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Regurgitation, or gastroesophageal reflux disease (GERD)?
Five minutes after having drunk his milk like a glutton, he often returns a good part of it, and that worries you? We are in the case of GERD, the famous gastroesophageal reflux. “In fact, everyone has reflux, adults and children alike. It’s normal. But these bolts of food from the stomach to the esophagus do not necessarily go into the mouth, and in this case, they mostly go unnoticed. In fact, all babies have reflux! Regurgitation testifies to a high rise, more energetic, strong and intense, which arrives from the stomach and the esophagus into the baby’s mouth and is externalized rather passively, in a jet or on the corner of the mouth. , or even occasionally through the nose. Regurgitations are not serious in themselves, but they worry parents when they are frequent or abundant, ”explains Professor Jean-Pierre Hugot, professor of pediatrics, head of the department of digestive and respiratory diseases in children at the hospital. Robert Debré hospital in Paris.
Why do babies spit up?
Their digestive system is immature. Very few children (and parents!) Are spared since two thirds of infants under 4 months regurgitate. Right after the bottle, sometimes when burping, the baby very suddenly and effortlessly expels a small portion of the contents of his stomach. This painless phenomenon can recur with every meal. It is possible because the lower esophageal sphincter, the muscular ring placed between the esophagus and the stomach (lower, in the belly, under the diaphragm), is immature and therefore does not do its job: it does not prevent the upward movement, in the opposite direction, of the contents of the stomach towards the mouth. And, knowing that the esophagus is shorter in babies than in adults, pumping up milk is therefore easier!
The baby’s stomach is horizontal. Very concretely too, “the stomachs of small babies are often horizontal, flat, whereas in adults, they are in a“ sock ”and descend with a bottom. The shape of the stomach does not make a siphon, ”notes Professor Hugot.
A baby eats in very large quantities! If we prorate, per kilo, compared to an adult, at 1 month, a child absorbs 120 calories / kg, which would correspond in an adult of 50 kg to 6 cal / kg (the average is 000 per day for a woman). We therefore ask him to digest three times more food relative to his weight.
An essentially liquid diet. The volume of the bottles too, compared to the size of their stomachs, has something to do with it: it’s as if you were drinking, in half an hour, from 3 to 5 liters of milk!
More rarely, some infants have a stomach made up of two pockets instead of just one. Suddenly, it is very quickly full. This is called gastric plicature.
When will the regurgitation stop?
A very large number of these regurgitations disappear spontaneously, once the sphincter is functional, at the age of walking, around 12 months on average. Sometimes as early as 6 months, and for others around 3 years. The older the child, the less he regurgitates. His esophagus gets longer over time. And around 1 year, the child acquires verticality and spends less time lying down.
When should you be concerned about regurgitation?
If the reflux is more important. Even if it seems like the baby is spitting out all of his bottle, most of the time, it is not. Its ever-increasing weight curve proves it. On the other hand, if it is sagging, it is necessary to consult a doctor. This is a sign that the regurgitation is more important. They then occur long after a meal, and even when the baby is asleep. This one is agitated during his sleep, he cries and he seems to be in pain.
If your baby is sick more often. Not only does he regurgitate, but he also has ear infections more often and recurrent nasopharyngitis, a sign that the acid reflux is irritating his respiratory tract. This fragility can also reveal other problems, such as the child’s allergy to milk proteins. In this case, consultation is essential. Doctors then speak of gastroesophageal reflux disease, or GERD, a real disease.
Solutions and treatments against regurgitation
How to treat regurgitation?
When reflux does not endanger the health of the child and the discomfort is acceptable, it is not medicated. Thus, the vast majority of cases do not require drug treatment. These are motivated by significant discomfort or complications. They must be of suitable duration and if they do not work, we stop them! Moreover, several drugs have been withdrawn from the market in recent years after evaluation of the benefit / risk ratio.
What solutions against regurgitation?
First precaution, the bib should preferably be thick and wide! Then, we forget the ritual of the teaspoon of orange juice which promotes regurgitation. We settle in calm and we do not shake the baby too much during and after the feeding. His diaper or clothes should not be tight at the waist after eating. Tobacco is of course prohibited, because passive smoking increases reflux. We do not make him too abundant meals, and we try to divide them if the baby accepts it, by planning breaks to tire him out of the time to burp. We choose teats that are neither too fast nor too slow (it’s up to him to find the tempo). The baby should be held rather vertically and rested in his bed, especially on his back (prevention of sudden death requires), after the main burp. You can diversify your diet earlier. “After 4 months, as soon as the infant supports the spoon. Less liquid, the food rises less. It’s mechanical! »Assures Professor Hugot.
My baby is spitting up. Should we change milk?
If this is not enough, in the event of abundant and troublesome regurgitation, we adopt on medical advice a pre-thickened milk or anti-regurgitation milk (AR) which ballasts the stomach and reduces the frequency and volume of referrals. Sometimes it even makes them completely disappear. The problem of the maturation of the sphincter is not therefore resolved and if we resume normal milk, regurgitation may reappear, unless in the meantime the sphincter has become fully operational. These milks (‘AR’ in pharmacies, ‘Comfort’ in supermarkets) are thickened with carob flour, waxy rice or corn starch, the preparation constraints of which are different. The thickeners added in the past to the reconstituted bottle (a tedious handling and source of dietary errors) are no longer of interest.
An inclined plane? Bad plan …
In practice, this is not easy. The baby’s bed should be tilted between 30 and 40 degrees. But if you place a directory under the feet of the bed, it risks falling. With a commercial inclined mattress, the baby rolls down the mattress. There remains the solution of the inclined plane with proclive harness bought in a pharmacy, But at home, it is complicated because it is damaged quite quickly in washing even though it must be cleaned very often because of… regurgitation.
When should you consult?
Prof. Jean-Pierre Hugot advises to consult if:
- The child does not gain weight.
- He vomits with a little blood: this is a sign of esophagitis, irritation of the esophagus. It is rarely serious in the newborn.
- The rejection is not food, the vomiting is bilious: yellow or green.
- The baby begins to vomit more and more around 2 or 3 weeks of life. It is then necessary to think of a stenosis of the pylorus.
- There are recurrent bronchitis or ear infections, bronchiolitis or later asthma.
- In front of discomfort occurring after the meal. In toddlers, the flow of milk can cause ENT congestion or discomfort blocking breathing for a few moments.
- Other associated digestive signs, such as severe constipation, diarrhea, a large, bloated and tense stomach.
- Other non-digestive signs such as fever, drowsiness, unusual behavior.
Namely
Medication is unnecessary for most regurgitations. However, a few, more severe or if they are still present beyond 12 to 18 months, probably require a prescription drug. Consult your doctor.
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