Materiały źródłowe

• #1 Gastroesophageal reflux disease in neonates and infants : when and how to treat – PubMed

  https://pubmed.ncbi.nlm.nih.gov/23322552/

  Gastroesophageal reflux (GER) is defined as the involuntary retrograde passage of gastric contents into the esophagus with or without regurgitation or vomiting. […] The predominant mechanism causing GERD is transient lower esophageal sphincter (LES) relaxation, which is defined as an abrupt decrease in LES pressure to the level of intragastric pressure, unrelated to swallowing and of relatively longer duration than the relaxation triggered by a swallow. […] Sandifer syndrome, apnea and apparent life-threatening events are the extraesophageal manifestations of GERD in infants. […] Pharmacotherapeutic agents used to treat GERD encompass antisecretory agents, antacids, surface barrier agents and prokinetics. […] Although Nissen fundoplication is now well established as a treatment option in selected cases of GERD in children, its role in neonates and young infants is unclear and is only reserved for selective infants who did not respond to medical therapy and have life-threatening complications of GERD.

• #2 Gastro-oesophageal reflux: a mixed methods study of infants admitted to hospital in the first 12 months following birth in NSW (2000–2011) | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-018-0999-9

  Gastro-oesophageal reflux (GOR) is common in infants. When the condition causes pathological symptoms and/or complications it is considered gastro-oesophageal reflux disease (GORD). […] GORD is one of the most commonly misunderstood, and difficult to treat problems that infants experience, and is characterised by chronic symptoms of mucosal damage caused by stomach acid rising from the stomach into the oesophagus. GORD is associated with a range of adverse respiratory, gastrointestinal, and neurobehavioral effects. […] Transient lower oesophageal sphincter relaxation (TLOSR) resulting in an abrupt drop in oesophageal pressure below gastric pressure, unrelated to swallowing, is regarded as the dominant mechanism and main contributor to the pathophysiology of GORD in both term and preterm infants.

• #3 Infant Regurgitation (Gastroesophageal Reflux) Explained

  https://www.dr-tummy.com/gastroesophageal-reflux

  Gastroesophageal reflux means the backward movement of stomach contents up the oesophagus (the „swallowing tube”). This can take place only in the lower part of the oesophagus or reach up to the mouth or even the nose. Reflux often includes the release of the material from the mouth, as in infants who „spit up.” […] Reflux is a normal phenomenon, occurs when the muscle between the oesophagus and stomach relaxes (as it does during burping), allowing stomach content to leak up the oesophagus. […] Reflux is normal and very common. Up to 70% of healthy babies spills regularly with a peak around the age of 4 months. This happens because infant’s gastroesophageal sphincter is not fully developed, and their meals are mostly liquid. It is very common for infants to spill the reflux, sometimes even forcefully. That is because of the very small volume that the infant oesophagus can hold and because of the amount of time they spend lying down. Infants who spill, even multiple times, but otherwise are healthy, considered to have physiologic reflux (Happy spillers). This is not a disease or condition that need to be treated.

• #4 Mechanisms of gastro-oesophageal reflux in preterm and term infants with reflux disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1773397/

  Transient lower oesophageal sphincter relaxation (TLOSR) is the predominant mechanism of gastro-oesophageal reflux (GOR) in healthy infants but the mechanisms of GOR in infants with GOR disease (GORD) are poorly understood. […] In infant GORD, acid reflux associated TLOSRs are abnormally common and likely to be a major contributing factor to the pathophysiology of GORD. […] While TLOSR was the predominant mechanism of GOR in infants with GORD, the number of TLOSRs was similar to normal infants but GORD infants had a higher proportion associated with acid reflux. […] These data demonstrate that TLOSR is likely to be a major contributing factor to the pathophysiology of GORD in these babies. […] Abdominal straining was also an important factor increasing the likelihood of TLOSRs to trigger acid GOR episodes.

• #5 Pediatric Gastroesophageal Reflux: Practice Essentials, Background, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/930029-overview

  In pediatric gastroesophageal reflux disease (GERD), immaturity of lower esophageal sphincter function is manifested by frequent transient lower esophageal relaxations, which result in retrograde flow of gastric contents into the esophagus. […] The causes and risk factors for gastroesophageal reflux in children are frequently multifactorial. […] Transient lower esophageal sphincter relaxation (tLESR) – This is currently believed to be the main mechanism of gastroesophageal reflux, accounting for 94% of reflux episodes in children and adults; poor basal LES tone was previously thought to be a cause. […] The major mechanism in infants and children has now been demonstrated to involve increases in tLESRs. Factors that may promote gastroesophageal reflux during tLESRs include increased intragastric liquid volume and supine and „slumped” seated positioning.

