What is acid reflux in babies

Reflux disease in babies

Reflux disease(gastro-oesophageal reflux disease): Backflow of chyme from the stomach into the esophagus.

In infants, gastro-oesophageal reflux is very common and often regarded as normal - it is not for nothing that the "burp cloth" is part of normal baby equipment. The disease disappears by itself in over 90% of cases by the first birthday. It is less common in older children, but is then characterized by symptoms and symptoms.

Reflux disease in adults: see gastroesophageal reflux disease.

Leading complaints

Baby:

  • After feeding, belching or "spitting", sometimes real gush-like vomiting
  • Difficulty getting food combined with difficulty swallowing
  • Screaming attacks for no apparent cause and colicky pain
  • Possibly restlessness, signs of malaise, v. a. after feeding
  • Possibly cough, v. a. at night
  • Possibly convulsive overstretching (bending back) of the head and upper body during or after feeding
  • Possibly insufficient weight gain and failure to thrive.

Older children:

  • Acid regurgitation, heartburn
  • Vomit
  • Pain behind the breastbone and in the upper abdomen.

When to the doctor

In the next few days if

  • Your baby is spitting profusely after feeding and is not gaining enough weight.
  • Your baby is coughing a lot.
  • Your older child has heartburn frequently.

Today if

  • bloody or brownish threads can be seen in the milk that has run out.
  • Your baby has a fever in addition to the reflux symptoms.
  • Your baby will vomit "in a gush" (that is, in a high arc) after each meal and gradually become apathetic.

The illness

causes

As in adults (reflux disease in adults), the entrance of the stomach together with the diaphragm acts like a valve in children: although food can get from the esophagus into the stomach, it can hardly return. This protective valve mechanism is disturbed in various diseases, e.g. B. in the case of a diaphragmatic hernia (hiatal hernia) with displacement of the stomach into the chest cavity.

In many cases, however, no sure cause is found in children: the children are otherwise healthy and everything is anatomically normal. In some cases the child does not tolerate a certain food, as a rule it is high-fat or sweet food. A cow's milk protein allergy should also be considered as a cause of reflux disease.

The doctor differentiates between two types and causes of reflux diseases:

  • Functional reflux: Especially in infants, the muscle ligament that closes the stomach entrance (called the internal sphincter or esophageal sphincter) relaxes a few times, causing stomach contents to flow back. But the anatomy of infants also favors a functional reflex, as the "kink" between the esophagus and stomach is often not yet pronounced, so that the milk runs back relatively easily. The problem usually disappears with age.
  • Secondary reflux: In this rare cause of reflux, a neurological disease causes reflux between the stomach and esophagus.

clinic

Since the esophageal mucous membrane, in contrast to the gastric mucous membrane, is not "built" for the acidic stomach contents, it becomes inflamed with constant contact with the strongly acidic stomach contents. Heartburn, pain, but also creeping blood loss and subsequent ulcers or even scarring are possible long-term consequences.

Risk factors

Former premature babies and children with neurological diseases are particularly affected. Even with general muscle relaxation (hypotension), which occurs in many neurological disorders or as a result of a lack of oxygen during childbirth or other developmental delays, the seal between the esophagus and stomach is often disturbed.

Complications

If babies keep losing milk, they can't keep up with drinking and gain insufficient weight.

Anemia. Sometimes the inflammation is so severe that chronic anemia (anemia) develops due to the constant oozing bleeding.

Lung infection. In cases of reflux disease, part of the food pulp rarely gets into the bronchi (aspiration); this happens especially in children with neurological problems, e.g. B. cerebral palsy. The affected children cough a lot and recurring aspiration pneumonia occurs, which is particularly high-risk pneumonia.

Asthma. If acidic porridge gets into the larynx, the bronchi narrow via reflexes, so that in some cases asthma can also occur.

Pauses for breath. Reflux in premature babies and newborns is particularly dangerous because the chyme gets into the airways during sleep. The bronchi narrow, the infant holds its breath for a while. The consequences are sometimes serious pauses in breathing (apneas).

Otitis media. The risk of inflammation of the middle ear (otitis media) is also increased if gastric juice flowing back enters the middle ear via the Eustachian tube. As a connecting channel between the nasopharynx and the middle ear, the Eustachian tube ensures a ventilated middle ear, if ventilation problems occur here, middle ear infections are favored.

