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What Causes Acid Reflux In Babies

Spitting up a small amount of food just after being fed is a common in many infants. While spitting up on its own is not a cause for concern, it can be a symptom of gastroesophageal reflux or GER [1] if other signs such as poor growth, frequent coughing, throwing up forcefully or vomiting and bloody stools are witnessed as well.

As the digestive system of a neonate is still developing, the muscle between the oesophagus and the stomach is not working to its optimum level, causing the stomach contents to flow back towards the throat. In most neonates, the instances of spitting up following a feed usually go away as they grow older.

acid reflux in babies

To minimize undue strain on the delicate stomachs of the babies, doctors recommend exclusive breastfeeding in the first six months which can be continued till the baby is of two years of age. While additional solids or liquids might be given after your baby is six months old, breastfeeding should preferably be the only mode of nourishment in the initial six months.

However, despite your baby being exclusively breastfed, there is nonetheless still the possibility of your baby developing GER because of something in your diet. All said and done, for a breastfeeding mother, it is important to be cautious about whatever she eats or drinks, as that will indirectly affect her baby.

What Is Gastroesophageal Reflux (GER)?

The food that we eat passes on to the stomach through the oesophagus or food pipe. A ring of muscles, the oesophageal sphincter [2] , lies between the oesophagus and the stomach. The purpose of the ring is to ensure that what goes down stays down. It is in cases where the ring is not working properly that we see the appearance of GER. Babies are usually suffer GER due to the oesophageal sphincter not working as it should be.

Here, we must understand the difference between vomiting and reflux. At the time of vomiting, it is the contraction of the diaphragm as well as the muscles in the oesophagus that throw the food forcibly back from the stomach right up to the throat.

On the other hand, in reflux, the food simply rises up and there is no force discernible whatsoever. This simple rising up of the food back to the throat is also referred to as 'regurgitation' [2] . While most babies outgrow this phase, the acid reflux in your baby might require medical supervision in certain cases.

When Do You Need To See A Doctor?

There is no cause for concern if your baby is thriving for his age. As spitting up is quite commonplace at this age, spitting up alone does not require medical supervision as such. Frequent reflux in a prematurely born baby might imply that the intestines have not formed properly. However, even if your baby was born full-term, do consult your doctor if you come across the following symptoms that reveal acid reflux.

  • Vomiting: Recurrent bouts of vomiting are the first symptoms of acid reflux in babies. Forcefully throwing up food is different from merely spitting up.
  • Spitting up frequently: You should seek your doctor's advice if your baby is spitting up a lot, not growing up as expected for his age or is comparatively underweight when compared to other babies of the same age. At times, your baby can spit up even despite not having been fed recently.
  • Coughing: Coughing, wheezing or frequent clearing of the throat might also signal that your baby's stomach acids are refluxing.
  • Pain: Acid reflux in babies can cause the baby to feel a lot of pain. Abdominal pain is accompanied by colic or heartburn as well as gas. These symptoms are most noticeable just after the baby has been fed or even during a feeding session.
  • Fever and diarrhoea: Babies who have GER often develop a fever with diarrhoea. At this age, losing too much fluid can lead to dehydration in a short span of time, thereby requiring prompt medical assistance.
  • Eating problems: If your baby is suffering from acid reflux, he might have difficulty in feeding or may refuse to feed altogether. If the baby is exclusively breastfed, he might appear to have problems while nursing. Such problems usually manifest as choking or gagging.
  • Regurgitation: A baby suffering from GER might also regurgitate a lot. Frequent instances of acid reflux in your baby might be due to GER. As in GER, excessive backflow of stomach acids can damage the food pipe and also cause respiratory illness [2] if the food travelling back from the stomach somehow ends up in the lungs, GER should not be ignored in babies.

Causes Of Acid Reflux In Babies

While acid reflux in babies can be caused by a variety of reasons such as the immaturity of the intestines in a premature baby, the most commonly witnessed reason is to do with the diet of the mother when the baby is exclusively breastfed. Usually, a mother is not well-informed as to what substance in her diet might be causing the acid reflux in her baby.

Here, we are providing a list of foods that, when consumed by the mother, have been seen to cause acid reflux in their breastfed babies.

1. Caffeine

Caffeine [3] is best avoided by breastfeeding mothers. As caffeine is said to turn the lower oesophageal sphincter muscles lax, there is an increased chance of the stomach acids and juices finding their way back all the way to the throat. Since this muscle is responsible for holding down the stomach content, any relaxing of the muscles intensifies acid reflux. Caffeine can be found in tea, coffee, sodas, chocolates and other caffeinated beverages.

2. Spicy foods

Spicy foods [3] are the common culprits when it comes to heartburn and acidity in grown-ups. Similarly, a maternal diet with spicy foods tends to cause acid reflux in the breastfed baby. Excess spices in diet tend to irritate the lining of the intestines as well as the stomach, causing acid reflux. As the breastfed baby is solely dependent on the mother's milk for his sustenance, spicy foods in the mother's diet can have an adverse effect on the still-developing sensitive stomach of the baby.

3. Fruits

Lemons and oranges can also irritate the digestive system. If consumed by the mother, citrus fruits lead to acid reflux in the breastfed baby.

acid reflux in babies

4. Carbonated drinks

The unstable gas molecules in a carbonated drink have an adverse effect on the lining of the stomach, thereby leading to acid reflux or GER.