• #6 Mechanisms of gastro-oesophageal reflux in preterm and term infants with reflux disease | Gut

  https://gut.bmj.com/content/51/4/475

  Transient lower oesophageal sphincter relaxation (TLOSR) is the predominant mechanism of gastro-oesophageal reflux (GOR) in healthy infants but the mechanisms of GOR in infants with GOR disease (GORD) are poorly understood. […] TLOSR was the predominant mechanism of GOR, triggering 50100% of GOR episodes (median 91.5%). […] In infants with GORD, the number of TLOSRs overall was similar to normals but the proportion of TLOSRs accompanied by acid GOR was significantly higher than in normals (16.5% v 5.7%, respectively; p0.001). […] In infant GORD, acid reflux associated TLOSRs are abnormally common and likely to be a major contributing factor to the pathophysiology of GORD.

• #7 Reflux in Infants: MedlinePlus

  https://medlineplus.gov/refluxininfants.html

  There is a muscle (the lower esophageal sphincter) that acts as a valve between the esophagus and stomach. When your baby swallows, this muscle relaxes to let food pass from the esophagus to the stomach. This muscle normally stays closed, so the stomach contents don’t flow back into the esophagus. […] In babies who have reflux, the lower esophageal sphincter muscle is not fully developed and lets the stomach contents back up the esophagus. This causes your baby to spit up (regurgitate). Once his or her sphincter muscle fully develops, your baby should no longer spit up. […] In babies who have GERD, the sphincter muscle becomes weak or relaxes when it shouldn’t.

• #8 Infant acid reflux – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/infant-acid-reflux/symptoms-causes/syc-20351408

  If the muscle between the esophagus and the stomach relaxes when the stomach is full, food might flow up the baby’s esophagus. The muscle is called the lower esophageal sphincter. […] In infants, the ring of muscle between the esophagus and the stomach is not yet fully developed. This muscle is called the lower esophageal sphincter, also known as LES. When the LES is not fully developed, it allows stomach contents to flow back up into the esophagus. Over time, the LES typically matures. It opens when a baby swallows and remains tightly closed at other times, keeping stomach contents where they belong. […] Sometimes, infant reflux can be caused by more-serious conditions, such as: GERD. The reflux has enough acid to irritate and damage the lining of the esophagus.

• #9 Gastro-Oesophageal Reflux Disease – Management – TeachMePaediatrics

  https://teachmepaediatrics.com/gastroenterology/upper-gi/gastro-oesophageal-reflux-disease/

  The lower oesophageal sphincter is responsible, along with the diaphragm, for preventing stomach contents from entering the oesophagus. In cases of GORD the tone of this muscular portion of the lower oesophagus is too low, resulting in uncontrolled reflux of stomach contents. Infants have a number of anatomical and physiological features that can contribute to this mechanism: […] Short, narrow oesophagus […] Delayed gastric emptying […] Shorter, lower oesophageal sphincter that is slightly above the diaphragm […] Liquid diet and high calorie requirement, distending the stomach and increasing pressure gradient between stomach and oesophagus […] Larger ratio of gastric volume to oesophageal volume […] Spending significant periods recumbent.

• #10 Gastroesophageal Reflux in Infants and Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/1201/p1853.html

  Gastroesophageal reflux disease (GERD) is a pathologic process in infants manifested by poor weight gain, signs of esophagitis, persistent respiratory symptoms, and changes in neurobehavior. Abnormal signs and symptoms that warrant a diagnosis of GERD occur in approximately one in 300 infants. […] In the gastrointestinal (GI) tract, the lower esophageal sphincter is located at the distal end of the esophagus and is under tonic smooth muscle control. Transient lower esophageal sphincter relaxations unassociated with swallowing may be the major mechanism allowing the gastric refluxate to return into the esophagus. Delayed gastric emptying is another mechanism in infants and older children that predisposes them to gastric distension, increased acid secretion, and esophagitis. Gravitational and positional factors may exacerbate GER and increase the risk of GERD by allowing reflux to occur in a supine position.

