COMMON CHARACTERISTICS OF REFLUX

VOMITING

1. 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).
2. Vomit can take the form of;
• Unchanged milk or undigested food
• Curdled milk or partly digested food
• Gastric contents
• Fresh blood, coffee-grounds appearance or bile in vomit
3. The number and amount of vomits vary. “Reflux” infants may vomit without discretion- anytime, anywhere, over anybody or anything!
4. 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 the infant as vomiting. The child may still be symptomatic but the signs may have changed. If you are concerned about this possibility, please discuss your concerns with your Doctor.
5. Doctors may consider a milk protein sensitivity in a child who vomits

SILENT REFLUX

1. 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.
2. 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.
3. Silent reflux can be more damaging because it can sit in the oesophagus longer.
4. 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
5. Medical intervention is often necessary and the same complications can arise as in other forms of reflux.
6. 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.
7. 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

1. Irritability can cover such symptoms as screaming, whinging, crying, fussiness and inconsolable behaviour.
2. These signs can occur at any time of the day or night, and commonly occur during and after feeding and when baby is laid down.
3. These infants are often described as ‘colicky’ or ‘windy’ because of their irritability and failure to settle after feeds.
4. 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’.
5. 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.
6. Some children shove their hand/fist/fingers down their throat, and may even gag themselves because of pain/oesophagitis.
7. Parents may have a ‘gut feeling’ that their child is in pain.

FEEDING ISSUES

1. 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.
2. 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
3. Reflux occurs in both breast and bottle-fed babies.
4. Changing from breast to formula feeding will usually not solve the problem, though bottle-feeding may alleviate some stress on the mother, and may make positioning easier. Remember it is the fact of putting something in the stomach- it may not matter whether it’s breast or bottle.
5. Changing from one brand of formula to another usually won’t help, although using thickened formula can sometimes help to decrease the amount of vomiting (and a hypoallergenic one may help if food sensitivities are an issue).
6. 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

1. Some reflux infants are more comfortable in an upright position and they generally object to being laid down.
2. There is a high incidence of sleep disturbance among these infants. Many are very alert babies because they sleep so little.
3. Most are frequent night wakers, however it is not uncommon for some reflux babies to sleep through the night
4. Some babies are great ‘cat-nappers’. They will often only sleep for five minutes before waking again in a distressed state.
5. Some are easily disturbed from sleep.

FAILURE TO THRIVE

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

1. They may have poor growth as a result of feeding disturbances; and either refusing, or being unable to eat well.
2. Their poor growth may be a result of excess vomiting. Inadequate food remaining in the digestive system means the child may not retain enough food to maintain growth.
3. They may have high energy needs as a result of complications of their reflux (e.g. severe respiratory issues)
4. 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.
5. There may be a combination of these factors that contribute to the growth issues.

OTHER CHARACTERISTICS

• Reflux may be hereditary and is quite common in premature babies.
• It may worsen if the child becomes ill (eg with a cold or infection), has allergies, is teething, has immunizations, is overtired, out of routine, or if the weather changes dramatically. It may even worsen when the baby is crawling.
• Many babies, especially very sleepy ones, do not show any pain or discomfort for up to three months of age.
• Signs and symptoms in relation to severity are quite variable.
• The infant can also go through quite “normal” phases where the problem appears to be improving and then re-occurs quite suddenly for no apparent reason. This occurs because reflux can be cyclic.
• 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 when the child loses their baby teeth, or cuts their adult ones.
• 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.