Your baby can bring up food when the valve-like mechanism (lower oesophogeal sphincter) between her oesophagus and tummy momentarily relaxes. This allows tummy contents to come back up. It’s a type of vomiting and is sometimes called ‘posseting’.
We don’t know exactly what causes gastro-oesophageal reflux. It might rarely be associated with a hernia, which is when the bowel bulges upwards through the diaphragm (hiatus hernia).
The symptoms of gastro-oesophageal reflux usually develop within the first month after birth. Your baby might begin to vomit milk – this can happen all the time during, between and after feeds.
Most children with reflux will grow out of it by the time they become toddlers. This is probably because they’re spending more time in an upright position by this age. They’re also eating more solid foods. A small number continue to have symptoms after the toddler period.
In some babies, vomiting of the acid contents of the tummy into the oesophagus will very occasionally lead to complications. In this case, your baby might have gastro-oesophageal reflux disease (GORD).The symptoms associated with GORD might include pain and discomfort of the oesophagus. This might cause irritability and crying. Children might also arch their backs.
Sometimes your baby’s sleep might be upset or your baby might show poor weight gain. You should also look out for a chronic cough and wheeze, which might be associated with GORD.
When to see your doctor
You should see your doctor if your child:
- has bile (green fluid) or blood in her vomit
- finds it difficult to swallow
- has a fever
- is irritable and difficult to settle a lot of the time
- won’t eat
- is losing weight or not gaining any weight according to basic guidelines.
Usually, no tests for reflux are necessary.
In a small number of children, particularly those who have complications of reflux, doctors might recommend pH monitoring (checking the level of acid) to see whether there’s too much acid from the stomach in the oesophagus. This is done by placing a tiny probe in the baby’s oesophagus for 24 hours.
Sometimes the doctor might want to have a look at the lining of the oesophagus. This test is called an endoscopy and is done under anaesthetic.
If your baby’s reflux is mild, and his weight gain is OK, you might try nursing him in a more upright position to ease the problem.
Propping your child up in a cot or placing her on her tummy for an hour after feeds can also help. Sleeping on the tummy has been linked to Sudden Infant Death Syndrome (SIDS), though, so you shouldn’t leave your baby alone in this position.
If your child seems to be in pain after vomiting, or isn’t gaining enough weight, your doctor might prescribe an acid suppressant. The doctor might also recommend thickening formula or using pre-thickened formula for formula-fed babies, or thickening breastmilk with rice cereal or a thickening agent for breastfed babies.
Your doctor can advise you on the most appropriate treatment for your baby. It’s always advisable to consult your doctor if your baby is vomiting a lot with feeding.