• #11 Pediatric Gastroesophageal Reflux: Practice Essentials, Background, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/930029-overview

  Decreased gastric compliance is believed to lead to LES relaxation at lower intragastric volumes in infants. This aspect, in conjunction with abdominal wall muscle contraction (if it occurs during periods of LES relaxation) propels refluxate into the esophagus, with subsequent regurgitation. […] An association between gastroesophageal reflux and delayed gastric emptying is recognized. This is more common in premature infants.

• #12 Gastroesophageal Reflux in Preterm Neonate | PPT

  https://www.slideshare.net/slideshow/gastroesophageal-reflux-in-preterm-neonate/64822346

  Gastric emptying The time for gastric emptying increases with decreasing gestational age. […] The delay in gastric emptying in preterm infants may provide a greater gastric volume of liquid available for reflux. […] Esophageal motility In the preterm infant, esophageal motility may be immature and contribute to GER. […] Respiratory disorders GER may occur more frequently in infants who have respiratory disorders, such as bronchopulmonary dysplasia [BPD]. […] The presence of nasogastric or orogastric tube, which is commonly used in preterm infants, may increase GER because it may cause greater LES relaxation and/or decreased gastric emptying.

• #13 Mechanisms of gastro-oesophageal reflux in preterm and term infants with reflux disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1773397/

  Our data clearly show that GE was not delayed in GORD patients and challenge the logic of acceleration of GE for the treatment of acid reflux. […] In conclusion, like older children and adults, TLOSR is an important factor in the pathophysiology of GORD in preterm and term infants while delayed GE does not appear to be.

• #14 Addressing Reflux in Babies – Le Bonheur Children’s Hospital

  https://www.lebonheur.org/blogs/practical-parenting/addressing-reflux-in-babies

  Reflux in babies is a common occurrence, but many parents find it to be a challenging issue to navigate. […] When a person eats, food moves from the mouth through the esophagus, then into the stomach. The esophagus expands and contracts to move food to the stomach. […] Occasionally, the lower esophageal sphincter does not stay closed completely, or it can relax at the wrong time. This allows the liquids in the stomach to wash back into the esophagus causing an episode of reflux. […] Infants consume large amounts of milk and food relative to their small size and the small size of their stomachs. Their stomachs have poor compliance or stretchiness, explains Dr. Vickers. When presented with these large volumes, some of the gastric content will then reflux back into the esophagus. […] Dr. Vickers states that two main types of reflux can occur in infants: gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD).

• #15 Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/1015/p705.html

  Gastroesophageal reflux is defined as the passage of stomach contents into the esophagus with or without accompanied regurgitation (spitting up) and vomiting. […] The lower esophageal sphincter is the primary barrier to gastroesophageal reflux. Most reflux events are caused by transient lower esophageal sphincter relaxation triggered by postprandial gastric distention. Frequent large-volume feedings, short esophagus, and supine positioning predispose infants to regurgitation or vomiting induced by transient lower esophageal sphincter relaxation. This relaxation continues into childhood, but growth and upright positioning decrease its frequency. […] The following conditions are associated with increased risk of GERD (listed from highest to lowest odds ratio): hiatal hernia (including congenital diaphragmatic hernia), neurodevelopmental disorders, cystic fibrosis, epilepsy, congenital esophageal disorders, asthma, and prematurity. Obesity and parental history of reflux may also be risk factors for GERD in children.

• #16 Pediatric Reflux

  https://mobile.fpnotebook.com/GI/Peds/PdtrcRflx.htm

  Postprandial gastric distention associated with Delayed Gastric Emptying […] Transient reflexive Lower Esophageal Sphincter (LES) relaxation (response to increased pressure) […] Exacerbated by factors that increase gastric pressure (e.g. crying).

• #17

  https://formuland.com/blogs/news/a-guide-on-acid-reflux-in-infants?srsltid=AfmBOop-GlZznDySrrFFpd-JZHulUaQZFuZFZ_OpdNBcQzDR9ogtdBaa

  Acid reflux in infants occurs when stomach contents come back up into the mouth or esophagus. This causes heartburn, spitting up, and regurgitation. There are two main forms of GERD, which share similar symptoms: […] GERD is a more serious form of gastroesophageal reflux. In general, doctors make this diagnosis when acid reflux occurs more than twice a week. Without proper treatment, this condition can affect the babys health and quality of life. […] This disorder is often the result of a weak esophageal sphincter. Your babys diet plays a role too. […] Infants can also develop this condition due to congenital disorders, food allergies, and certain medications. Exposure to cigarette smoke and air pollutants may contribute to GERD we well. […] Babies spend most of their lying down. This makes it easier for food and beverages to splash back up. Plus, their esophageal sphincter muscle isnt fully developed, causing your child to spit up.

