Reflux disease

I noticed that it has been 3 months since I updated my blog. To all my followers, i apologize. Too many things at hand
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Recently I came across many infants in my clinic, where parents complained that their child is vomiting frequently. Of course after much probing, that vomiting was actually regurgitation.
Next question is how can we differentiate the 2. There are simple questions that we, as parents can ask ourselves and see if it's vomiting or regurgitation.

1. Is the child well?
2. Is the child gaining weight?
3. Is the child satisfied after feeding?
4. Does the child sleeps after feeding?
5. Does the amount of milk comes out from the mouth or nostrils minimal amount?

If the answer is yes to all the questions above, then chances are it's just regurgitation.
A small percentage of children, especially infants, will have recurrent regurgitation, sometimes to a certain extend that parents began to be very worried. The child may have GORD (gastroesophegeal reflux disease). Some of us may be familiar with GERD instead, well it's just American or British spelling.


There are essentially 3 types of severity for GORD, mild, moderate or severe.

For mild cases, symptoms will usually be just mild regurgitation. Sometimes milk can come out, not only from the mouth, but from the nostrils as well. Children with mild GORD do not have weight loss, still gain weight well, and eager to feed. To treat mild cases, we simply just need to prop the child up for a little longer and 'burp' them for a longer period of time. The commonest myth is people think that after burping once, then it's considered done. We can burp the child longer or even more than once!

For moderate cases, we probably need to change the types of feeds for children. There are in the market formulas that are AR (anti regurgitation). As long as we see the word 'AR', then that formula is specially made for children with regurgitation. If you are from Malaysia, AR formula can be brought from any hypermarkets. These children may not have adequate weight gain.

For severe cases, the child will usually have weight lost. For these children with severe reflux, then they need drugs to make them better. Sometimes, they need to be admitted to the hospital to stabilise them, push up their weight. To a certain children we may need to 'tube' feed them.

Next question is why does GORD occur? In our food pipe, called the 'esophagus' is connected to our stomach. Just at the point of connection, there is a 'door like' valve which we call 'sphincter' that helps to ensure that contents in the stomach do not goes up back to the esophagus. (see the diagram above). The function of this 'door' is to provide one way traffic for milk to go into the stomach. If this door is not 'shut' properly, then stomach contents will be able to move up back to the esophagus, and hence the term 'reflux'. In infants, this is particularly common. Reflux happens in adults too. Public term reflux in adults as 'heartburn'.

The good news is, for most of the infants, when they grow older, the 'door' will tend to function better and keep the 'traffic' of milk one way. Usually by the time, children reaches 8-9 months, that is by the time they started to sits on their own, the symptoms of reflux will gradually disappear. They 'grow out' of it.!