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Ultrasound Is there a connection to Gastro-esophageal Reflux in Babies?

Written by Elisabeth Madsen, B.Sc, DC, MCC(Paeds)   
Thursday, 26 June 2008 12:50
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I have noticed in my practice what appears to be a worrying trend. Many babies presenting to my clinic with persistent and severe gastro-oesophageal reflux (GER) have been exposed to multiple ultrasounds prenatally. Has anybody else seen this? Is this something we ought to study?


Gastro-oesophageal reflux (GER) in infancy

Gastro-oesophageal reflux is a common condition occurring in young babies (approximately 4 in 10 babies) whereby milk and stomach acid spill back from the stomach into the oesophagus (gullet). This apparently occurs due to an immature lax valve allowing back-flow. This back-flow is called posseting if the vomits are only small spills. Doctors believe that this posseting and vomiting can cause pain similar to that of 'heartburn', and make the baby unsettled. (Reflux is worse if the baby has a cold). Most infants will remain healthy and thrive with symptoms settling down between 6 and 10 months of age when the infant starts to become more upright.

Vomiting due to reflux may occur at any time but especially after a feed. A baby may refuse to feed despite hunger because of the pain of the inflamed gullet or he may want to feed constantly as the milk may temporarily sooth the burning. Baby may be irritable just at certain times, especially when lying down for a while, or he could be irritable all day. Some babies have reflux without vomiting. Reflux is diagnosed clinically. Investigations include barium meal, endoscopy with biopsy (to diagnose oesphagitis with inflamed gullet), and pH manometry (measurement of acidity in the gullet over 24 hour period).


Parents are told by doctors to:

  1. Maintain posture; A more upright posture helps keep the acid contents in the stomach and therefore relieves the pain from the inflamed gullet. When feeding try to sit the baby up or feed with baby prone on mother's body with her back reclining at a 30 degree angle. Keep the baby upright while winding and for 30 minutes after a feed. The 30-degree prone position is the best for relief of reflux and irritability. If the baby does not like lying on his tummy try sitting him upright in a buggy or car seat to an angle of at least 60 degrees. However, the car seat encourages slumping and many babies are often irritable if left in it for long. A baby sling may also be useful in keeping a wakeful baby upright. The baby can also be propped up with pillows while changing a nappy. (diaper)

  2. Feeding; After three months of age it becomes increasingly difficult to sit baby still in these positions so more attention needs to be given to thickening feeds.

  3. Medications; A number of medications may help relieve reflux but should only be started after consultation with a GP.

  4. Agents to thicken feeds to reduce vomiting.

  5. Infracol food thickener can be mixed with boiled water or expressed breast milk and given by spoon, syringe or bottle with each feed. Or Infant Gaviscon 1/2 to 1 teaspoon can be mixed with boiled water or expressed breast milk and given by spoon or syringe. It causes feces to look 'sandy' and may cause constipation

  6. Antacid.

  7. Colief -helps digest the milk protein

  8. Homeopathic remedy - colocynth