• #18 Gastroesophageal Reflux in Infants and Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/1201/p1853.html

  In the respiratory tract, complex reflex responses to the gastric refluxate occur in children by three mechanisms. First, the aspirated material may cause luminal mechanical obstruction. Second, neurally mediated impulses from the refluxate result in local airway or distal esophageal afferent signals stimulating mucous secretion, edema, and bronchial smooth muscle contraction. Third, aspiration stimulates the chemical release of inflammatory mediators that cause further respiratory luminal obstruction. These responses can result in signs of upper airway (apnea, stridor, laryngomalacia) and lower airway (chronic cough, wheezing) obstruction. In infants, activation of laryngeal chemoreflexes associated with regurgitation of gastric contents into the pharynx may be associated with episodic prolonged apnea.

• #19 Episodic apnea: gastroesophageal reflux associated with gastric organo-axial malrotation: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-022-03367-x

  Gastroesophageal reflux is a normal physiologic process occurring several times a day in healthy infants. […] Gastric malrotation is one of the anatomic causes associated with severe reflux, which could lead to serious complications. […] Infants with gastric malrotation have been thought to be at risk for reflux because they usually have a defective gastroesophageal junction during fetal development. […] It is hypothesized that pharyngeal penetration of reflux may activate local vagal stretch and trigger induction of apnea through pathways mediated by the brain stem. […] Gastric malrotation is one of the anatomical conditions that may cause severe reflux and life-threatening complications. […] Organo-axial type of malrotation occurs when the stomach rotates along its long axis and becomes obstructed, with the greater curvature being displaced superiorly and the lesser curvature located more caudally in the abdomen.

• #20 What is baby reflux? Symptoms and support | NCT

  https://www.nct.org.uk/information/baby-toddler/baby-and-toddler-health/what-baby-reflux-symptoms-and-support

  Reflux can occur because the ring of muscle between the oesophagus (food pipe) and stomach is not fully developed. This means food or milk can travel back up the food pipe (NHS, 2019). […] Baby reflux is different from gastro-oesophageal reflux disease (GORD), which is defined as reflux with 'troublesome symptoms or complications’ (NICE, 2019). […] Reflux is more common among babies who were born prematurely and babies who had a low birth weight. Its also common in babies or children with some impairment of their muscles and nerves, such as cerebral palsy, or those with a cows milk allergy (Patient, 2018). […] Baby reflux doesnt usually need any specific treatment either but you might find the feeding suggestions above helpful. Babies who cry uncontrollably or are in obvious pain may be prescribed an anti-reflux medication (Tighe et al, 2014; NICE 2019). […] In rare cases, and if a healthcare professional thinks they might be helpful, an endoscopy, pH monitoring or barium swallow test can be done (NHS, 2019; NICE, 2019).

• #21 Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/1015/p705.html

  GERD is much less common with an incidence of 1.48 cases per 1,000 person-years in infants, declining until 12 years of age, and then peaking at 16 to 17 years of age. […] The diagnosis of gastroesophageal reflux and GERD should be based primarily on history and physical examination findings because other diagnostic tests have not shown superior accuracy. […] The effectiveness of H2 antagonists may be limited by tachyphylaxis (diminution of response) or tolerance with chronic use. […] PPIs block sodium-potassium adenosinetriphosphatase (Na+,K+-ATPase) enzyme activity, which is the final step in parietal cell acid secretion. Low-quality evidence suggests that PPIs improve symptoms of GERD in infants; however, there is weak, conflicting evidence on whether they improve the reflux index, and no evidence of endoscopic improvement. […] Surgical options are available and should be considered in children with complications from severe GERD if medical therapy is unsuccessful or is not tolerated.

