Gastro-oesophageal reflux disease (GORD) in infants and Children Part 1

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

It is natural for an infant to have some regurgitation after feeding. The issue is whether GORD is causing a problem in your infant rather than whether GORD is occurring at all. Reflux is most common between one to four months and approximately 67% of infants have more than 1 daily episode of regurgitation at four months. By 12 months only 5% have symptoms. By 12-18 months, most cases of GORD will resolve as the sphincter (valve between oesophagus and stomach) matures, the infant adopts an upright posture and begins having a more solid diet.

Symptoms of reflux in infants

Reflux causes frequent or recurring vomiting. This is not the small mouthfuls of vomit seen in all infants, but the vomiting of large amounts of vomit. This can happen straight after a feed or right up until the next feed. When the infant’s oesophagus becomes sore from exposure to the regurgitated acid (the equivalent of heartburn) this leads to irritability, pain and poor feeding. If GORD is severe, the infant may have difficulty gaining weight.

Other common symptoms of reflux include;

• Sometimes screaming suddenly when asleep. Infants can be inconsolable especially when laid down flat
• Poor sleep habits typically with arching their necks and back during or after feeding
• Frequent burping or frequent hiccups
• Swallowing problems
• Frequent ear infections or sinus congestion
• Infants are often very windy and extremely difficult to burp after feeds, failure to wind them successfully usually means reflux and vomiting is worsening
• Refusing feeds or frequent feeds for comfort
• Night time coughing
• Rarely inhaling vomit leading to respiratory problems such as asthma, bronchitis and even chest infections.

When to see doctor?

It is very rare for reflux to lead to serious complications but if the infant vomits severely or has any of the following symptoms you should see doctor:

• blood or bile (bile is a yellow fluid) in their vomit
• difficulty in swallowing or is choking easily
• a fever
• is irritable, crying and hard to settle
• listlessness, dark circles under the eyes, refusal to feed and dry nappies
• breathing problems that could lead to apnoea (the infant may temporarily stop breathing)
• is losing weight or not gaining weight as you think they should

To be continued…..next week I will discuss treatment of GORD in infants and children

This article is shortened to fit within Newspaper space limits. More detailed information and leaflets is available in Whelehans