Diagnostic assurance

If a baby thrives despite frequent spitting, i.e. regularly puts on weight and shows no other symptoms, neither technical examinations nor special treatment are required. Because frequent spitting is pretty normal in the first year of life.

In the case of more severe symptoms, however, an exact diagnosis and therapy are necessary.

24 hour pH metry. Since the pH level in the gastric contents flowing back is acidic, reflux can be detected using special probes that are pushed from the mouth or nose into the esophagus and remain there for up to 24 hours.

Imaging diagnostics. Special ultrasound, X-ray or isotope examinations also show the position of the stomach and the speed at which the stomach is emptied.

Esophagoscopy (Esophagoscopy). If more extensive inflammation of the esophagus (reflux esophagitis) is suspected, an endoscopy of the esophagus is required.

treatment

Pharmacotherapy

To suppress stomach acid, children are often given drugs that suppress the formation of hydrochloric acid in the stomach (proton pump inhibitors such as omeprazole).

These drugs, some of which are also available without a prescription, should only be given after consultation and prescription by a doctor. The same applies to drugs that promote gastric emptying such as metoclopramide, which "buffer" stomach acid such as antacia (e.g. Gaviscon®) or suppress its formation (e.g. Zantic®, Antra®).

Operative treatment

In rare cases - if the drug treatment fails or if there are complications - an operation is necessary, but here, as with drug therapy, only the symptoms are treated, but the cause directly.

The surgical procedure known as fundoplication ("suturing" the stomach) is intended to prevent the stomach contents from flowing back into the esophagus. Parts of the stomach are wrapped around the lower end of the esophagus like a cuff. As soon as the stomach is full, this "cuff" tightens around the esophagus and thus presses it shut. The result is that stomach contents no longer flow into the esophagus. When the stomach empties, the cuff loosens again and the pulp flows normally into the stomach again. Two techniques are available for such an operation: the open and the laparoscopic. In the open process technique, an incision is made directly over the stomach, whereas in the laparoscopic procedure ("keyhole technique") the procedure is carried out through several small accesses in the abdominal cavity.

The prospects of a permanent cure are around 90% with both procedures. Young patients in particular benefit from surgical therapy; In addition, fundoplication is more cost-effective than lifelong drug therapy in young patients. However, as with any operation, there is also a risk of complications and should therefore always be reconsidered.

forecast

The symptoms usually go away on their own as soon as the children learn to walk - the symptoms are then also improved by maintaining an upright posture.

However, it is important to recognize when no spontaneous improvement is to be expected. Then it is important to treat promptly and courageously. If this happens, a cure can also be expected here.

Your pharmacy recommends

What you can do as a parent

Small meals.

Frequent and small meals of a maximum of 120 ml are recommended. Especially in the evening, eating should not be too plentiful and rather early, so that the child does not go to bed "with a full stomach".

Thickening of the food.

If your child receives bottle-fed food, it is thickened with rice gruel flakes or Nestargel®, which reduces the "sloshing back" of the meal. The addition of locust bean gum or corn starch also helps increase the caloric density of the food so that the baby can thrive.

Upright position after eating.

Babies are best held upright in your arms for about 15-30 minutes after a meal before they are put down. A slight elevation of the upper body is also good for children; because this keeps the food in the stomach.

Sleeping position.

To sleep you put a pillow under the head end of the mattress so that your child lies in a slightly elevated upper body (approx. 30 ° angle). The food is held "below" by gravity and the transport of the pulp is supported. The previously recommended prone position is now being rejected because it increases the risk of sudden infant death syndrome. The right side position is best for the digestive process.

Hypoallergenic food.

Do not try z. B. on cow's milk or other proteins, as a food intolerance may be causing the symptoms.

Wrap.

Since a diaper that is too tight also increases the pressure in the stomach in the first few months of life, the child must not be swaddled too tightly.

Move.

Older children should get enough exercise, as sitting increases pressure in the abdomen and promotes reflux.

Authors

Dr. med. Herbert Renz-Polster in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update of the sections "Description", "Symptoms and complaints", "When to see the pediatrician", "The disease", "Confirmation of diagnosis", "Treatment", "Prognosis" and "Your pharmacy recommends": Dagmar Fernholz | last changed on at 10:01 am


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.