Treating Infants with GERD

Treatment of infant reflux depends on the severity of the problem. Your baby's doctor may decide no treatment is needed, that the reflux will disappear on it's own as your baby grows older. For most babies, reflux will resolve itself during the first year of life. If your baby is otherwise healthy, happy, and growing, your doctor may recommend a few lifestyle changes for your baby in order to ease her reflux problem. These include:

Hold Baby Upright
Keep infants upright during feedings, and for at least 30 minutes after feedings. This will decrease the amount of gastric reflux.

Nighttime Sleep Position
As noted above, position your infant on his back, and elevate the head of the bed 30 degrees. Gravity will help keep stomach contents where they belong.

Try Smaller, More Frequent Feedings
Feedings every two to three hours when the infant is awake will reduce the occurrence of gastric reflux. Overfeeding can increase abdominal pressure, which can lead to gastric reflux.

Rice Cereal May Help
This can reduce the amount an infant will regurgitate. Start with one teaspoon of rice cereal to each ounce of formula. If the baby is breast-feed, try pumping and then adding rice cereal to the breast milk.

Diet Modifications for Mothers who Breastfeed
Certain foods -- such as caffeine, chocolate, and garlic -- can promote reflux, so if you breastfeed your infant, you should consider cutting these foods out of your diet.

Infant Seats and Car Seats
The way the infant is positioned in the car seat can cause regurgitation to increase. If the infant slouches over, it causes abdominal compression, increasing the risk of reflux. Using simple supports to keep the infant upright will prevent this.

Burping the Infant
Burping your infant several times during the feeding will help minimize gastric pressure, and the reflux it can cause. Waiting to burp your infant until after she has a full stomach can increase the chances of regurgitation.

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If the reflux is more serious, or if your baby has been diagnosed with GERD, the doctor may prescribe a prescription medication or over-the-counter remedy to help treat the reflux. These remedies include: Acid Suppressers - These suppress acid production in the stomach. These include Tagamet, Pepcid, Zantac. and Axid. Acid Blockers - These completely block acid production in the stomach. Prilosec and Prevacid have been approved for children over certain ages. It is very important to discuss treatment options with your baby's doctor before beginning any treatment method, especially before using any over-the-counter remedy.

Sources:

"Gastroesophageal Reflux in Infants." NIH Publication No. 06-5419 August 2006. National Digestive Diseases Information Clearinghouse (NDDIC). 06 Mar 2008

"Heartburn, Hiatal Hernia, and Gastroesophageal Reflux Disease (GERD)." NIH Publication No. 03-0882 June 2003. National Digestive Diseases Information Clearinghouse. Accessed on 06 Mar 2008

Marsha Kay, M.D., Vasundhara Tolia, M.D. "COMMON GASTROINTESTINAL PROBLEMS IN PEDIATRIC PATIENTS." The American College of Gastroenterology. 06 Mar 2008

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Treating GERD

If you have had heartburn or any of the other symptoms for a while, you should see your doctor. You may want to visit an internist, a doctor who specializes in internal medicine, or a gastroenterologist, a doctor who treats diseases of the stomach and intestines. Depending on how severe your GERD is, treatment may involve one or more of the following lifestyle changes and medications or surgery. If you smoke, stop. Do not drink alcohol. Lose weight if needed. Eat small meals. Wear loose-fitting clothes. Avoid lying down for 3 hours after a meal. Raise the head of your bed 6 to 8 inches by putting blocks of wood under the bedposts--just using extra pillows will not help.Your doctor may recommend over-the-counter antacids, which you can buy without a prescription, or medications that stop acid production or help the muscles that empty your stomach.

 Antacids
Antacids, such as Alka-Seltzer, Maalox, Mylanta, Pepto-Bismol, Rolaids, and Riopan, are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. Many brands on the market use different combinations of three basic salts--magnesium, calcium, and aluminum--with hydroxide or bicarbonate ions to neutralize the acid in your stomach. Antacids, however, have side effects. Magnesium salt can lead to diarrhea, and aluminum salts can cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects. Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can also be a supplemental source of calcium. They can cause constipation as well.

Foaming agents
Foaming agents, such as Gaviscon, work by covering your stomach contents with foam to prevent reflux. These drugs may help those who have no damage to the esophagus.

H2 blockers
H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), impede acid production. They are available in prescription strength and over the counter. These drugs provide short-term relief, but over-the-counter H2 blockers should not be used for more than a few weeks at a time. They are effective for about half of those who have GERD symptoms. Many people benefit from taking H2 blockers at bedtime in combination with a proton pump inhibitor.

 Proton pump inhibitors
These include omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which are all available by prescription. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms in almost everyone who has GERD.

 Prokinetics
Another group of drugs, prokinetics, helps strengthen the sphincter and makes the stomach empty faster. This group includes bethanechol (Urecholine) and metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract, but these drugs have frequent side effects that limit their usefulness.

Because drugs work in different ways, combinations of drugs may help control symptoms. People who get heartburn after eating may take both antacids and H2 blockers. The antacids work first to neutralize the acid in the stomach, while the H2 blockers act on acid production. By the time the antacid stops working, the H2 blocker will have stopped acid production. Your doctor is the best source of information on how to use medications for GERD.

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The preceding information was adapted from the National Digestive Diseases Information Clearinghouse, NIH Publication No. 03-0882 June 2003

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