Does your baby have reflux? Here's how a paediatric dietitian can help

Does your baby struggle with reflux? Reflux, also known as gastroesophageal reflux (GOR), is a motility disorder caused when the lower oesophageal (food tube) sphincter muscle relaxes. As a result, nutrition from the stomach can come back up the oesophagus and into the mouth.

Reflux is physiologically normal in infants and often resolves with age.  However, in some cases gastroesophageal reflux disease (GORD) can cause complications to your baby such as faltering growth, hematemesis, irritability, strictures, oesophagitis or aspiration. This is when a paediatric dietitian’s input can be helpful in managing these complications and your baby’s health. A dietitian will conduct an assessment and review your infant’s nutrition, symptoms and offer specific treatment strategies to address reflux complications.  

Treatment can include:

·         Smaller, more frequent feeds and avoid overfeeding. If you are breastfeeding don’t stop! Just modify the feeding times to be more frequent and smaller in volume. For formula, check the volume prescribed on the formula tins is accurate, as ‘feeding guides’ often overprescribe. A dietitian can calculate how much volume to modify to feed your baby to avoid overfeeding.

·         Positioning therapy. Postural strategies can be useful to promote digestion and decrease your baby’s reflux events.

·         Cow’s milk protein exclusion for 2-4 weeks and then reintroduction. If breastfeeding, eliminate cow’s milk protein in the maternal diet. If formula feeds speak to your pediatrician for a specialized formula. Consider calcium supplements/alternatives during the 2-4 weeks exclusion. It’s important to speak to a Paediatric Dietitain if starting any elimination diet.

·         Thickening feeds via a commercial thicker or using an Anti-reflux formula.

·         Tube feeding may be required. In severe cases, feed may need to be via the jejunum to reduce the reflux burden.

Overall, the best treatment is time, reassurance and working with a peadiatric dietitian.

Where to get help:

Diagnosis of GORD should include a medical assessment with your infant’s GP, peadiatrician and if reflux is not improved referral to peadiatric GI.

Here at Balance Nutrition, paediatric dietitian, Laura is highly skilled in managing complex paediatric cases, including GORD. Laura will help simplify complex nutrition information, tailor strategies depending on your baby’s symptoms and guide you through the process step by step.

To book an appointment with Laura, visit https://www.balancenutrition.com.au/book-an-appointment or call us on 07 4566 0765.

Written by Georgia Simpson, APD

References:

•       Rosen R, Vandenplas Y, Singendonk M, Cabana M et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenerology, Hepatology and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN); JPGN. 2018;66(3):516-554

•       Kwok  TC, Ojha  S, Dorling  J. Feed thickener for infants up to six months of age with gastro‐oesophageal reflux. Cochrane Database of Systematic Reviews 2017, Issue 12. Art. No.: CD003211. DOI: 10.1002/14651858.CD003211.pub2.

•       Nelson SP, Chen EH, Syniar GM, Christoffel KK. Prevalence of Symptoms of Gastroesophageal Reflux During InfancyA Pediatric Practice-Based Survey. Arch Pediatr Adolesc Med. 1997;151(6):569–572. 

•       Davies I, Burman-Roy S, Murphy MS, Guideline Development Group. Gastro-oesophageal reflux disease in children: NICE guidance. BMJ. 2015;350:g7703. Published 2015 Jan 14. doi:10.1136/bmj.g7703