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THE BURNING QUESTION
ACID REFLUX IS A COMMON OCCURRENCE IN BOTH BABIES AND CHILDREN.
THE FAMILY GROOVE ASKS PEDIATRICIAN JESSICA GRANT, MD, ABOUT THE MOST COMMON
SIDE EFFECTS OF ACID REFLUX IN YOUNG CHLDREN AND THE BEST WAYS TO PUT OUT THE FIRE.
Acid reflux isn’t just for adults. “It’s a completely normal process in
all ages. And, it happens much more
commonly in infants,” said Dr.
Jessica Grant, a pediatrician with the Montefiore Medical Group in
the
Bronx
and a graduate of Columbia University of Physicians and
Surgeons. “Parents don’t come in with the complaint
that my child
has
acid reflux. Parents come in with the complaint that my child is constantly spitting up.”
Simply defined, acid reflux is a retrograde or backwards movement of gastric content or stomach acid into the esophagus. According to Dr. Grant, 50 percent of children less than three months old have at least one episode of spitting up every day. At the age of four months, that number rises to 60 percent. (That increase is most likely due to the fact that at four months babies start to eat other foods in addition to breast milk or formula. Additionally, they are sitting up and, as a result, being jostled more.)
At five months, spitting up decreases again and, by one year of age, only five percent of children will have one episode of spitting up each day. The good news for parents is that only one out of 10 babies will go on to develop any complications from spitting up or acid reflux. (Those cases requiring medical intervention may be diagnosed as Gastroesophageal Reflux Disease or GERD.) Said Dr. Grant, “[We refer to those] babies who are gaining good weight, have a normal physical exam and are spitting up small amounts here and there as happy spitters.”
Here, Dr. Grant gives parents a primer on how to recognize and treat acid reflux in their little ones.
THE FAMILY GROOVE: What is the most common concern you hear from parents about acid reflux?
Dr. Jessica Grant: The most common thing parents come in with is that a baby spits up a lot. [That can] mean one or two times a day to the baby’s every feed, which could be 12 times a day. In a healthy newborn, reflux can occur somewhere around thirty times a day. But, of those 30 times, it won’t always come out of the mouth. What I tell parents is that we have a door in the tube that goes from the mouth to the stomach and when we finish eating our door closes and we don’t spit back up. But, in a baby that door doesn’t work very well and food is more likely to come back up.
Babies also have a much smaller stomach. Their stomach is the size of their little hand and if you overfill it, the [food] is going to have to come back up. It’s annoying for mom and dad because they have to do a lot more laundry, but it’s not dangerous for the baby.
TFG: What can parents do to decrease the amount of spitting up?
JG: A normal baby will take between two and three ounces every two to three hours. The most common thing we tell parents is [to give] small, frequent feeds. The child will get the same amount over the course of the day, but in smaller chunks. Also, when parents are feeding the baby, especially bottle fed babies, they should try to avoid having them swallow a lot of air. That [excess air] tends to make spitting up more common. Burp the baby half way thru the feed and then burp again at the end.
Breastfeeding also helps. Breast milk goes through the stomach faster and breastfed babies don’t overfeed because [they will] stop when they are full.
TFG: What are the signs that spitting up may be more than just acid reflux?
JG: Parents should be concerned if the baby starts vomiting green; if the vomit has blood in it; if vomit is very forceful; if the baby is not gaining weight or seems like they are in a lot of pain; and if there are any changes in their bowel movements, such as sudden diarrhea or constipation.
TFG: What treatments are available for acid reflux in babies?
JG: [A doctor may] put rice cereal in the feed. We think the thickening actually weights the food down so it stays in the stomach. But, this should not be done without a doctor’s guidance because it has to be in very specific amounts. Or, [a doctor might] try a baby on a hypoallergenic formula because the symptoms of an allergy to milk or a milk intolerance can mimic the spitting up of reflux.
TFG: What about acid reflux in toddlers?
JG: Most kids who are older than 18 months who are still vomiting or regurgitating on any regular basis would probably [need additional tests]. There are three main tests we do: an upper GI series, for which you have the child eat and then pictures are taken of the esophagus into the stomach. [In this case we are looking] for any abnormality in the actual anatomy; secondly, a pH probe test is for acidity. A sensor is threaded through the nose and down the throat into the esophagus. The test records the amount of acid in the back of the esophagus for up to 24 hours; and, lastly, an endoscopy is when the doctor puts a tube down the esophagus to see if it looks damaged by acid.
TFG: How can parents treat acid reflux in older kids?
JG: If the child is old enough to tell you they feel a burning in their chest then most doctors will try a two to three month trial of [acid reflux] medicine. For kids we only use two categories of medicines: the first category is called the proton pump inhibitor, which decreases acid production. (The common name for them is Prilosec and Prevacid.) The other common category is called a histamine type 2 receptor antagonist, which block acid production. (Those include Zantac and Pepcid.)
Additionally, for older kids (over the age of two), some things you can do before you put them on medicine or in conjunction with medicine are: elevate the head of the bed or have kids sleep on a couple of pillows. The thought is that the gravity keeps the food down better; don’t feed them within two hours of going to bed at night; and no caffeine. That means no coke or chocolate as well as no spicy foods.
—Jennifer Carofano
After a decade of subways, bagels and window shopping in New York City,
Jennifer Carofano now lives with her husband and their two cars in sunny Los Angeles.
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