Gastric Reflux: Re-visited and Updated

Gastric Reflux is a common problem particularly in pre term babies. It can be defined as a transient, inappropriate relaxation of the lower oesophageal sphincter allowing stomach contents to flow back into the oesophagus.

This can result in regurgitation or vomiting, which may upset the child by causing pain and discomfort or, in milder cases there may be no apparent distress related to these events.'

When there is no distress there is no need for treatment. More moderate to severe reflux should be treated because there is a link to reflux and Asthma in early childhood. 

 In practice, sick children's hospitals, and some special baby care units, use infant Gaviscon as an antacid. This is made from seaweed and forms a "jelly like " layer at the top of the stomach. The result is that this less acid "jelly" is what floats back to the oesophagus and thus pain is reduced.

The only side effect of this, and only in some infants, is constipation. Medical trials using Gaviscon Infant powder have shown that this was effective in reducing vomiting and regurgitation in episodes at 14 days, but did not reduce the level of vomiting. Another double blind trial, found no difference when Gaviscon was used.'

Some Consultant Paediatricians will prescribe medications which will reduce the amount of acid that is released into the stomach. These are only used in the short term and, once the child is established on a semi solid diet these are generally discontinued. Family Doctors are always reluctant to prescribe such medication without the overview of a Consultant.

Although symptoms of reflux can be demonstrated there is only one way to accurately diagnose reflux and that involves a short hospital stay and the passing of an acid monitor to check the level of acid in the oesophagus. This is not always reliable and most Paediatric Consultants will accept the parents description and treat this uncomfortable condition.

Using formulas which thicken on contact with stomach acids , such as Efamil AR and SMA Staydown ( both available on NHS prescription) are only moderately effective in treating reflux in otherwise healthy children.

This is because this issue is often one of mechanics, and nothing is going to make the sphincter muscle mature and perform it's function as it should, other than maturity. Using an antacid or something which will reduce the acid production, is really the only way to reduce discomfort and distress.

The first line of treatment is usually Gaviscon infant powder, and where this is successful, there is no need for further intervention. If this proves ineffective then it is worth exploring other options.

Another study, looking at positioning the infant with the head of the crib raised, found that this is not always justifiable, however, placing infants on their left side, can reduce reflux. Lying on one side is not a stable position for infants and using pillows to maintain this position is not recommended.

It is possible to use a breathable fabric rolled against the child's back and supporting the child's legs but, this needs to be done with some care to avoid overheating.

Reflux, like colic, is self limiting. It can be difficult for parents to watch an infant in distress and pain without seeking assistance to make the child more comfortable.Children affected by any degree of reflux often take longer to settle after a feed and can be fussy, because feeding does not comfort them as it would an unaffected child.