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Why is baby spitting up?
Already in 2011, a French study revealed that in children under one year of age, 80% of prescriptions for gastroesophageal reflux were not justified. Despite this alarm bell, the situation is still the same today.
Infant reflux: why this over-medicalization?
First, because in babies less than one year old, it is not easy to differentiate physiological reflux from pathological reflux. Indeed, having regurgitation of milk after feeding is almost inevitable: 80% of children under 6 months have it several times a day. At this age, this is explained by the immaturity of their digestive system. More precisely, because the small valve located at the bottom of the esophagus is not yet functioning properly. As a result, when the child swallows a large amount of milk, the pressure in the stomach increases, with the risk of rising into the esophagus. The excess milk is then spat out… on the bib. Most often, these releases take place during the day and are not very abundant.
Differentiate between banal reflux and pathological GERD
Although unpleasant, this physiological gastroesophageal reflux disease (GERD) is harmless and without risk of complications. But there is also a so-called pathological GERD. Rarer, it concerns in particular premature babies or children suffering from malformations of the digestive system. There, treatment is necessary, or even, in exceptional cases, surgery. It is not always easy to differentiate these two refluxes, because the symptoms are very similar. What opposes them: the pain felt or not during regurgitation. In a banal ebb, regurgitation is not painful, while in pathological reflux, acid reflux irritates the esophagus and causes a burning sensation. And since the baby is unable to give reasons for his discomfort, it is difficult to separate things out. Of course, parents will notice if their child is embarrassed or cries when he spits up. But, then again, how can you be sure that he grimaces because of the gastric acid reflux or because of colic, for example? Suddenly, we tend to blame the reflux on crying, eating or sleeping disorders. And the temptation is great to prescribe drugs to relieve babies.
How to detect and relieve pathological GERD?
Techniques to check for the presence of pathological GERD are particularly invasive. These are tests like endoscopy – a camera is inserted into the esophagus to check for ulcers. Or pHmetry: the child must wear a probe for 24 hours to quantify the reflux. So, “there is no question of carrying out these examinations on all babies who have regurgitation and for whom a pathological GERD is suspected! », Assures Professor Frédéric Gottrand.
As a result, as a precaution and sometimes under pressure from parents – a quarter of babies spit up more than five times a day – doctors tend to prescribe drugs. The catch: these treatments have not all been proven effective and can sometimes be potentially dangerous.
Thus, gastric dressings are most often prescribed for children under one year of age. “If they have the merit of relieving babies by calming the burning sensations due to acid reflux, these drugs do not treat the cause of regurgitation”, insists the doctor.
Proton pump inhibitors (PPIs)
Likewise, proton pump inhibitors (PPIs) make it possible to treat the acidity of gastric reflections and therefore to treat esophagitis (inflammation of the esophagus). But be careful, they don’t prevent GERD either. “Usually, the baby is relieved after four days,” adds Professor Gottrand. If there is no improvement after two or three weeks, consider other causes of the regurgitation., such as intolerance to milk proteins or colic, for example. “Because if PPIs are very well tolerated in the short term, they have many side effects when used for a long time. “They can cause diarrhea or pneumonia,” says the doctor.
Prokinetics
Along with PPIs, there are also prokinetics. Given 15 minutes before meals, they stimulate the tone of the muscular ring which closes the passage from the lower esophagus to the stomach (the sphincter). They limit reflux by speeding up the emptying of the stomach and reducing the flow of gastric fluid into the esophagus. The problem : ” The only one still prescribed for children under a year old (Motilium) has not proven its effectiveness, and the other two traditionally used and potentially effective drugs have either been withdrawn from the market (Prépulsid) or not recommended for toddlers (Primperan), ”explains Professor Gottrand. It is then tempting to wonder why take the risk of prescribing so many drugs. While often, simple steps are enough.
How to prevent baby from regurgitating?
Anti-reflux pacifier and pause times
First of all, if your baby swallows too much air during a feed, she is more likely to have regurgitation. Check that the opening of the pacifier is suitable for its age. and tilt the bottle correctly so that there is not too much air inside. Another risk factor: if your child drinks too fast. To calm the gluttonous babies, it is advisable to take a break in the middle of the bottle or to split meals. “You should also avoid diapers and clothes that compress your stomach too much,” advises the doctor.
Favor the sitting position
Likewise, to limit the pressure on the stomach, do not put your child in a high chair until he can sit up on his own – usually around 6 months. Next, no way to put him to bed immediately after feeding : wait at least 30 minutes, the time for digestion to take place. You can install it in a deckchair in a semi-vertical position. “On the other hand, raising your mattress is not effective”, notes Professor Frédéric Gottrand.
Put thickener in infant milk
Infant milk thickened with carob flour or starch based is sometimes recommended: ask your doctor for advice. Rest assured, in the majority of cases, the symptoms of GERD tend to decrease or even disappear with food diversification, when the child begins to eat solid and when he begins to walk. Thus, at 18 months, 85% of toddlers no longer have regurgitation.