What to do when your baby has reflux

Here’s what to expect – and what to do – when your little one is suffering from reflux, advises paediatrician Dr Iqbal Karbanee.

17 November 2014
by Dr Iqbal Karbanee

Gastro-oesophageal reflux (GOR) is a very common condition that can affect newborns up until they’re about six months old. GOR refers to the process where the milk that baby has been drinking comes up from the tummy, into the back of the throat and sometimes into the mouth. The milk that comes up can look like the milk baby has just been drinking or, if the GOR occurs sometime after the feed, will be curdled to some degree. When babies bring up a small amount of milk, this is called posseting, and is completely normal.

When is treatment needed for GOR?

When is GOR significant and in need of medical attention? The answer depends upon these factors:

1. Weight Gain. If baby is posseting, but is otherwise completely well, and is gaining weight according to what’s expected, then the GOR isn’t worrying. This type of reflux will generally resolve as baby gets bigger, particularly around six months. Treatment isn’t generally required here.

However, if your medical practitioner does feels treatment is necessary, then the usual treatment is primarily positional. In other words, once baby has had a good feed and is falling asleep, it’s best not to let baby lie down flat, as this will increase the chance of milk coming up from the tummy into the foodpipe.

Rather try to let baby sleep in a slightly elevated position with the head and shoulders raised. This has the effect of allowing the milk to settle better in the tummy. Thickening their milk feeds with a special treatment is also an option that may be necessary.

2. Acid Reflux. When GOR does occur, the milk that comes up contains acid from the stomach. In some babies, this acid affects the baby and cause baby to cry excessively, or be irritable after feeds. Because these symptoms are very general and can be due to lots of different causes, if acid reflux is suspected, it’s best to get the opinion of a child specialist. Treatment options here include antacid therapy. Antacids don’t change the amount of GOR but simply reduce the acid in the fluid that is refluxed.

One of the main dangers of GOR is when the fluid comes up into the upper part of the foodpipe and then goes into the lungs. This acid is extremely irritating to the lungs and can cause long-term damage. This is quite a rare complication but should be considered in cases of GOR where baby coughs after bringing up milk. This type of GOR responds well to antacid therapy.

Most cases of GOR resolve as the baby gets older. The very rare case of severe GOR, when accompanied by complications, may require corrective surgery. This decision should be made by an experienced child health specialist. 

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