Reflux

Introduction

Reflux is also known as gastro-oesophageal reflux, or GOR. It is when the contents of the stomach are brought back up into the oesophagus or the mouth after eating.

The oesophagus is a tube that leads from the mouth to the stomach with a valve that stops food and stomach acid from coming back up. Reflux is when the valve at the top of the stomach opens back up, allowing stomach acid and contents to travel upwards. This can be caused by muscle weakness or underdevelopment, and increased pressure or pushing from the stomach.

In babies, reflux is often called posseting. Posseting is common and happens after feeding with the breast or bottle.

Reflux should usually stop by about 12 – 18 months of age, unless there are other health issues including:

• conditions that affect the muscles, like cerebral palsy
• taking certain medications
• exposure to cigarette smoke
• obesity.

Some children can develop complications from ongoing reflux. This is called gastro-oesophageal reflux disease (GORD).

Most babies and children with reflux should gain weight and develop normally, even if it seems like they bring their milk or formula up quite often. Reflux may feel unpleasant but should not cause any distress.

Babies with GORD can bring their milk or formula up often while also having symptoms like:

• irritable and unsettled behaviour, especially after feeds
• difficulty settling to sleep
• arching of the back
• poor weight gain
• choking, gagging, or coughing during feeds.

See your local doctor as soon as possible if your child develops the following symptoms:

• vomit stained with blood that looks dark, like coffee grounds
• sudden weight loss
• black, tar like poo
• blood or mucus in poo
• refusing to eat
• bloated or swollen stomach with pain
• fever
• persistent regurgitation after 18 months of age
• vomit that is a yellow or green colour.

If your child’s vomit is a colour ranging from yellow to dark green, call triple zero (000) for an ambulance or go to your nearest emergency department. This is called bilious vomiting and can be a sign of an emergency bowel obstruction.

Your child’s doctor or maternal child and family health nurse can generally tell if they have reflux from their health history, watching a feed and by doing an examination. If regurgitation or posseting is the only symptom of reflux and your child is otherwise healthy, further tests are not necessary.

If your doctor or nurse thinks your child might be having complications from reflux, they may order special tests including:

• a barium swallow x-ray - where your child drinks a special liquid that helps show swallowing on an image
• oesophageal pH or impedance study – where a small tube is inserted into the stomach through the nose to measure the amount of reflux that happens over 24 hours
• endoscopy – where a thin camera is inserted down the oesophagus to check for any damage caused by reflux.

Reflux does not usually require any treatment. In most cases, it will resolve by itself in time. Reflux and GORD can be distressing for parents and babies as it can cause disruption to normal feeding, sleeping, and crying patterns. You and your baby are struggling with managing reflux, speak to your local doctor, or maternal child and family health nurse for advice and safe strategies.

Things you can try at home include:

• following safe sleep recommendations of placing baby on their back to sleep, on a firm, flat mattress
• keeping baby as comfortably upright as you can during breast and bottle feeding
• giving baby time to rest after a feed by keeping them upright and reducing movement and stimulation, like bouncing or playing
• not smoking around your child, or in areas that your child will be like the car or house.

Depending on how severe your child’s GORD is, or any other complications, their doctor may prescribe medication or recommend a change in their diet.