COMMON CHARACTERISTICS OF REFLUX

VOMITING

• Those infants who vomit can: -

• Merely regurgitate, ruminate, or posset down their chins and clothing; or
• Projectile vomit with food literally being forced out, sometimes through their nostrils. (Beware- there are other reasons why an infant might projectile vomit. It is important to have these infants seen by a doctor for a correct diagnosis).

• Vomit can take the form of

• Unchanged milk or undigested food
• Curdled milk or partly digested food
• Stomach contents
• Fresh blood, coffee-grounds appearance or bile in vomit

• The number and amount of vomits vary. Reflux infants/children may vomit without discretion- anytime, anywhere, over anybody or anything!

• Reflux (and vomiting) may lessen when the infant sits up and in some cases worsen when they crawl. Some infants may stop vomiting when they become upright but may still reflux stomach contents into their oesophagus many times a day. This may cause as much or more discomfort to them as vomiting. They may still have symptoms but the signs may have changed. If you are concerned about this possibility, please discuss your concerns with your doctor.

• Doctors may consider a milk protein sensitivity in a child who vomits

SILENT REFLUX

• Not all infants suffering from reflux actually vomit; some may have what is termed ‘silent’ reflux- where the stomach contents only come part way up the oesophagus. Any form of reflux may disturb the baby and cause problems.
• Since the signs of silent reflux are not always obvious, it can be difficult for doctors to confirm the condition, and for a diagnosis to be made.
• Silent reflux can sometimes be more damaging because it can sit in the oesophagus longer.
• Some babies with silent reflux will feed as a means of soothing their pain, so they may not have issues with their weight like other reflux babies do. This can further delay diagnosis and treatment as the problem is sometimes overlooked.
• Medical intervention is often necessary and the same complications can arise as in other forms of reflux.
• Your baby may suddenly start crying while feeding, or after the feed, without any other obvious cause for the crying, or they may grimace, or make a screwed up face like they are tasting something bad. They may be.
• You may notice any of the other signs of reflux apart from the obvious one; vomiting. Sometimes you may hear the baby reflux, or see them swallow repeatedly, and see no evidence of it.

PAIN AND IRRITABILITY

• Irritability can cover such symptoms as screaming, whinging, crying, fussiness and inconsolable behaviour.
• These signs can occur at any time of the day or night, and commonly occur during and after feeding and when the infant is laid down.
• These infants may be described as ‘colicky’ or ‘windy’ because of their irritability and failure to settle after feeds.
• Some infants display clinginess, extreme sensitivity, and other behaviours as a result of pain. Many appear to be overly sensitive to noise, which may be because they are not getting enough sleep, or are simply ‘on edge’.
• These children can be happy sometimes when they are distracted e.g. they smile at the doctors, when visiting grandma or at the shopping centre.
• Some children shove their hand/fist/fingers down their throat, and may even gag themselves because of pain/oesophagitis.
• Parents may have a ‘gut feeling’ that their child is in pain.

FEEDING ISSUES

• Some are difficult feeders. Behaviours may include;

• Distress during feeding
• Fussing at breast/bottle- may fight/pull off after a short time
• Back arching, squirming, pushing breast/bottle away and general distress during feeding (some are happy between feeds).
• Screaming and refusal to feed (or only taking a small amount) despite being hungry
• Crying during or after feeds, but may be happy between feeds
• Taking relatively small amounts of food
• Nervous, excitable, easily over-stimulated. Even talking may interrupt these infants; a darkened room, a routine of soft music or absolute quiet is necessary for some to feed.
• Displaying a fear of food, or an unwillingness to eat.
• Gagging / spluttering, or having problems swallowing
• Older children may be particularly fussy eaters.

• Some babies’ comfort feed. Their behaviour includes: -

• Feeding frequently
• Unhappy unless feeding, or showing signs of wanting to be fed frequently
• Sucking vigorously
• Huge weight gains
• Some may even have a large number of wet nappies in a day

• Reflux occurs in both breast and bottle-fed babies.

• Changing from breast to formula feeding will usually not solve the problem. Remember it is the fact of putting something in the stomach- it may not matter whether it’s breast or bottle.

• Some babies can be inconsistent with weight gain. Most infants gain weight well, however a small percentage fail to thrive due to feeding difficulties (or excess vomiting).

SLEEPING ISSUES

• There is a high incidence of sleep disturbance among these infants.
• Some reflux infants are more comfortable in an upright position and they generally object to being laid down.
• Most are frequent night wakers, however it is not uncommon for some reflux babies to sleep through the night
• Some babies take ‘catnaps’. They may only sleep for five minutes before waking again in a distressed state.
• Some are easily disturbed from sleep.

WEIGHT ISSUES

Most infants gain weight well, however a small percentage can be inconsistent with weight gain, and some may be labelled failure to thrive.

• They may have poor growth as a result of feeding disturbances or excess vomiting. Inadequate food remaining in the digestive system means the child may not retain enough food to maintain growth.
• They may have high energy needs as a result of complications of their reflux (e.g. severe respiratory issues)
• An intolerance or allergy to milk protein can cause problems with the nutrients being absorbed properly. Also, if a restricted diet is not medically supervised, there may be inadequate replacement of foods that need to be avoided.
• There may be a combination of these factors that contribute to the growth issues.
• Some children have huge weight and weight gains, particularly if they feed frequently for comfort.
• Weight issues do not necessarily reflect the severity of a child’s reflux. Some infants/children can have normal weight and weight gains even with significant reflux.

OTHER CHARACTERISTICS

• Reflux may be hereditary and is quite common in premature babies.
• Many parents report that their child’s reflux often worsens if their child becomes ill (e.g. with a cold or infection), is teething, has immunizations, is overtired, out of routine, constipated, or even if the weather changes dramatically. It may also worsen when their baby is crawling or learning to crawl.
• Signs and symptoms in relation to severity are quite variable.
• Reflux can be cyclic. The child can also go through quite “normal” phases where the problem appears to be improving and then re-occurs quite suddenly, sometimes for no apparent reason.
• Occasionally infants can be seen to hold their head to one side in an unusual position to ease their discomfort (called Sandifer’s Syndrome)
• In most children, reflux signs generally disappear before they turn 2 yrs, but they do occasionally continue or recur. They may sometimes recur or worsen during times of stress or when the child loses their baby teeth, or cuts their adult ones.
• Signs and symptoms may change as the child gets older.
• The amount of pain does not necessarily correlate to the amount of inflammation or damage seen with testing. Some children can have severe pain, and show no inflammation, while others can have no pain and show signs of severe inflammation.
• Older children may develop behavioural issues such as crying easily or losing ‘the plot’ over small issues, having temper tantrums (extreme or outside of the normal age range), being clingy, difficult to reason with, or displaying self-harming behaviour (e.g. head banging).