The Facts About GER and GERD
Q. Are GER and GERD ever serious problems?
A. GER is a common, normal occurrence in infants. On the other hand, GERD is more rare. Although most infants with GERD regurgitate frequently, some have what is known as "silent reflux," in which stomach contents back up into the esophagus and cause painful irritation without reaching the mouth. GER and GERD occur more often among preemies, babies with developmental delays, infants born from a prolonged labor or traumatic delivery, and those with chronic lung disease or gastrointestinal birth defects.
If your infant cries excessively, doesn't eat well, or has difficulty sleeping, GERD may be the cause. During feedings, infants with GERD often appear irritable and uncomfortable, frequently arching while pulling away from the breast or bottle, presumably due to heartburn. Many infants with GERD stretch and turn their necks in an effort to lengthen the lower esophagus, a posture known as Sandifer's syndrome. And they may prefer to graze, taking only a small amount of milk at frequent intervals, because a distended tummy aggravates reflux.
Babies with GERD (often called "scrawny screamers") may also gain weight slowly, due to difficulty feeding or excessive loss of nutrients from frequent regurgitation. Other symptoms of GERD include coughing, wheezing, choking, and gagging. These respiratory symptoms are the result of acid irritation of the airways and inflammation in the lungs. Constant reflux increases the risk that stomach contents can enter the windpipe through inhalation, and can ultimately cause pneumonia. To further compound these potential complications, anemia can be yet another risk because of bleeding from the damaged esophagus.
There is no single test to confirm that a baby has GERD. The diagnosis is often made after an infant is referred to a pediatric gastroenterologist for severe reflux.
Q. How is GERD treated?
A. Typically, the lifestyle and feeding changes used to treat GER can help alleviate GERD. But if these methods don't work, your pediatrician may prescribe medications either to reduce reflux episodes by speeding stomach emptying or to protect the lining of the esophagus from acid damage by suppressing the production of stomach acids. Antacids, though, are generally not recommended for infants.
In addition, cow's milk may cause allergic reactions, such as vomiting or inconsolable crankiness in infants, which can mimic the symptoms of GERD. (Although milk allergies are rare, infants with eczema, chronic congestion, or a family history of allergies are more at risk.) To determine the true cause behind baby's ill health, pediatricians may first ask that formula-fed infants with severe reflux be switched to a protein hydrosolate formula, which doesn't contain cow's milk, for a week or two to see if symptoms improve. Similarly, the mother of a breastfed infant may be asked to eliminate cow's milk from her diet for a trial period.
If your baby's irritability is caused by reflux disease, the complications are rarely severe enough to warrant surgery.
Q. What can I do to decrease GER?
A. Several lifestyle and feeding changes may help minimize reflux:
- Keep your baby as upright as possible during feedings. Frequent, small feedings are often recommended to decrease reflux because there is less volume to regurgitate. Some babies with GER will even self-regulate, preferring to drink small amounts often. Others with reflux cry if their hunger isn't satisfied and insist on taking a full feeding.
- Avoid bouncing and jostling your baby after meals. Instead, keep her quiet and upright for about 20 minutes after feedings. If you don't have time to hold her upright, carry her in a front pack or prop her in a swing.
- Avoid tobacco smoke, which has been linked to reflux, because among many detrimental effects, it reduces muscle function in the LES and boosts acid secretion.
- Keep your baby's diaper loose to reduce pressure on the abdomen, and avoid changing his diaper right after he eats, as laying him on his back or bending him at the waist during a diaper change can provoke spitting.
- If using formula, check with your pediatrician about thickening baby's feedings by adding rice cereal to the formula (up to 1 tablespoon of dry rice cereal for each 1 to 2 ounces of milk). This increases the caloric content of feedings, allowing you to give your baby a lesser volume. The thickened formula, which may need to be fed through a cross-cut nipple (widening nipples isn't recommended for other formula), decreases episodes of reflux. Some formulas are available (such as Enfamil AR) with added rice cereal that thickens when it reaches the stomach.
- Although reflux is most likely to occur when a baby is on his back, this sleeping position is recommended to reduce the risk of SIDS. Elevating the head of the crib may help decrease reflux during sleep, as will putting your infant on his stomach after feedings when he's awake.
Marianne Neifert, MD, also known as Dr. Mom, is a clinical professor of pediatrics at the University of Colorado Health Sciences Center, in Denver, an author of four parenting books, a professional speaker, and a mother of five.
Originally published in American Baby magazine, August 2005. Updated 2010
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.