Did you know that gastroesophageal reflux (GER) in infants is very common? According to the National Institutes of Health, about half of all infants spit up in the first 3 months of life and it typically resolves by 12-14 months of age. GER occurs when the lower esophageal sphincter, which is the opening between the esophagus and stomach, opens spontaneously, for varying periods of time, or does not close properly. This allows stomach contents rise up into the esophagus. Adults know GER more commonly as acid reflux, because digestive juices (acids) rise up with the food.
When does GER become GERD?
Occasional GER episodes are common, like when you burp and it brings up some acidic juices from the stomach. So if GER sometimes happens to your baby it doesn’t necessarily mean they have GERD, which is gastroesophageal reflux disease. If the reflux is persistent and happens more than twice a week, then it may be considered GERD, which can lead to more serious health problems for babies including failure to gain weight, bleeding, respiratory problems or esophagitis.
Some or all of the following symptoms may indicate your baby could have GERD:
- Vomiting or spitting up frequently
- Pain associated with regurgitation
- Back arching
- Refusal to eat
- Constant or sudden crying
- Chronic hiccups
- Irritability or fussiness
- Weight loss or poor weight gain
- Gagging or trouble swallowing
If you think that your little one’s reflux is serious and might be GERD, check in with her pediatrician, who may refer you to a pediatric gastroenterologist.
Does GERD become EoE?
If your child’s reflux symptoms are not improving despite your best efforts with your doctor, your child may have a disorder known as eosinophilic esophagitis, or EoE. If you would like to read more about EoE, make sure to read a previous post that takes a deeper dive into Eosinophic Esophagitis.
The symptoms of GERD and EoE may be similar, and both conditions can result in a small type of white blood cell – an eosinophil – hanging out in the tissues of the esophagus, where it normally doesn’t belong. (The picture above shows with eosinophils look like under a microscope!) When the eosinophils are in the esophagus due to GERD, they will go away once the GERD is under control.
An esophageal biopsy is needed to make a diagnosis of EoE, and it’s done after trying a GERD medication for a few weeks. The biopsy requires a procedure to look closely at esophagus and to take a small sample of cells to look at under a microscope. If that sample has a high number of eosinophils (≥15 per high power field), then your child may be diagnosed with EoE. It is the physician who makes the final diagnosis of EoE or GERD.
How can diet be used to managed GERD and EoE?
Some babies, GER may be related to a cow milk allergy and/or other food allergies. Essentially the reflux can be one side effect of the food allergy when it isn’t managed and the allergen is still in the baby’s diet. If that is the case for your infant, then she doesn’t have GERD, and symptoms can be managed with a hypoallergenic formula like Neocate. In other cases, though, reflux can happen unrelated to food allergies. When food allergies aren’t the culprit, the management options depend on the patient, but often include prescription medications. In some cases surgery can be helpful.
Management of EoE may include medication and/or dietary adjustment. The diet sometimes includes a special diet with a hypoallergenic, amino acid-based formula like Neocate. The Neocate family of products can be used for infants, children, adolescents and adults. There are powdered products like Neocate Syneo Infant and Neocate Junior, as well as ready-to-drink liquids like E028 Splash and Neocate Splash Unflavored. If your little one is diagnosed with EoE, make sure the healthcare team takes the time to explain all of the options, answer your questions, and help you decide on the best approach for your family. Your healthcare provider should be sure to help you find the soluation that will best suit your child’s needs.
Ellen Sviland-Avery joined the Nutricia team during the summer of 2014. She has extensive experience in pediatrics, metabolics and tube feeding. Prior to coming to Nutricia, she worked in home infusion. She has been a registered dietitian for more than 12 years. Her passion in pediatric nutrition started when she was in Birmingham working with children with neurodevelopmental disabilities and has continued throughout her career.