Infant reflux occurs when food backs up from a baby’s stomach, causing the baby to spit up. Also called gastroesophageal reflux (GER), the condition is mostly harmless and becomes less common as the baby grows up. It is very rare for infant reflux to continue once the baby turns 18 months old. Reflux can happen in a healthy infant multiple times a day. As long as the baby is healthy, content, gaining adequate weight and milestones are normal, reflux is not a cause for concern.
Signs and symptoms of Reflux in Babies
- Bringing up milk or being sick during or shortly after feeding
- Coughing or hiccupping when feeding
- Being unsettled during feeding
- Swallowing or gulping after burping or feeding
- Crying and not settling
- Back-arching
- Having screaming episodes, and being difficult to settle
- Drawing legs up
- Not gaining weight
- Discomfort on lying flat
Causes of Reflux in Babies
- First 6 months of life, infants spend much of their time lying down and do not have a fully developed oesophagus and lower oesophageal sphincter. They also eat larger liquid meals, relative to their body size, than older children or adults. So the chance of their stomach contents coming back up into the oesophagus is higher. It starts to reduce as the baby starts sitting erect, eating more solid foods as part of growing up.
- Premature birth
- conditions that affect the lungs, such as cystic fibrosis
- conditions that affect the nervous system, such as cerebral palsy
- hiatal hernia
- previous surgery to correct esophageal atresia
Pathophysiology of Reflux in Babies
The primary mechanism of reflux in neonates especially in preterm infants is transient lower oesophageal sphincter relaxation (TLESR). TLESR is a reflex caused by a decrease in lower oesophageal sphincter (LES) pressure to levels at or below intragastric pressure. It is not related to swallowing. Preterm infants have many TLESR each day, most of which are associated with GER. GER is normal in infants, exacerbated by a pure liquid diet and age-specific body position. GER is seen more immediately after a feeding, likely because of gastric distension. Body position also influences it. The prone position also decreases episodes of GER than supine position, likely because of more optimal positioning of the LES relative to the distended stomach. Mechanisms to protect the oesophagus and airway from GER is intact even in the preterm babies with reflex forward peristalsis of the oesophagus after distention from refluxate in the lower oesophagus. It happens with the closure of the upper oesophageal sphincter to prevent reflux from reaching the pharynx. And if refluxed food gets into the upper oesophagus, the upper oesophageal sphincter will reflexively open to allow the material into the pharynx, which results in the frequent emesis observed in infants.
Diagnosis of Reflux in Babies
- Upper gastrointestinal (GI) endoscopy
- Oesophageal pH monitoring
- upper GI series
Treatments of Reflux in Babies
Lifestyle changes like
- avoid exposing the infant to passive smoking
- burp the infant more often.
- change the infant’s diet.
- hold the infant upright for 20 or 30 minutes after he or she eats, if practical
- An infant should always be placed on his or her back for sleep
Medicines like proton pump inhibitors (PPIs) or H2 blockers are used in some cases.
Prognosis of Reflux in Babies
Mostly self-limiting, and self-relieving
Complications of Reflux in Babies
Esophagitis
Poor weight gain
Cough
Laryngitis
Pneumonia
Wheezing
Ayurvedic Concept of Reflux in Babies
Sisuchardi
Ayurvedic Nidana of Reflux in Babies
Unwholesome diet of the mother
Bad quality of breast milk
Ayurvedic Purvaaroopa of Reflux in Babies
Not mentioned
Ayurvedic Samprapti of Reflux in Babies
Not mentioned
Ayurvedic Lakshana of Reflux in Babies
Frequent belching without any reason
Excessively sleepy baby
Excess yawning
Ayurvedic Divisions of Reflux in Babies
Not mentioned
Ayurvedic Prognosis of Reflux in Babies
Saadhya
Ayurvedic Chikithsa of Reflux in Babies
While describing Ayurvedic treatment of babies, Acharya explains that, for any disease developed in a baby who is only breastfed, medicines and treatments are recommended only for the mother unless an emergency condition.
Chardi in babies are very common and usually is self-limiting. It gets better with time as the baby starts crawling and walking. Taking solid foods also helps the baby to get rid of frequent vomiting.
So, treatment is needed only when the nourishment is compromised and the child is weak & sick.
Samana
Aamappaachana and agnideepana with medications to the mother
Sodhana
Vamana and virechana for the mother only in needed cases
Commonly used Ayurvedic medicines for Reflux in Babies
Dhanwantaram gulika
For Mother
Panchakolasavam
Abhayarishtam
Soothikamrutham
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies for Reflux in babies
Tap the baby’s back and let him release the air ingested while feeding through the mouth.
Diet(mother)
- To be avoided
Heavy meals and difficult-to-digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, obstruct channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, fresh fruits & vegetables
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from extreme hot & cold climates.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid a sedentary lifestyle. Be active.
Yoga for Reflux in Babies
Regular stretching and mild cardio exercises are advised for otherwise healthy mothers. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve the bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles of Reflux in Babies
PMID: 31861951
A multicenter perspective cross-over study was conducted in formula-fed infants with persisting regurgitation, randomly assigned to receive two weeks of a magnesium-alginate-based formulation followed by two weeks of thickened formula, or vice-versa. Infants, exclusively breastfed, were followed up for two weeks while receiving magnesium alginate. Symptoms of gastroesophageal reflux (GER) were evaluated through the Infant Gastroesophageal Reflux Questionnaire-Revised (I-GERQ-R). The direct cost of treatments was also calculated. Seventy-two infants completed the study. The researchers found a significant reduction of I-GERQ-R scores over time in all groups with no difference between the sequences of administration in formula-fed infants and between exclusively breast-fed and formula-fed infants receiving magnesium alginate. The mean cost savings per infant was lesser in formula-fed infants treated with magnesium alginate compared to thickened formula. Conclusions were that the magnesium-alginate formulation reduces GER symptoms both in formula-fed and breast-fed infants. In formula-fed infants, clinical efficacy is similar to thickened formulas with a slightly lower cost of treatment.
*These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake. All the Ayurveda Supplements mentioned here are in the Indian Market with GMP Certification from India
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
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