MANNAGING STOMACH REFLUX IN CHILDREN: A SIMPLE GUIDE

Interestingly, milk or acid reflux reflux is not always acidic! However, it stomach reflux a common term for a condition known as Gastro-oesophageal reflux (GOR) among medics.

This might sound like a complex medical term, but in simpler words, it's when stomach contents come back up into the oesophagus (the tube that connects the mouth to the stomach). While this might happen occasionally in adults and babies, it can be a bit trickier when it comes to children. Let's dive into what you need to know about gastro-oesophageal reflux in children.

What Causes this reflux in Children?

In babies and young children, the muscles that keep food down in the stomach might not be fully developed, which can lead to reflux. This is usually a very normal part of growing up. You would be surprised at how common this is among children. Most children grow out of it naturally as their musculature grows stronger as part of growing. 

Additionally, their diet, the way they are fed (like being laid flat during or after feeding), and certain medical conditions can contribute to reflux.

My most important advice to parents is not to panic at mild symptoms because this is quite a natural and common symptom in childhood.

Signs and Symptoms

Spotting gastro-oesophageal reflux in children can sometimes feel like detective work. Look out for:

1. Spitting Up:  If your child often spits up after feeding, it could be a sign of reflux.

2. Irritability: Sometimes, children might be irritable, especially during or after feeding.

3. Arching Back: If your child arches their back during or after feeding, it might be a discomfort caused by reflux.

4. Coughing or Wheezing: Reflux can sometimes cause coughing or wheezing, especially when lying down.

5. Heartburn

6. Pain in chest

7. Pain in upper tummy, just below the ribs in the centre.

Common questions answered and myths busted:

1. Is this common in children?

It is s very common in children. In fact, it affects at least 40% of children under 1 year of age.

2. What age does it usually start?

Symptoms usually begins before your baby is 8 weeks old.

3. How frequent are the symptoms?

Symptoms may be quite frequent. In fact, 5% of those affected can have 6 or more episodes each day.

4. Do symptoms of reflux settle with time?

Yes, indeed. In most cases, symptoms resolve naturally with time. In about 90% of children, these self-resolve before the child is 1 year of age.

5. Would my child need special investigations or treatment?

I know you feel worried and anxious to see your child distressed due to these symptoms. 

However, I wanted to take the opportunity to reassure you that in most cases, children do NOT need any special investigations or treatment.

Diagnosis and Management

If you suspect your child has gastro-oesophageal reflux, it is useful to consult a healthcare professional. They might ask about your child's symptoms and medical history. In most cases, your children would not need any investigations or treatment. 

In a few cases with significant symptoms of distress, they might recommend tests like pH monitoring or an upper GI endoscopy to confirm the diagnosis. However, in most cases, reflux can be managed at home with simple strategies.

When it comes to managing reflux in children, here are some tips:

1. Feeding Changes: Modifying feeding techniques like holding your baby upright during feeds and avoiding overfeeding can help reduce reflux.

2. Positioning: Keeping your child upright after feeding and elevating the head of their crib can also minimize reflux episodes. However, these positional strategies should not be used when your child is sleeping.

3. Feeding changes: In some cases, your healthcare professional may advice beast feeding advice. In other cases, only after review by your healthcare professional, you may be advised strategies like reducing feed volumes (only if excessive for your baby’s weight), offering a trial of smaller but more frequent feeds, or a trial of thickened formula ( for example, rice starch, corn starch etc.)

4. Use of @Gavison: In babies with significant symptoms, your healthcare professional may advice a trial of alginate therapy. The most commonly used alginate product is @Gaviscon.

3. Medication: Please note that medication is only reserved for most complicared cases only. Otherwise there is a risk of medicalising this natural condition. In a very few cases with associated complications and significant symptoms, your healthcare provider might prescribe medications like proton pump inhibitors or H2 receptor antagonists to reduce stomach acid and alleviate symptoms.

When to Seek Medical Help

While most cases of gastro-oesophageal reflux in children can be managed with lifestyle changes, it's essential to seek medical help if:

- Your child is experiencing severe symptoms like breathing difficulty or swallowing problems

- Reflux symptoms persist despite lifestyle changes and medication.

- Your child is not gaining weight or is losing weight.

- If the regurgitation becomes more persistently projectile

- there vomiting is bile‑stained (green or dark green) or there is blood in vomit

- symptoms start after 6 months of life

- there is persistent, frequent regurgitation beyond the first year of life.

- there is presence of blood in stools

- there is associated distended tummy or you can feel a mass in the tummy area.

- there is long standing case of associated loose stools

- your child appears unwell 

- there is presence of teeth (dental) erosion associated with a neurodisability (like in a child with cerebral palsy)

- frequent middle ear infections (>3 infections in a 6 month period)

- there is associated urinary problems

- there is associated altered responsiveness, for example, lethargy or irritability

Conclusion

Gastro-oesophageal reflux in children can be challenging to deal with, but with the right knowledge and guidance, it can be managed effectively. By understanding the signs and symptoms, seeking timely medical advice, and implementing appropriate management strategies, you can help your child feel more comfortable and thrive despite reflux. Remember, you're not alone in this journey, and healthcare professionals are there to support you every step of the way.