The Cause and Treatment of Infant and Adult Reflux and Is it normal gastric reflux (GER) or the rarer, more serious condition GERD (Gastroesophageal Reflux Disease)? What is the difference between GER and GERD?
GER (Gastro Esophageal Reflux, a.k.a.“reflux”) is simply defined as the backward flow of stomach contents into the esophagus (the tube that connects the mouth to the stomach). GER is a normal, common process that occurs time to time in almost everyone, of all ages, particularly after meals. It usually involves regurgitation. Almost all babies will regurgitate or “spit up” after some feedings, whether they are breast or bottle-fed. The prevalence of GER peaks between 1 to 4 months of age1, and usually resolves by 6 to 12 months.2 Regurgitation, or “spitting up” has been reported in up to two thirds (65%) of healthy infants,3 but decreases to 1% by one year of age. Babies with GER regurgitate without secondary signs or symptoms of inadequate weight gain, esophagitis, or respiratory disease. Infants with GER are thriving and represent the majority who present to the physician with this condition.
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In contrast, GERD (Gastroesophageal Reflux Disease) is a less common, more serious pathologic process that usually necessitates medical management and diagnostic evaluation. It is also referred to as “Pathogenic GER”. Approximately 1 in 300 infants will present signs and symptoms of GERD and it is more common in children with neurological impairments.4 Patients with GERD may manifest persistent regurgitation with typical complications such as inadequate growth, failure to thrive, feeding and oral aversions, esophagitis,etc. or atypical complications such as wheezing, pneumonia, chronic sinusitis, etc.5What is “Silent GER or GERD”?
When no outward or typical symptoms occur, it could indicate that the refluxed material is not coming back all the way up the esophagus and into the mouth, but rather part way Some children may swallow back down the refluxate instead of spitting up or vomiting. This can be much more difficult to diagnose, since the typical symptoms do not show. It can also be more damaging to the esophagus as the acid not only comes up, but also goes back down again. Whether or not the condition needs to be treated depends on the complications it may create.What is Laryngopharyngeal Reflux?
When stomach acid makes its way all the way up through the upper esophageal sphincter (UES) and to the back of the throat, it can cause problems such as sore throat, hoarseness, chronic cough, etc. The throat and back of the nasal passages are especially delicate and sensitive. What is “Secondary GER”?
In secondary GER, something else is occurring to cause episodes. One possibility is pyloric stenosis, in which there is a blockage of the pyloric sphincter. Other examples might be food allergies, metabolic disorders, infection, NG tubes, etc.The Benefits of Breastfeeding
Breastfed babies have been shown to have fewer and less severe reflux episodes than their artificially fed counterparts. Human milk is more easily digested than formula and is emptied from the stomach twice as quickly. This is important since any delay in stomach emptying can aggravate reflux. The less time the milk spends in the stomach, the fewer opportunities for it to back up into the esophagus. Human milk may also be less irritating to the esophagus than artificial formulas6.
Another advantage of nursing the baby is the closeness between mother and baby. When your baby is in pain or unhappy, it is easy to become overwhelmed and stressed. Nursing is nature’s perfect way to comfort your baby, and the hormones produced when you breastfeed help promote relaxation which goes a long way in helping you deal with a very fussy baby. Nursing keeps you in touch with your baby's cues, and while you can't always eliminate discomfort or unhappiness, the comforting that nursing provides, with the closeness and body contact that it involves) is unequaled. One common challenge that often arises when dealing with reflux is that baby may be hesitant to eat, knowing that pain may result afterwards. This can be terribly frustrating for both you and your hungry baby, and can result in low weight gain.
Here are some techniques to encourage your baby to nurse:
1. Minimize distractions and keep feedings as peaceful and calm as possible. Nurse in a quiet, dark room and play soothing music.
2. Try nursing when baby is sleepy. Babies with reflux tend to wake more often, so take advantage of this opportunity to work in extra feedings. Keep baby close to you during the night.
3. Give baby lots of skin-to-skin contact and cuddling. Try nursing him in a warm bath.
4. Practice with different positions, and try nursing while standing and walking around. Baby slings are great for this, and help keep the baby upright while your hands are free.
If your baby is generally happy and growing normally, any reflux is most likely GER, not GERD. You may want to try the following tips to minimize spitting up:
5. Handle baby gently and burp often.
6. Try to keep baby in an upright position during and after feedings. Nurse frequently. Smaller, more frequent feedings are easier to digest. If you have a large supply of breast milk, and your baby chokes or gags when the milk lets down, then spits up afterward, try offering only one breast per feeding. You may also try taking your baby off the breast when the milk first lets
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