Medical Therapy

The treatment of reflux depends upon the infant’s symptoms and age. Some babies may not need any treatment, as GER can resolve in many cases without treatment. Healthy, happy babies may only need the feedings thickened with cereal and to be kept upright after they are fed. Over feeding can aggravate reflux, and your health care provider may suggest different ways of handling the problem. For example, smaller volume with more frequent feeding can help decrease the chances of regurgitating. If a food allergy is suspected they may ask you to change the baby’s formula (or modify the mother’s diet if the baby is breastfed) for one to two weeks. If a child is not growing well, feedings with higher calorie content or tube feeding may be recommended.

1.

When a child is uncomfortable, or has difficulty sleeping, eating or growing, the doctor or nurse may suggest a medication. Different types of medicine can be used to treat reflux by decreasing the acid secreted by the stomach. One class of these medications is the H2-blockers such as cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid) and nizatidine (Axid). Another type of medication is the proton-pump inhibitors such as esomeprazole (Nexium), omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex) and pantoprazole (Protonix).

2.

Very rarely do infants have severe GER that prevents them from growing or cause breathing problems. In some of these infants, surgery may be the best option.

Diet Nutrition and Lifestyle

Gastroesophageal Reflux (GER) occurs during or after a meal when stomach contents go back into the tube that connects the mouth to the stomach. GER occurs often in normal infants. Most infants with GER are happy and healthy even though they spit up or vomit. Spitting up tends to peak at 4 months and most infants stop spitting up by 12 months of age. If your baby is spitting up without discomfort and is making appropriate weight gains, then he or she is probably a normal spitter. Things that you can do at home to help reduce spitting up:

Avoid overfeeding

1.	Don't feed the baby again after he or she spits up - wait until the next feeding.
2.	Consult your doctor to see if the baby is taking appropriately sized bottles or nursing the appropriate amount of time. For formula fed infants, feedings can be thickened
3.	For formula fed infants, try a hypoallergenic formula for 2 weeks
4.	Keep infant upright for at least 30 minutes after meals
5.	Avoid car seat positioning in the home Avoid tight diapers and elastic waistbands
6.	Avoid exposure to tobacco smoke

Most infants with GER will be helped with the treatment mentioned above. If symptoms are severe or persistent then your primary care provider may consider treatment with a medication or referral to a pediatric gastroenterologist.

Signs and Symptoms and Diagnosis for Infants

Gastroesophageal Reflux (GER) occurs when stomach contents come go into the esophagus (the tube that connects the mouth to the stomach), during or after a meal. Most infants with GER are happy and healthy even though they spit up or vomit. An infant with GER may experience:

• Spitting
• Vomiting
• Coughing
• Irritability
• Poor feeding
• Blood in the stools

GER occurs often in normal infants. More than half of all babies experience reflux in the first 3 months of life. Only a small number of infants have symptoms due to GER. Most infants stop spitting up between the ages of 12 to 18 months.
In a small number of babies, GER may result in symptoms that are concerning. These include problems such as

• Poor growth due to an inability to hold down enough food
• Irritability or feeding refusal due to pain
• Blood loss from acid burning the esophagus
• Breathing problems

Each of these problems can be caused by disorders other than GER. Your health care provider needs to determine if GER is causing your child’s

For more information click on the links below go to the Patients and Parents site and check out the resources on Infant GER below