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Acid Reflux Treatments

Acid Reflux Basics

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Updated May 16, 2014

Many newborns and infants have reflux, spitting up after almost every feeding.

Fortunately, many don't require any treatment if they are simply making a mess, are gaining weight, sleep well, and aren't fussy.

Several acid reflux treatments are available for those babies who need it though.

Lifestyle Changes

One of the first lifestyle changes that parents should make is to protect their clothing and furniture from the spit up. That can mean using burp rags and towels and warning those who hold your baby that she frequently spits up. You should also avoid putting baby in tight diapers and constricting clothing.

Another important lifestyle change involves how you position your baby after she eats. Surprisingly, most babies do worse if they are placed in a seated position after they eat. Instead, your baby may do best in an upright carried position, like in an infant carrier or baby wrap, or on her stomach. Keep in mind that stomach positioning should only be used when your baby is awake and being observed. Because of the risk of SIDS, even kids with reflux should be put to sleep on their back unless your pediatrician recommends otherwise.

Another positioning technique that can be helpful is to elevate the head of your baby's crib about 30 degrees. A tucker sling, with or without a wedge, can also be helpful to keep your baby in a good position when sleeping to help minimize her reflux symptoms.

What about a car seat? Its positioning is actually not a good one after a feeding for a baby with reflux and should be avoided, unless you are actually in your car.

Some babies only spit up more when they drink large amounts in a sitting. Changing your baby's feeding schedule so that she eats smaller amounts more often can alleviate her reflux symptoms.

Frequently burping your baby, like after every few ounces, sometimes is helpful for babies with reflux. Others get fussy when you interrupt their feedings and spit up more, so you may have to experiment to see if this lifestyle change works for you.

'Reflux' Baby Formula

Pediatricians have long advised that parents of infants with reflux thicken their baby's formula. You do this by adding one tablespoon of rice cereal for every ounce or two of formula your baby drinks.

In addition to being thicker, so it hopefully stays down better, babies may be able to drink a little less at a time, since this mixture has more calories than standard formula.

Two baby formulas are available that may help kids with reflux so that you don't have to add cereal on your own. These include Enfamil AR (added rice) and Similac Sensitive RS (rice starch).

Some experts also recommend that children with reflux have a trial of an elemental formula, such as Nutramigen or Alimentum, for a few weeks, in case the reflux is a sign of a milk protein allergy.

Acid Reflux Medications

Even with lifestyle changes and reflux baby formulas, the mainstay of reflux treatments are reflux medications.

These acid reflux medications for children include antacids and acid reducers such as:

  • Antacids (very short-term use)
    • Maalox
    • Mylanta
  • Histamine-2 receptor antagonists
    • Zantac
    • Axid
    • Pepcid
    • Tagamet
  • Proton pump inhibitors (PPIs)
    • Prevacid
    • Prilosec
    • Nexium
    • Aciphex
    • Protonix
  • Other medications include Reglan, bethanechol, and erythromycin, which are described as prokinetic agents. These medicines can actually help the stomach empty faster, but are not used as much because they tend to have a lot of side effects.
Keep in mind that Zantac is the only acid reflux medication that is FDA approved to treat reflux in infants. Other medications are often used off-label for younger children though, including Axid and Prevacid.

Older Children with Reflux

Many parents think of acid reflux as being a 'baby' disease, but older children and teens can get reflux too.

It can sometimes help acid reflux if your older child:

  • Avoids acidic foods, including tomatoes, pickles, citrus, and chocolate.
  • Avoids acidic drinks, including juices, carbonated and caffeinated drinks, which means no soda and no energy drinks.
  • Avoids eating within a few hours of bedtime.
  • Avoids spicy foods and high-fat foods.
  • Loses weight if she is overweight.
  • Chews gum and drinks water when she has reflux symptoms.
As with younger children, it may also help to elevate the head of your child's bed, encourage him to eat frequent small meals, and try an acid reflux medication when lifestyle changes aren't enough to stop reflux symptoms.

Other Reflux Treatments

For kids with severe reflux who don't respond to effective medical treatments, fundoplication, in which the upper part of the stomach is wrapped around the lower part of the esophagus, is an option. Although some parents view this surgery as too invasive, it can be a good option for those with severe reflux symptoms, such as poor weight gain, weight loss, choking and breathing problems, or frequent irritability.

A pediatric surgeon, along with a pediatric gastroenterologist, can help you determine if your child with severe reflux is a candidate for a fundoplication.

What You Need To Know

  • Most children outgrow their reflux symptoms by the time they are 9 to 12 months old, although it sometimes lingers until 18 months.

  • Zantac is a common first-line treatment for infants with reflux. But if it isn't working, talk to your pediatrician about trying a PPI like Prevacid.

  • A cross-cut nipple or larger nipple can help when you are thickening your baby's formula.

  • Don't be quick to feed your baby again when she spits up. Instead, wait until the next feeding so that you don't inadvertently overfeed your baby. Talk to your pediatrician if you think your baby is not getting enough to eat because she is spitting up so much.

  • A pediatric gastroenterologist can be helpful to evaluate and manage your child with reflux.



Sources:

Behrman: Nelson Textbook of Pediatrics, 17th ed.

Gastroesophageal reflux disease: could intervention in childhood reduce the risk of later complications? Gold BD - Am J Med - 6-SEP-2004; 117 Suppl 5A: 23S-29S.

North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Guidelines on Pediatric GERD. J Pediatr Gastroenterol Nur, Vol 32, Suppl. 2, 2001.

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