Treating Gastro-Oesophageal Reflux in Infants and Children

Written by the Reflux Infants Support Association (RISA) Inc. Content reviewed by Associate Professor (Adjunct) Jeanine Young, Nursing Director – Research, Royal Children's Hospital & Health Service District, Brisbane

Acid Reflux and Gastro-Oesophageal Reflux Disease (GERD) are closely related, but the terms aren't necessarily interchangeable. Sometimes acid reflux progresses to GERD, a more severe form of reflux. GERD is a common medical issue for children of all ages.

It occurs when the stomach contents (including food and stomach acid) flow upwards into the oesophagus (foodpipe). It is commonly seen in babies as they vomit following a feed, although not all children with this condition will vomit. Among the many signs and symptoms these children can experience irritability, sleeping and settling issues, feeding difficulties and back arching.

If you suspect your child may have gastro-oesophageal reflux, or if you have any concerns, it's important to discuss this with your child’s doctor. A thorough medical assessment is required before a diagnosis of gastro-oesophageal reflux can be made as there are many conditions that can present similarly.

Once gastro-oesophageal reflux is diagnosed the type of treatment needed is determined, taking into account the severity of your child’s reflux, any complications, and age. In some situations medical advice and reassurance is needed, while for others it may take time to find the right treatment. For many, the first line of treatment includes lifestyle changes however if your child’s symptoms are severe or persistent, your doctor may also consider treatment with medication or referral to a paediatrician or paediatric gastroenterologist. A very small percentage of children with reflux may ultimately require surgery.

Nurses, health professionals (speech pathologists, dietitians, psychologists) and complementary medicine therapists (osteopaths, chiropractors, massage therapists, Bowen therapists) may also play a role, depending on the issues being faced, and the family circumstances. Finding the right treatment for your child may take time, and it can help if you listen to your instincts, keep looking for answers, and consult your doctor.

Suggestions for Lifestyle Changes

Talk to your doctor whenever you have any questions or concerns.

For Infants (up to the age of two years)

Feed your infant in an upright position, if possible, and keep them upright for at least thirty minutes after each feed. Held up to your shoulder is a good position. Avoid the upright seated position (car seat positioning) during this time as this can cause more episodes of reflux
Avoid slumping as this can increase intra-abdominal pressure and cause more reflux episodes
Avoid exposure to tobacco smoke
For some infants with reflux, a dummy may be useful to help settle the baby. Consider a dummy if you're comfortable with the idea. Talk to your child health nurse if you are unsure about using a dummy or need more information about potential advantages and disadvantages.
When possible, change baby’s nappy before rather than after the feed. Avoid tight nappies and elastic waistbands
Try feeding baby smaller amounts more often
Avoid overfeeding; talk to your child health nurse if you are unsure
Try burping baby frequently during feeds
Avoid vigorous movements or bouncing baby
Consider whether food allergies or intolerances may be a factor in your child’s reflux; and talk to your doctor about the possibility. Cow’s milk allergy in particular is commonly associated with gastro-oesophageal reflux. 1
Follow the SIDS and Kids safe sleeping recommendations for positioning your baby for sleep. To reduce the risk of sudden infant death and sleep baby safely, you can 2:
Sleep your baby on their back from birth – never on their tummy or side. (Side positioning is unstable and not recommended as an alternative to sleeping baby on their back. Aids and devices intended to keep baby in certain sleep positions are not recommended.) 2, 3
Sleep your baby with their head and face uncovered
Avoid exposing your baby to cigarette smoke, before and after birth
Sleep your baby in their own cot or bassinette in the same room as you for the first six to twelve months
Provide a safe sleeping environment, night & day: safe cot, safe mattress, safe bedding & safe sleeping place
For further information, go to www.sidsandkids.org
If your baby is under twelve months of age, elevating the head of the bed is not supported by evidence from research studies 4

For Children (over the age of two years)

Adapt strategies for younger children e.g. avoid lying down for several hours after meals, eat smaller meals more often
Help your child to have good eating habits and make healthy decisions
Help your child to avoid large meals, especially before bedtime or exercise
Encourage your child to wear loose, comfortable clothing (and to lose weight if overweight)
Minimise foods and drinks that cause irritation or increase the risk of reflux eg spicy foods, citrus fruits, tomatoes and other acidic food, peppermint, carbonated drinks and fatty foods. “Difficulty with any foods may be indicators that investigation for suspected food intolerance should be considered.” Joan Breakey, dietitian
Elevate the head of their bed as it may be helpful in reducing reflux
Encourage them to sleep on their tummy or on their left side as this may help reduce episodes of reflux

Written by the Reflux Infants Support Association (RISA) Inc
Content reviewed by Associate Professor (Adjunct) Jeanine Young, Nursing Director – Research, Royal Children's Hospital & Health Service District, Brisbane

PO Box 1598 Fortitude Valley QLD 4006
Ph: (07) 3229 1090 Email: info@reflux.org.au

References
1. Salvatore, S., and Vandenplas, Y. "Gastroesophageal Reflux and Cow Milk Allergy: Is There a Link?" Pediatrics 110, no. 5 (November 2002): 972 - 84.
2. SIDS and Kids. (2007). Sudden Unexpected Death in Infancy (SUDI) Frequently Asked Questions. Melbourne: SIDS and Kids.
3. Queensland Health. (2008). Queensland Health Policy: Safe infant care to reduce the risk of sudden unexpected deaths in infancy. Brisbane: Queensland Health.
4. Craig, W. R., Hanlon-Dearman, A., Sinclair, C., Taback, S., & Moffatt, M. (2004). Metoclopramide, thickened feedings, and positioning forgastro-oesophageal reflux in children under two years (Review). Cochrane Database of Systematic Reviews (3), Issue 3. Art. No.: CD003502. DOI:10.1002/14651858.CD003502.pub2.