Gastroesophageal reflux, happens because of too much relaxed muscle between the oesophagus
or so-called gullet and the stomach. As a consequence, the food the baby has taken,
milk through the products, will get mixed with acid from the stomach, then will go up
in the gullet or oesophagus. It will cause pain and discomfort. The baby will be screaming.
Gastroesophageal reflux is more prevalent, is more common in babies who have other problems.
For example, with those with cow's milk protein allergy, cerebral palsy. Those babies who
have problems with the lower end of the gullet. Gastroesophageal reflux happens in one in
two babies. And sometimes it becomes as a disease leading to poor weight-gain, extreme
vomiting and poor growth.
We know that baby has got the gastroesophageal reflux going back looking at the baby's behavior
particularly after feeds. When the baby regurgitates the milk they have taken, the milk may smell
acidic. But on the other hand, we know that in the same age baby may present with the
sign of colic or milk allergies. But the behavior of the baby with colic is completely different,
because those will draw up legs, they scream and stop, whereas gastroesophageal reflux
is more continuous. Those babies who vomit, who regurgitate are more likely to be suffering
gastroesophageal reflux other than colic.
Gastroesophageal reflux is caused by relaxation of the muscle between the gullet, also called
the oesophagus in the stomach. And we know that this is very common in babies because they
are very young. With age this matter becomes stronger and there shall be no milk going
from the stomach into the gullet. As a consequence, we have to think about strategies to put in
place to make sure that what they eat is more thickened. On the other hand, make sure that
we play with the position of the baby. Upright position would decrease the chance of the
milk going from the stomach to the gullet.
The diagnosis of a gastroesophageal reflux is straightforward for paediatricians. It's based
on pattern recognition on good history taking from the information given by parents about
the baby behaviour around feeds and after feeds. The baby will be regurgitating, will be vomiting,
will be vomiting with acidic smell and babies will be screaming in pain after feeds. So,
based on that we can make a diagnosis, but in some cases, we end up doing a pH study
which involves putting a probe in the gullet and measuring the period, the degree of acidity
in the gullet to demonstrate that the acid has gone from the stomach into the gullet.
In very rare cases, in some centres they do endoscopy. In other centres, they do barium
swallow studies. But these are very unusual tests as the majority of babies will gastroesophageal
reflux are recognised on clinical grounds.
Majority of babies with gastroesophageal reflux do not need treatment. The management of the
condition is mainly making sure that we minimise the chance of the milk going from the stomach
into the gullet. And that will include positioning the baby. Make sure the baby is upright, or
you sleep on the back because that's safer. The other step of management without medication
would be to make sure that the milk is thickened. That again will decrease the chance of milk
going from the stomach to the gullet as it is less liquid. In some babies, we recommend
that on top of positioning, thickening, the baby get some special amount of milk reduced.
So, the volume they are getting every, for example, three hours is reduced to two hours.
Which means that volume being low, the content in the stomach is lower than what the stomach
can hold. As a consequence, the milk will not go back into the stomach. In rare cases,
then we need to give some medication. And medication given for gastroesophageal reflux:
we start with the simple one: Gaviscon, which the mainstay is to improve the lining of the
gullet in the stomach. When this does not work, then we have to think about giving medication
to reduce acidity in the stomach. And in those cases, we give ranitidine, in some situations,
we give omeprazole. These tend to work because it is increasing the acidity. It means that
even if you had some reflux, the amount of harm particularly of pain-causing screaming
is reduced.