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• Propping the baby up when they’re sleeping on their back can also help


• Small frequent feeds, burping often during feedings and giving a baby a dummy can all help to lessen his discomfort


• experts reckon that breastfeeding will reduce the chance that a baby will develop silent reflux; but this isn’t guaranteed


“Baby reflux isn’t usually a cause for concern if a baby is happy and is gaining weight”


> So what symptoms do you advise patients to look out for if you think that their baby is experiencing reflux – silent or otherwise?


These are the top ten signs of reflux that are often easily spotted.


Spitting up and vomiting Spitting up is perfectly normal for babies and is normally painless. In most cases, even if a baby is spitting up, he should still appear to be happy and content. If, however, he is experiencing forceful spitting up or vomiting, then this will prove more painful for him and will often be accompanied by crying and distress. Forceful spit-up can also be a symptom of a condition called gastroesophageal reflux disease (gerD). also, if a baby is spitting up blood, green or yellow fluid, or a substance that looks like coffee grounds, this can also be a sign of gerD and, again, the patient should be advised to contact their gP for further investigation.


Frequent coughing a baby, who is experiencing reflux, may also cough frequently. This is due for the most part to acid or food coming up into the back of his throat. In addition, this regurgitated food may also be inhaled into his lungs, which can lead to bacterial pneumonia.


Failure to gain weight naturally, in the first few months of a baby’s life, health visitors and midwives will regularly check his weight. Failure to gain weight or, on


22 - ScOTTISh PharMacIST


occasion, actual weight loss can be the result of excessive vomiting or poor feeding associated with reflux.


Refusal to eat/difficulty eating or swallowing If a baby is experiencing pain while feeding due to the reflux, then he may become reluctant to eat. again, if a patient is complaining that their baby is refusing to eat or appears to be having difficulty with either eating or swallowing, then they should be advised to see their gP.


Abnormal arching


Babies suffering from reflux will often ‘arch’ their body either during or after feeding. This is the result of the painful burning sensation which is caused by the build-up of fluid that has gone back into the esophagus from the stomach.


If a baby is also spitting up or refusing to eat while arching his body abnormally, this can be another symptom of gerD.


Gagging or choking a baby experiencing reflux may appear to gag or choke while feeding. This can be extremely distressing for both parent and child. The position of the baby’s body during feeding can make it worse, so advise the patient to keep their baby in an upright position for at least 30 minutes after feeding them, as this will help to prevent food or milk from coming back up into the esophagus.


Irritability during feeding It probably goes without saying that


babies with reflux may start screaming and crying during feeding. This is usually due to abdominal discomfort or esophageal irritation.


Burps or hiccups


When a baby spits up liquid when they burp or hiccup, this is referred to as a ‘wet burp’ or ‘wet hiccup’. again, this is generally a symptom of acid reflux.


Chest pain or heartburn as with adults, regurgitated stomach contents can often irritate the esophageal lining and cause heartburn. While it is one of the most common signs of acid reflux in older children and adults, it can be difficult to recognise in babies.


Disturbed sleep


The pain and discomfort caused by reflux can often make it more difficult for a baby to sleep right through the night. The patient should be advised to feed her baby quite a while before his bedtime as this will ensure that the stomach contents have an opportunity to settle fully.


Treatment


If the patient’s gP or midwife confirms silent reflux, then antacid medication is often prescribed. There are steps, however, that the patient can take to help alleviate some of their baby’s discomfort.


• Positioning a baby with silent reflux upright during and for 30 minutes after feeds can help lessen reflux by keeping stomach contents down


• Patients should ensure that they give their baby breaks during feeds and should provide them with shorter but more frequent feeds


• Keeping baby’s head higher than their bottom during feeds may prove beneficial


• Patients should be advised about thickened ‘anti-reflux’ formula milk. While these are available on an over- the-counter basis, it’s vitally important that you provide advice to the patient as to their various options


• If a baby has a cows' milk allergy, then special formula milk that doesn’t contain cows’ milk may be recommended


Diagnosis and treatment usually, babies with reflux don’t need any tests, since the condition can often be diagnosed simply based on the symptoms detailed above. In rare cases, however, and if a gP or other healthcare professional thinks they might be helpful, then an endoscopy, ph monitoring or barium swallow test may be carried out.


Baby reflux usually doesn’t need any specific treatment but the feeding suggestions above might be helpful. In severe cases, a gP or gastroenterologist can prescribe medicines that might help with pain and discomfort. Surgery might also be recommended for a small number of babies who have underlying medical conditions, such as cerebral palsy.


When should the patient seek medical advice for her baby’s reflux?


Baby reflux isn’t usually a cause for concern if a baby is happy and is gaining weight. however, if reflux starts after six months of age, continues beyond a year or if the baby has any problems as discussed in this article, then signposting to a midwife, health visitor or gP is highly recommended.


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