Infant Reflux: To Worry or Not To Worry

Infant Reflux: To Worry or Not To Worry
by Ma. Theresa Hilario-Jimenez, MD, FPPS

Infants are usually noted to spit up milk (lungad) after feeding. This is a normal process and can be seen even after proper burping of babies. In a survey done in 200 Filipino mothers last 2020, it showed that all the mothers said that their babies had milk regurgitations or spit ups. They have been told by elders that they are transient and will disappear once the baby grows up. Although some expressed concern over the regurgitation, not much attention was given to them and was dismissed with the hope that it will end sooner than later. However, babies continue to cry incessantly without any reason and care givers are exhausted and maybe traumatized with the inconsolable babies.

Reflux versus Regurgitation

There is a difference between regurgitation and reflux. Reflux in babies is when the milk from the stomach goes back to the esophagus with or without reaching the mouth. 1 While regurgitation is when the milk already reaches the mouth. For some, it becomes more worrisome when the milk comes out of the nose rather than just the mouth. Regurgitation is common during infancy, occurring once a day in half of the infants up to 3 months of age. However, more infants experience regurgitation at 4 months of age where almost half of the babies regurgitate during most feedings and 2/3 at least once a day. This gradually declines up to 12 months of age but may persists up to 2 years of age.

Reflux in babies maybe a normal process however, the symptoms of reflux can be troublesome to babies. Common symptoms include regurgitation, incessant crying, irritability and back arching. 2These symptoms can also be seen in babies with colic (kabag) or allergy to milk (cow's milk protein allergy). Babies develop infant reflux because of the following: 1, 3, 4i 5

  1. The muscle (lower esophageal sphincter) that serves as a gate to stop milk/food from the stomach to go back to the esophagus, is not yet fully developed
  2. The babies' diet is mostly liquid, making it easier to go back the esophagus
  3. Babies are usually lying- down making it easier for milk to go back the esophagus.

Effects of Infant Reflux

Reflux in babies maybe normal, but if causes distress or troublesome symptoms in the baby, then it becomes a disease or what we call Gastroesophageal Reflux Disease (GERD) in babies. Infants' quality of life can be affected by the symptoms of reflux. 6i7 This is because the milk or food that passes the esophagus causes pain resulting to the common symptoms. Some babies will cry incessantly or non-stop and neither the mother or another care giver can comfort or stop them from crying. Because of this, the quality of life of the care giver is also affected. Studies have shown that coping with the symptoms of infant reflux can be stressful to the parents and eventually have an impact as well on their health and social life. 7 Because of their inability to comfort and stop their babies from crying, some parents feel rejected by their babies and this will lead to feelings of failure as a parent. There is no need to worry if your baby is not showing symptoms of infant reflux But if you are bothered by the symptoms your baby is showing and youthink your baby is suffering from infant reflux, consult your doctor. Ask for the gentle relief for infant reflux as soon as possible in order to get the appropriate reflux management for your baby. 

References:
1. Baird DC, et al. Diagnosis and treatment of gastroesophageal reflux in infants and children. Am Fam Physician. 2015;92(8):705-714.
2. Rosen R. Per:Rabic GastroesoPhaDeal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGRAN) and the European Society for Pediatric Gastroenterology, Hepatology, and NutritiOn (ESPGHAN). J Pediatr Gastroenterol Nut 2018;66:516-554.
3. Omani TI, et al. Mechanisms of Destro-oesophageal reflux in preterm and term infants with ref lux disease. Gut. 2002;51:475-479.
4. Newell SJ, et al. Maturation of the lower oesophageal sphincter in the western baby. Gut. 1988;29167-172.
5. National Institute for Health and Care Excellence. Colc - infantile. Clinical Knowledge Summary, June 2017. Available at.httnc.r/rEs nire (WM Ilk/COW, inf antae
6. Czinn SJ, Blanchard S. Gastroesophageal reflux disease in neonates and infants when and how to treat. Pediatr Drugs. 2013;1519-27.
7. Kim J, et al. Simultaneous development of the Pediatric GERD Caregiver Impact Questionnaire (PGCIQ) in American English and American Spanish. Health Gust Life Outcomes. 200514:35.