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If you have a ‘sickly’ baby, it’s difficult to know whether there’s a bigger underlying problem. Dr Azam Fard, specialist paediatrician at Dubai London Clinic, explains what reflux is, and when you should visit your doctor

Interview, Health

What is reflux and why do so many babies seem to have it?
Reflux is the retrograde movement of stomach’s content (food and acid) coming up into the oesophagus. At the end of oesophagus there is a sphincter made of muscular ring called the lower oesophageal sphincter (LES). This prevents the backward movement of stomach contents into the oesophagus. The LES doesn’t function properly until a child reaches ten to 12 month of age, and that is why so many babies have reflux. Reflux in infants can be physiological, such as the occasional regurgitation or spitting up small of amounts after feeding, which you’ll see in the first few months of life. However, if an infant spits more than a mouthful, three or more times a day, you should check him or her for gastro oesophageal reflux disease or for other more serious conditions.

We keep hearing this term ‘silent reflux’. What does it mean?
Reflux is usually combined with vomiting or posseting. But, there are other text book signs which include irritability, arching of the back, choking, gagging, and an aversion to feeding which can result in weight loss. ’Silent reflux’ is when baby has reflux without actually spitting up. It means the content of their stomach doesn’t actually come out of their mouth, but it does still come up into the oesophagus, and therefore can potentially cause damage. But it is more difficult to diagnose because the child doesn’t seem to be vomiting.

Is it a potentially serious problem?
Reflux can be serious if it is persistent because it may result in several complications. Reflux can cause inflammation of the oesophagus and may cause poor weight gain due to caloric deficits. Respiratory complications caused by reflux include apnea, hoarseness and chronic coughs because the throat becomes irritated.

What can parents do to help alleviate the symptoms?
When a child is diagnosed with gastro oesophageal reflux disease (GERD), therapy is devised on a step-by-step basis to control the reflux. In general, when feeding, make sure the baby does not swallow air. Burping after feeding to help remove air from the stomach and decrease distension, can relieve the amount of posseting that’s occurring. Keep the baby upright for about 20 minutes after feeding, and avoid any bouncing movements. Eliminate exposure to tobacco smoke too as this seems to aggravate reflux symptoms. Other measures need to be advised by your doctor and may include, in the case of bottle feeding, thickening of milk or using a commercially pre thickened formula. Or, if a milk allergy is suspected, a short trial of a hypoallergenic diet may be tried. Correct positioning of the infant is very important. For example, the sitting position worsens reflux, while elevating the head of the bed or bassinet is helpful in decreasing it.

Do children always grow out of reflux? If so at what age can you expect to see an improvement?
Infant reflux begins in the first few month of life and peaks at about four months of age. In more than 80 per cent of cases, infant reflux is resolved by 12 months – and nearly always by 24 months of age.

Does it ever require surgical intervention?
In majority of cases as described above reflux is resolved within 24 months; however, in severe cases Surgery is the effective treatment when the reflux is very difficult to control and in those with chronic lung disease.

If you suspect your child has reflux, who is the person to talk to?
Due to the impact of reflux on infants’ sleep, eating, growth, and behaviour, it is important to first discuss the issue with the paediatrician. If further investigation is required, the paediatrician may then refer the infant to a gastroenterologist.

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