Gastroesophageal Reflux Disease (GERD) in Newborns
Reflux happens when gas or liquid from the stomach comes up the esophagus. It can cause babies to "spit up." All babies have reflux from time to time. This is because in babies the muscle that opens and closes the top of the stomach is very relaxed. It opens easily, so gas and fluid tend to escape. Babies with severe reflux have gastroesophageal reflux disease (GERD). A baby with GERD may spit up too much and not get enough nourishment from food. The baby can also aspirate (breathe in) spit-up liquid. This can cause problems with the baby's breathing.
When does reflux need treatment?
Reflux is treated if the baby:
- Has apnea (breathing that stops for 15-20 seconds at a time).
- Is growing poorly.
- Develops pneumonia or breathing difficulties from breathing in spit-up liquid.
- Is vomiting blood.
How is reflux treated?
- Feeding changes. This may include feeding smaller amounts more often, and burping more often during feedings. In other cases, allowing more time between feedings may help.
- Propping the baby up after feeding. For 30 minutes after feeding, the baby is positioned with the head higher than the stomach. In the hospital, the baby may be put on his or her stomach (prone). Note: It is OK to lay the baby prone in the NICU because the baby is being monitored. Unless told otherwise, once at home, you should put the baby to bed on his or her back or side to help prevent SIDS (sudden infant death syndrome).
- Medicins. This may include medicines to decrease the acidity of the stomach. This keeps the stomach acids from damaging the esophagus. Other medicines may be used to speed up digestion, so food passes out of the stomach quicker.
- Surgery. In severe cases, a surgery called a Nissen fundoplication may be done. The surgery makes the valve at the top of the stomach stronger. It does this by wrapping part of the stomach around the esophagus. When the stomach is relaxed and empty, food can pass through. When the stomach is full, pressure closes the valve.
What are the long-term effects?
In most cases, reflux gets better over time and causes no long-term problems.