5. Fried foods

Causing an interference with the proper functioning of the digestive system, the unhealthy fats in fried foods in the mother's diet cause acid reflux and indigestion in breastfed babies.

6. Alcohol

In addition to being off-limits for pregnant women, abstinence from alcohol is also recommended while breastfeeding. Alcohol causes acid reflux owing to its propensity for relaxing the muscles and irritating the digestive system.

7. Artificial fruit juices

Containing a lot of preservatives and added sugars as well as artificial flavourings, artificial fruit juices available in the market are best avoided by mothers who breastfeed. Such artificial fruit juices are not easily digested by the sensitive stomachs of babies, leading to gastroesophageal reflux.

8. Smoking

Smoking is also best avoided by pregnant or breastfeeding mothers alike. When a breastfeeding mother indulges in smoking, the breastfed baby tends to feel the adverse effects of the harmful smoke in the form of heartburn.

9. Pre-natal vitamins

Vitamins are usually prescribed to a pregnant mother to supplement her nutritional needs during pregnancy. While being essential for the health of the expectant mother as well as the growing foetus in her womb, the same pre-natal vitamins that she took during pregnancy, when taken post-delivery, might cause heartburn to her baby. If you believe that your multi-vitamin pills are indeed to blame for causing acid reflux in your baby, ask your doctor to prescribe alternative pills that might safely be taken while breastfeeding.

10. Cabbage

Consumption of excess amounts or undercooked portions of cabbage has been proven to cause acidity and acid reflux in grown-ups. Owing to the property of cabbage of irritating the digestive system, an exclusively breastfed baby experiences heartburn when cabbage finds its place in the maternal diet.

11. Capsicum

Capsicum contains capsaicin which has been known to cause post-prandial heartburn or heartburn experienced soon after a meal. By having a direct effect on the sensory neurons [4] of the body, capsaicin is a confirmed irritant of the digestive system. Studies have revealed that the magnitude [5] of the acid reflux caused by ingestion of capsaicin is related to the type and variety of chilli consumed.

A maternal diet containing capsicum can also cause acid reflux in her breastfed baby.

12. Broccoli

Despite its reputation for being a superfood, broccoli can cause gassiness and a feeling of bloating when consumed. An exclusively breastfed baby can get a bout of heartburn if the mother includes broccoli in her diet.

13. Kidney beans

Universally known to be responsible for causing gas problems after consumption, kidney beans are best avoided by a breastfeeding mother.

14. Black beans

With almost the same effect on the stomach, when consumed by the mother, black beans, like kidney beans, also cause gas problems and acid reflux in breastfed babies.

As an exclusively breastfed baby is solely dependent on the mother for nourishment, it is imperative that the mother take special care of her diet throughout the duration that she is breastfeeding. The mother must take care to either completely do away with foods causing acid reflux, and if it is not practical to cut them out altogether, at least minimize all heartburn causing things in her diet.

As unnecessary medications are not advisable to be administered to infants, conservative management [6] is the first line of approach in treating acid reflux in infants. This is done through modifications in posture and feeding, along with making changes in the maternal diet.

While the term gastroesophageal reflux [GER] is used to define the backward flow of stomach contents and acids straight up to the food pipe or oesophagus and even the mouth, the term gastroesophageal disease [GERD] is used when this acid reflux leads to other troublesome symptoms and/or complications. [7] Acid reflux is quite a common occurrence in neonates, with around 70-85% {desc_11} of infants suffering from regurgitation in their initial two months of life. Usually, the symptoms of acid reflux resolve on their own by the time that the infant turns one year old.

In exclusively breastfed babies that suffer from acid reflux, effective treatment would be to eliminate eggs and cow's milk from the maternal diet.

View Article References
  1. [1] Rosen, R. (2014). Gastroesophageal reflux in infants: more than just a phenomenon. JAMA pediatrics, 168(1), 83-89.
  2. [2] Informed Health Online [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Pregnancy and birth: Reflux in babies. 2008 Jul 3
  3. [3] Jeong, G., Park, S. W., Lee, Y. K., Ko, S. Y., & Shin, S. M. (2017). Maternal food restrictions during breastfeeding. Korean journal of pediatrics, 60(3), 70-76.
  4. [4] Rodriguez-Stanley, S., Collings, K. L., Robinson, M., Owen, W., & Miner, J. P. (2000). The effects of capsaicin on reflux, gastric emptying and dyspepsia. Alimentary pharmacology & therapeutics, 14(1), 129-134.
  5. [5] Rodriguez-Stanley, S., Collings, K. L., Robinson, M., Owen, W., & Miner, J. P. (2000). The effects of capsaicin on reflux, gastric emptying and dyspepsia. Alimentary pharmacology & therapeutics, 14(1), 129-134.
  6. [6] Rybak, A., Pesce, M., Thapar, N., & Borrelli, O. (2017). Gastro-Esophageal Reflux in Children. International journal of molecular sciences, 18(8), 1671.
  7. [7] Indrio, F., Riezzo, G., Raimondi, F., Cavallo, L., & Francavilla, R. (2009). Regurgitation in healthy and non healthy infants. Italian journal of pediatrics, 35(1), 39. doi:10.1186/1824-7288-35-39
  8. [8] Czinn, S. J., & Blanchard, S. (2013). Gastroesophageal reflux disease in neonates and infants. Pediatric Drugs, 15(1), 19-27.

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