• #22 Gastro-oesophageal reflux: a mixed methods study of infants admitted to hospital in the first 12 months following birth in NSW (2000–2011) | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-018-0999-9

  The traditional view is that infants with GORD also have delayed gastric emptying, though the role of delayed gastric emptying in promoting GORD is unclear. […] It has also been proposed that increased intra-abdominal pressure, and the fact that infants ingest a much higher volume per kilogram of body weight than older children and adults may increase the incidence of reflux during a TLOSR. […] Determination of the exact prevalence of GOR versus GORD is challenging because there is unclear demarcation between physiologic and pathologic reflux and incidence and prevalence data. […] The most significant finding was that women with a maternal psychiatric diagnosis were nearly five times as likely to have a baby with GOR/GORD. […] We propose a new way of approaching the GOR/GORD issue that considers the impact of early birth (immaturity), disturbance of the microbiome (caesarean section) and mental health (maternal anxiety in particular).

• #23 Cow’s Milk Allergy or Gastroesophageal Reflux Disease—Can We Solve the Dilemma in Infants?

  https://www.mdpi.com/2072-6643/13/2/297

  Gastroesophageal reflux (GER) and cow milk allergy (CMA) occur frequently in the first year of life. The pathogenesis of these two conditions is complex and involves multiple mechanisms of nutrition, motility, immunology and hypersensitivity. […] GER and other persistent gastrointestinal symptoms in allergic patients are predominantly associated with cellular immune mechanisms and delayed reactions. In non-IgE mediated CMA, activated mast-cells, eosinophils and Th2 lymphocytes, release histamine, tryptase, IL-4, IL-5, IL-13, eotaxin and other chemokines that lead to increased permeability, epithelial dysfunction, inflammatory infiltration in the mucosal, submucosal and, in some cases, muscle layers and nociception. […] A migration of activated mast cells in proximity of enteric nervous system has been demonstrated in allergic children exposed to CM proteins and may determine gastrointestinal dysmotility and related symptoms.

• #24 Cow’s Milk Allergy or Gastroesophageal Reflux Disease—Can We Solve the Dilemma in Infants?

  https://www.mdpi.com/2072-6643/13/2/297

  Inappropriate relaxations of the lower esophageal sphincter (LES), ineffective clearance and the impaired resistance of the esophageal mucosa contribute to GERD. […] GER and CMA can coexist in the same patient and it has been reported that CMA can induce GER and also be a predisposing factor for gastrointestinal functional disorders. Conversely, treatment with acid inhibitors for GERD increase the risk of allergy later in life.

• #25 Gastroesophageal Reflux in Infants – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/gastrointestinal-disorders-in-neonates-and-infants/gastroesophageal-reflux-in-infants

  Complications of GERD are due mainly to irritation caused by stomach acid and to caloric deficit caused by the frequent regurgitation of food. […] Stomach acid may irritate the esophagus, pharynx, larynx, and, if aspiration occurs, the airways. […] Significant esophageal irritation (esophagitis) may cause mild, chronic blood loss and lead to esophageal stricture and food refusal. […] The North American and European specialty societies recommend that infants and children with GERD unresponsive to feeding and positioning modifications be given a proton pump inhibitor (PPI). […] Promotility (prokinetic) medications are theoretically beneficial by speeding gastric emptying and thus reducing the volume of gastric contents and amount of time the contents are present to be refluxed. […] Infants with severe or life-threatening complications of reflux that are unresponsive to medical therapy can be considered for surgical therapy. […] The main type of antireflux surgery is fundoplication. During this procedure, the top of the stomach is wrapped around the distal esophagus to help tighten the lower esophageal sphincter.

• #26 Reflux in Babies: Signs & Treatment

  https://my.clevelandclinic.org/health/diseases/reflux-in-babies

  Reflux happens when the muscular valve that connects your babys esophagus and stomach isnt fully developed or opens when it shouldnt. This valve is a ring-shaped muscle called the lower esophageal sphincter. It relaxes to let food travel from your babys esophagus to their stomach. It then tightens to prevent food from traveling back up. This muscle, like all of your babys muscles, is still developing during your babys first year. So, it might not stay shut as well as it will later on. […] GERD may lead to: […] Delays in normal weight gain and growth. […] Reflux esophagitis. […] Esophageal strictures. […] Barretts esophagus. […] Respiratory problems.

