proton Pump Inhibitors or PPIs Prilosec®, Prevacid®), Nexium® are extremely successful inhibitors of acid secretion. They work by blocking the final pathway for the production of acid. Tolerance can’t develop however, it’s important to use the correct dose. After approximately 4 weeks of age, infant’s metabolism of many medicines is at it’s best. The half-life of PPI medicines (half-life – time required for the amount of medicine in the body to be reduced by half) was shorter by 3 times faster than adults. Meaning, infants metabolize the PPI’s 3 times faster than adults.

A: Infants Have Shorter Half Life for PPI’s.

1. Flavored Lansoprazole Suspension in Pediatric GERD.

1. PPI Dosing Information for Your Doctor.

Study C showed that, infants benefit from two or more doses per day of a PPI. The younger the infant the more likely they benefited from three doses per day. Studies using single doses of PPIs per day showed no differencw than placebo, yet this small dose is often used in treating Infant GERD. Insufficient doses showed symptoms persisted or worsen and can create the long-term symptoms.

We know what you’re thinking. “I don’t want to give my baby medication.” It’s a hard pill to swallow, literally. Consider this, “Would you give your baby asthma treatment if needed?” “Of course!” Then why wouldn’t treat a baby with reflux if it works effectively and safely? It’s not a life style choice. It’s treatment to treat a temporary situation and keep them out of pain. Most babies outgrow infant reflux or GERD in the first year of life but don’t wait and lose those precious years of life. Don’t wait to get your baby out of pain.