What is GERD?
Most preemies have some degree of gastroesophageal reflux disease (or GERD)—also known as acid reflux. This is caused by the stomach contents being regurgitated back up into the esophagus, which irritates its sensitive lining. Normally when we eat, the muscular band that joins the esophagus to the stomach (the lower esophageal sphincter) contracts and closes, keeping the stomach contents down in the stomach. In many preemies, however, this muscular valve is very immature and underdeveloped and does not close properly. This causes the baby’s food and stomach acid to leak back up into the esophagus, causing heartburn-like symptoms. Because of their immaturity, preemies are very susceptible to this condition, which can prevent many challenges for them and their caregivers.
How Can You Tell if Your Baby Has GERD?
The severity of reflux varies greatly from baby to baby. Some preemies are “happy spitters” and the reflux is more a laundry problem rather than a medical one. In other babies, reflux can be so painful and irritating that it interferes with their healthy growth and development. Here are some typical signs indicating that your baby may be experiencing reflux:
Frequent spitting up. Although all babies occasionally spit up, babies experiencing reflux may sit up more often, more forcefully, and in larger quantities.
Hurting while eating. If your baby is showing signs that he’s in pain (i.e. arching away, squirming, crying, turning his head away from the nipple, making facial expressions, refusing/protesting the bottle) this could be a clue that he’s hurting.
Restless sleep/lack of sleep. Reflux mainly occurs when a baby is lying flat in a horizontal position. Therefore, interrupted sleep may be a clue that he’s experiencing reflux. Babies with GERD often feel more comfortable and have less painful discomfort when they are held upright rather than laid flat.
Gagging, retching, or coughing. These sounds are key indicators of reflux.
Breathing problems after feeding. Preemies may experience apnea/bradycardia spells during or after feeding if they are refluxing.
How is GERD Diagnosed?
Most reflux is diagnosed from the symptoms above. However, a doctor may also want to order a variety of tests to confirm the diagnosis. One of these tests being a pH probe study. A flexible tube will be inserted through the baby’s mouth or nose and down into the esophagus, where it ends just above the stomach. This device measures the amount of stomach acid that is regurgitated up into the esophagus. The doctor may also order a swallow study. This test is a series of x-rays (fluoroscopy) that examine what your baby’s esophagus does when he/she swallows. He/she will swallow a substance called barium, and multiple x-rays will be taken to film the movement of this substance as your baby swallows.
How is GERD Managed?
The basic strategy for managing GERD is to help lessen the severity of the symptoms that your baby is experiencing until he/she eventually grows out of it (around 6 to 12 months of age). Try these suggestions:
Breastfeed. GERD is much less severe in breastfed infants. Breast milk is easier for babies to digest and empties from the stomach much faster than formula. The less time the food spends in the stomach, the less opportunity there is for regurgitation.
Use a more stomach-friendly formula. Predigested, hypoallergenic formulas such as Pregestimil, Alimentum and Neocate empty from the stomach faster than regular, standard infant formula.
Offer shorter, more frequent feeds. As a general rule of thumb, babies with GERD should be fed half as much but twice as often. Smaller amounts of food in the stomach are easier and faster to digest.
Keep your baby upright after feeding. Let gravity help keep the food down by holding your baby upright and keeping the head of bed elevated after feeding.
Burp more often. This helps to free up more room in the stomach. When a big gas bubble is competing with food for space, stomach contents are more likely to be expelled.
Avoid eating irritating foods if breastfeeding. Sensitivity to a food in the mother’s diet may aggravate reflux. Common culprits often include dairy products, caffeine, alcohol, soy, nuts, shellfish, chocolate, tomatoes, citrus fruits, wheat, egg whites, corn, and gassy vegetables. Try eliminating some or most of these foods and see if it makes any difference in your baby’s symptoms.
Offer a pacifier. Frequent sucking stimulates the release of saliva, which can lubricate the irritated lining of the esophagus. This can also act as an antacid as well as have a calming effect on your baby.
Medications. If none of these strategies are helping your baby, your doctor may decide to prescribe medication such as Pepcid, Prevacid, Reglan, etc.
Does My Baby Quality For a Fundoplication?
Depending on your child’s situation, a Nissen fundoplication may be indicated. This is a surgical procedure that corrects GERD by creating an improved valve mechanism at the bottom of the esophagus. During a fundo, the upper portion of the stomach (fundus) is wrapped around the lower portion of the esophagus. This tightens the lower esophagus so that food and fluid can travel down into the stomach but cannot return up. This procedure is PERMANENT and IRREVERSIBLE, and the risks and benefits should be discussed with your doctor.