What is it?
Gastro-oesophageal reflux , also known as ‘spitting up,’ ‘possetting’, or ‘regurgitation’, describe the action of the stomach contents moving back up into the gullet (oesophagus) or mouth. It is not uncommon for regurgitation to occur in babies during and immediately after feeding because they are taking large volumes of milk and food to support their rapid growth rate. In most babies, gastro-oesophageal reflux disappears by about 12 – 15 months of age.
As long as there are no other symptoms, advise parents that bringing back feeds isn’t a major concern if their baby is growing well and seems happy. There is a risk, however, that if gastro-oesophageal reflux persists past the age of 18 – 24 months, it may progress into gastro-oesophageal reflux disease. This needs to be treated, as it can irritate and damage the lining of the oesophagus. This is because the feed that comes back up from the stomach contains acids that irritate the oesophagus lining. The regurgitated feed may also go into the lungs, and cause chest infections.
What are the symptoms?
Symptoms of gastro-oesophageal reflux to look out for:
- Regular vomiting
- Excessive crying
- Poor growth
- Poor sleep
- Food refusal
In addition to the above, other symptoms of gastro-oesophageal reflux disease include:
- Constant coughing
- Frequent chest, ear and sinus infections
What causes it?
The oesophagus of a baby is quite short. A baby’s stomach is also very small in size and does not stretch very easily. If babies are given a large amount of feed, it can make their stomach overflow and the feed return back up the oesophagus, causing them to spit up or vomit.
The way a baby is fed can also contribute to gastro-oesophageal reflux. For example, using formula feeds made up in the wrong concentration, or delivering feeds too quickly, could cause gastro-oesophageal reflux.
How can it be treated?
There are a number of tips for dealing with gastro-oesophageal reflux that can help parents:
- Winding their baby in the middle and the end of a feed. (Click here to find out more on winding)
- Holding their baby in an upright position for about 20 minutes after feeding to help with their digestion
- If feeding formula, it’s important parents follow the instructions on the label when making up the formula
- Recommend giving smaller, more frequent feeds, as long as they are careful not to increase or reduce the overall amount of feed given each day
- Inform them that in some instances, parental anxiety can make gastro-oesophageal reflux worse
Feed thickeners may help to keep a feed down. For breastfed babies, a thickener can be mixed with some expressed breast milk or cooled boiled water and given as a thick paste by spoon or cup both before and in the middle of a feed. Some babies may need to take some medication such as antacids alongside the thickened feeds.
For formula fed infants, a feed that contains a precooked starch may be recommended. This works by thickening in the baby’s stomach. The GP can prescribe a formula for this purpose such as SMA Staydown