• #27 Gastroesophageal reflux in infants Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/gastroesophageal-reflux-in-infants

  Gastroesophageal reflux occurs when stomach contents leak backward from the stomach into the esophagus. This causes „spitting up” in infants. […] A ring of muscle fibers prevents food at the top of the stomach from moving up into the esophagus. These muscle fibers are called the lower esophageal sphincter, or LES. If this muscle does not close well, food can leak back into the esophagus. This is called gastroesophageal reflux. […] A small amount of gastroesophageal reflux is normal in young infants. However, ongoing reflux with frequent vomiting can irritate the esophagus and make the infant fussy. Severe reflux that causes weight loss or breathing problems is not normal. […] When the infant begins to eat solid food, feeding thickened foods may help. […] Medicines can be used to reduce acid or increase the movement of the intestines. […] Most infants outgrow this condition. Rarely, reflux continues into childhood and causes esophageal damage. […] Complications may include: Aspiration pneumonia caused by stomach contents passing into the lungs, Irritation and swelling of the esophagus, Scarring and narrowing of the esophagus.

• #28 Episodic apnea: gastroesophageal reflux associated with gastric organo-axial malrotation: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-022-03367-x

  Data are insufficient concerning the respiratory symptoms directly associated with gastric malrotation. […] Especially infants with gastric malrotation have been thought to be at risk for GER disease. […] Gastric malrotation is more common than generally thought and should be specifically looked for in young children with reflux accompanied by respiratory symptoms.

• #29 Torticollis and Reflux: Understanding the Connection and Finding Solutions — Balance Chiro and Rehab | Denver Pregnancy & Pediatric Care

  https://www.balancechiroandrehab.com/blog/how-torticollis-and-reflux-go-hand-in-hand

  Reflux and torticollis are a seemingly unexpected couple that like to creep up together towards the end of the 4th trimester. In fact, about 25% of kiddos with reflux present with its partner – torticollis. […] Since a babys little stomach and esophagus are a bit off to the left side of the body, there is more discomfort in this area. SO, to guard and protect it, that little nugget with have a tendency to scrunch their little torso down to the left and rotate the top half of their body to the right side to get away from the discomfort. Now, the scrunching and pulling from the torso on the left side can tighten down a muscle in the neck known as the SCM. This little guy tightening up on the left will bring the left ear to the left shoulder and then turn babys head to the right. Wa-la, theres the mechanism behind the developing torticollis.

• #30 Torticollis and Reflux: Understanding the Connection and Finding Solutions — Balance Chiro and Rehab | Denver Pregnancy & Pediatric Care

  https://www.balancechiroandrehab.com/blog/how-torticollis-and-reflux-go-hand-in-hand

  In the same way that reflux can impact the overall tension and positioning of a little one, torticollis can directly impact reflux as well. If an infant has tension through one side of their body due to torticollis (originating from factors such as in-utero positioning, tongue tie, etc.) this can impact mobility and the way the GI system is functioning. This is ESPECIALLY true when the scrunched up side is on the left. The left side of the abdomen is where the descending colon exits the body. If there is tension and tightness here, it can impact bowel emptying and contribute to constipation. If there is increased pressure through the abdomen, pressing up into the stomach, this can exacerbate reflux.

• #31 Why Infant Reflux Matters – La Leche League International

  https://llli.org/news/why-infant-reflux-matters/

  6. Unhealthy gut microbiome – A healthy gut microbiome should allow for easy digestion and the production of gas that is reasonably comfortable and easy to pass. A gut microbiome which has more pathogenic species however, may cause issues with bloating, constipation, and straining. That constipation and straining can cause reflux due to abdominal pressure. […] 7. Physical separation between nursing parent and baby – A baby is extremely immature at birth, with a nervous system reliant on adult regulation. If a baby is not in contact with an adult, digestion does not work optimally. We may have been primed to believe that we need to set a baby down after feeding because it would spoil our babies, but separation from us causes distress and can lead to vomiting and crying. This may explain why baby wearing (carrying a baby in a soft carrier with direct body contact) also seems to help with reflux.

• #32 Medical management of gastro-esophageal reflux in healthy infants | Canadian Paediatric Society

  https://cps.ca/en/documents/position/gastro-esophageal-reflux-in-healthy-infants

  While the endoscopic evaluation of infants with esophagitis who have been treated with H2RAs appears to show histological improvement, it remains uncertain whether H2RAs can improve symptoms of GERD, such as crying and fussiness, when compared with placebo or PPIs. […] Several systematic reviews have assessed the effectiveness of PPIs in relieving GERD symptoms in infants. […] PPIs decrease acid secretion in the stomach, but it remains unclear whether they have any effect in reducing symptoms, compared with placebo, hydrolyzed formula, or H2RAs. […] An increase in neonatal infections, necrotizing enterocolitis, and death has also been reported with H2RA use in very low birth weight infants. […] Changes in the acidity of gastric secretions from acid-suppressive therapy may modify flora in the host, suggesting a mechanism for the increased risk of infection observed and associated with acid-suppressive medication use.

