(continued from Kansan Pediatrician eNewsletter, November 2018)
When discussing treatment options with parents, it is important to first discuss positioning. Some parents may already know to keep their baby upright for 30 minutes after feedings, but it is also important to tell them about other types of positioning techniques. In the supine position, the gastroesophageal junction is continually submerged in the consumed fluid, making reflux a common occurrence; however, positioning the infant in a left-sidelying or prone position clears the juncture of this fluid. 4 Thus, if parents are not able to hold their child and keep them upright for 30 minutes after feeding, the left-sidelying or prone position would be an effective alternative. Parents tend to put their baby in a car seat to keep them upright, however, this is counterproductive. It is important to not place a baby in a car seat for at least 30 minutes after feeding because the carrier puts pressure on the stomach. Plus the baby’s position in the seat causes the legs to flex, creating more pressure. Once the baby is independently sitting, the food will stay down easier. If regurgitation is still worrying the parents or if the baby is still showing concerning symptoms, try feeding in smaller amounts and more frequently.
Often, health care providers turn to prescription medication after evaluating positioning strategies, particularly if the child is not yet eating solid food. Medication is commonly prescribed if the infant is in pain or is not taking in the proper quantity of formula/breastmilk per day. Recently, there has been a large increase in GERD diagnosed in infants less than 12 months of age along with an increase in prescribing proton pump inhibitors (PPI). 1
Once GERD is treated, the issue is not always solved. There can be the potential for long-term effects. Infants with a history of GERD may develop a habit of avoiding certain foods due to their frequent regurgitation and become picky eaters. Something as simple as picky eating can have lasting effects years after infancy. Without intervention, these habits developed while the infant is refluxing can stay with them while they develop the ability to eat solid foods. If baby is a picky eater, they could be missing out on certain nutrients and vitamins essential to their growth and development. For some infants and children, untreated reflux can contribute to tooth decay from loss of dental enamel due to stomach acid. Additionally, parents may shy away from putting their infant prone on their stomachs if their baby is showing signs of reflux, due to abdominal pressure and possible increased fussing. Unfortunately, this lack of tummy time can have significant effects on gross motor development and delay achievement of age appropriate milestones.
If reflux disease is unable to be successfully managed by the primary care provider then the infant should be referred to a pediatric gastroenterologist for further evaluation and treatment. A pediatric gastroenterology specialist may perform further diagnostic testing, such as an esophageal manometry, endoscopy, ph impedance test, or a BRAVO placement in order to assist them in creating an individualized treatment plan.3 Referral to a speech language pathologist is warranted if feeding and/or swallowing difficulties are noted, since this is a common occurrence in infants with GERD. Speech therapists can serve as an additional resource for families and are important partners in helping families become the best advocate for their child especially when navigating through early intervention services.
For more information about childhood development, please visit www.pathways.org or email firstname.lastname@example.org. Pathways.org, founded in 1985, provides parents and health professionals with free educational resources on children’s motor, sensory, and communication development to promote early detection and intervention.
- Bennett WE, Harris BR. Infant Reflux in the Primary Care Setting: A Brief Educational Intervention and Management Changes. Clinical Pediatrics. 2017. doi:10.1177/0009922817738339
- Chen P, Karmaus W, Soto-Ramirez N, Zhang H. Association Between Infant Feeding Modes and Gastroesophageal Reflux: A Repeated Measurement Analysis of the Infant Feeding Practices Study II. Journal of Human Lactation. 2017. 33(2):267-277. doi:10.1177/0890334416664711
- Gastroesophageal Reflux Disease (GERD) Diagnosis and Treatment. Boston Children’s Hospital. http://www.childrenshospital.org/conditions-and-treatments/conditions/g/gerd/diagnosis-and-treatment. Accessed on March 21, 2017.
- Findlater CK, Schurr P. Neonatal Mythbusters: Evaluating the Evidence For and Against Pharmacologic and Nonpharmacologic Management of Gastroesophageal Reflux. Neonatal Network. 2012. 31(4):229-41. doi:10.1891/0730-0822.214.171.124