Reflux in infants: understand what it is and when you should care
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Gastroesophageal reflux (GER) is repeated returning of gastric contents into the esophagus. And, according to Catherine de Almeida Cabral, a pediatrician at the Hospital Anchieta, of the Federal District (DF), it is normal in infants due to the immaturity of their digestive tract, common in this age group.
But, says the pediatrician, GER is considered normal when it does not compromise the growth and development of the baby. "It can be considered a disease when it is associated with other signs and symptoms," he says.
Henrique Gomes, a pediatrician and gastropediatra the Hospital Santa Lucia, Brasilia, points out that in infants of up to three months of life is normal the appearance of reflux. "This is due to the development of the gastrointestinal system. Children in this age group, especially in the first month of life, presenting this system still in the process of maturation, thus, the occurrence of gastroesophageal reflux is more present this time, as well as a higher incidence of other related events such as colic of infant "he says.
Gomes explains that gastroesophageal reflux disease can be classified as physiological and pathological reflux.
physiological reflux: It is what happens most commonly in the first three months of life, and its occurrence is directly related to the maturation of the gastrointestinal system, not bringing the baby any harm with respect to weight gain or any other associated symptom.
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PGER: You may start in this age group, however, beyond the episodes of regurgitation, the baby also features irritability and / or low gain associated weight gain. This irritability is caused by pain caused by gastric juice in contact with the esophageal mucosa, and, in most cases, because of the intense cries of babies even during feedings. Some patients may experience respiratory symptoms and / or ENT associates.
A common concern is: reflux in baby can be a sign of a serious illness?
Catherine explains that GERD may be associated with specific conditions such as congenital esophageal stenosis, tracheoesophageal fistulas, hypertrophic pyloric stenosis, food allergies, among others.
Gomes emphasized that the reflux when pathological, is a picture that deserves special attention. "In addition to the nuisance caused by the regurgitation of milk, can cause the baby to have low weight gain, and other non-gastrointestinal diseases such as otitis media repeat, chronic cough or asthma," he explains.
The best way, then, is to be attentive to the signs, knowing distinguish between physiological reflux (which can be considered normal) of the disease, do not hesitate to seek medical help in this second case, or simply if you have questions.
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Symptoms: how to identify the reflux?
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It is important to know, first, what are the differences between regurgitation and reflux. Gomes explains that the regurgitation is the return of food, in this case, milk, swallowed. "Regurgitation can be either a symptom of physiological as gastroesophageal reflux. Remember the existence of hidden reflux when there is no presence of regurgitation of the mouth milk, however, can be painful at the time or even other associated diseases, "he says.
The gastropediatra points out that, also popularly called the "gush" regurgitation is normal until the sixth month of life, with large decrease in symptoms in the third month.
Catherine points out: "regurgitation can be defined as the return of small amount of gastric or esophageal contents to the pharynx and mouth, effortlessly. The reflux is the return of gastric contents into the esophagus. "
Symptoms of physiological reflux
Catherine explains that when the reflux is physiological, it is most common in the first months of life, occurring repeated regurgitation without other symptoms or associated conditions.
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Symptoms of pathological reflux
Gomes out as main symptoms in this case:
- Intense crying during or after feedings;
- Changes in sleep;
- respiratory and ENT associated symptoms (chronic cough, asthma, otitis media);
- Low weight gain.
What to do in case of reflux?
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You can try at home a few simple measures, such as keeping the baby upright for 20 minutes after each feeding and raising slightly the head of the cot. Another alternative is to increase the frequency of feeds to decrease the amount of milk in each one.
But it is worth noting, if the reflux is associated with other symptoms, it is best to take the baby to the pediatrician as soon as possible. Any kind of treatment, after all, should be guided by a doctor.
Causes of reflux in infants
Catherine points out that the main cause is the immaturity of the gastrointestinal tract. "Remember that the mechanisms that prevent the return of gastric contents into the esophagus and mouth are still developing," he says.
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In pathological cases, the reflux can be associated with specific conditions such as congenital stenosis of the esophagus, tracheoesophageal fistula, hypertrophic pyloric stenosis, food allergies, among others.
Gomes points out that, in some cases, the exclusion of anatomical defects, such as hypertrophic pyloric stenosis, is required. "Other risk factors are premature birth and association with neurological disorders," he says.
Preventive measures: how to avoid the problem?
Catherine explains that parents can take calls antireflux measures, which are:
- Elevation of the head to 30 degrees. Tip: This can be done by adopting pillows or cots with antireflux mechanism.
- Wait a few minutes after feedings to put the baby in the crib, even when he burped. Tip: usually 10 to 15 minutes after feeding is enough.
- Dietary measures: some foods can reduce the tone of the sphincter, which is one of antireflux mechanisms and / or increase gastric acidity. In such cases, fatty foods should be avoided, citrus fruits, tomatoes and coffee.
Gomes points out that foods that favor the cramps are also related to reflux in the first months of life, such as caffeinated, carbonated addition intake in excess of cow milk and derivatives.
Treatments against reflux in infants
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Catherine recalls that in the physiological GER cases, it is considered transitory, and its reduction is expected at around four to six months, with the introduction of solid foods and to adopt a more upright posture, given the neurological development.
Since the gastroesophageal reflux, as highlighted Gomes, it is treated with postural measures, of breast feeding habits changes, besides the specific drug treatment. "The pediatrician is able to give the necessary guidance in addition to starting drug treatment when this is the case. In some situations, the pediatric gastroenterologist is important for the follow-up of this patient, "he says.
Catherine reinforces the pathological reflux is treated with guidance to parents, antireflux measures, dietary measures as introduction of thickened infant formula, early introduction of solid foods and medications for protection and gastric emptying and decrease in regurgitation.
6 points that must be observed and taken to consultation
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It is interesting to go now prepared for consultation with the pediatrician, noting the possible symptoms associated with baby reflux and also leading questions to the doctor.
"Parents should inform the pediatrician their concerns and anxieties about the regurgitations and development of your baby. A routine visit baby up to six months, which should be monthly, is an important point to diagnose the condition of GERD because it pediatrician evaluates the weight and the baby's growth and the complaints of parents, "said Catherine.
In this sense, in relation to the preparation of parents and the time of the query itself, Henrique Gomes guides:
- It is important that the pediatrician east assistant parents on the differentiation of physiological gastroesophageal reflux disease;
- Parents should tell the doctor if the baby is very cranky if he gets angry during or after feedings;
- Parents should observe the baby's weight gain curve and always talk to your pediatrician about whether this gain is within normal parameters;
- Parents should see if the baby has persistent cough of difficult resolution, as well as respiratory or ENT infections of repetition;
- Should observe whether the baby regurgitates or vomits frequently;
- They must also observe the pattern of baby sleep (if it is busy, you wake up frequently).
With the watchful eye of parents and the baby routine consultations "days," it tends to run well and, although reflux is pathological, will be treated the best way possible.