• #33 Why Infant Reflux Matters – La Leche League International

  https://llli.org/news/why-infant-reflux-matters/

  2. Too much milk too quickly – Babies are designed to drink small amounts frequently. A baby feeding every three hours needs to drink twice as much at each feed as a baby drinking every one hour and a half. Overfilling the stomach causes it to stretch, loosening the valve at the top of the stomach – allowing the overflow to escape. Frequent feeding can reduce reflux episodes. […] 3. Aerophagia – This just means swallowing air. A baby who is gulping or spluttering may be taking in more air than they should. A poor latch, scheduled feeds, oral restrictions or difficulty managing flow can all cause excess air to be swallowed. The stomach valve will then open to allow it to escape. As air comes back up, milk escapes too. Correcting the feeding issue so that air isn’t swallowed can reduce or eliminate reflux.

• #34

  https://www.healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/What-is-the-safest-sleep-solution-for-my-baby-with-reflux.aspx

  Note: Many of the factors that contribute to GER in infancy are part of typical growth and developmentincluding a short esophagus in newborns that will grow as the baby does, along with a muscle at the bottom that is also relatively short and not as strong as it will be later in life. GER typically starts at 2-3 weeks of age and peaks at 4-5 months in full term infants. GER typically gets much better after 6 months once a baby learns to sit up; the esophagus gets longer and the lower esophageal sphincter functions properly. […] In addition, there is evidence that a semi-inclined position can make a baby’s reflux worse. […] Elevating the head of a baby’s crib is not effective in reducing GER. It’s also not safe as it increases the risk of the baby rolling to the foot of the bed or into a position that may cause serious of deadly breathing problems. […] Reflux will end for most babies. As difficult as it can be, wait it out. Most babies outgrow the symptoms. We know that by 4 months of age, the great majority of babies are spitting up. By 6 months, that dramatically drops off because they’re sitting up on their own.

• #35 How to Help a Baby Sleep With Acid Reflux – Smart Sleep Coach by Pampers™

  https://www.smartsleepcoach.com/blog/sleep-problems/reflux-in-infants-how-to-help-my-baby-sleep

  Reflux in babies happens because the lower esophageal sphincter (LES) the muscle ring at the top of your stomach doesnt close completely, allowing food and stomach acids to emerge back into the esophagus. […] Acid reflux often peaks in babies when they are around 4 months of age. […] There are some circumstances that will result in more severe cases of reflux. Those can be caused by Gastroesophageal Reflux Disease (GERD), food allergies, pyloric stenosis (the narrowing of the valve between the small intestine and the stomach), eosinophilic esophagitis (when white blood cells injure the esophagus lining), and Sandifer syndrome (an affliction that resembles seizures). […] If you suspect your baby has GERD, or have a family history of any of these, consult with your health care provider about the best route forward. […] Acid reflux typically resolves in babies between the ages of 12 months and 18 months.

• #36 Infant Reflux: Just Messy or a Real Malady? – Southwest Pediatrics

  https://swpedi.com/infant-reflux-just-messy-or-a-real-malady/

  In short: most reflux is normal, eventually goes away as the baby matures, and not worrisome. […] When reflux is this severe, it is usually termed gastroesophageal reflux disease (GERD) by physicians. There are some medicines that are sometimes helpful with reflux by suppressing acid production in the stomach, but these are rarely needed and usually not a “magic bullet” for curing GERD.

• #37 Reflux in babies

  https://www.nhs.uk/conditions/reflux-in-babies/

  Reflux usually happens because your baby’s food pipe (oesophagus) has not fully developed, so milk can come back up easily. […] Your baby’s oesophagus will develop as they get older and the reflux should stop.

• #38

  https://formuland.com/blogs/news/a-guide-on-acid-reflux-in-infants?srsltid=AfmBOop-GlZznDySrrFFpd-JZHulUaQZFuZFZ_OpdNBcQzDR9ogtdBaa

  Most times, medications are not necessary. However, if your baby has severe GERD, the doctor may prescribe proton pump inhibitors or alginates. These drugs reduce acid levels in the stomach and protect the esophagus. […] Surgery is only recommended in severe cases when acid reflux affects the babys growth or breathing. Doctors may prescribe surgical treatment when everything else has failed.

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