All babies regurgitate a tiny bit of milk after feeding, usually when they are burped. But sometimes, infant reflux can be more serious and prevent a baby from getting sufficient nourishment into its body. The most common sign of this is projectile vomiting. The milk from the last feed is ejected forcefully in its entirety so that no food is consumed.
In medical terms, this is known as pyloric stenosis. The pyloric valve should prevent regurgitation but sometimes the pylorus, which leads from the stomach to the small intestine, is thickened or narrowed and the muscles prevent food from entering. The condition is found more often in male babies up to six months old. In some instances, the problem spontaneously resolves a month or two later without any treatment.
Pyloric stenosis can result in an infant that is constantly hungry, dehydrated, and fails to gain weight. We look at getting a diagnosis and possible medicinal treatments. This is followed by feeding strategies. Finally, we look at the next steps if the condition continues after the child turns one.
Getting A Diagnosis (Infant Reflux)
You should never make your own diagnosis of pyloric stenosis. There could be other factors at play that need to be handled differently. If your baby does have pyloric stenosis, your doctor will confirm his size and weight for his age and check for other signs of development. A contented baby is unlikely to have been adversely affected, and there are strategies for feeding infants with this condition that ameliorate it.
But the doctor may need to run some tests first to confirm the diagnosis. This could involve an ultrasound, x-rays to pick up other blockages, urine, and blood tests to eliminate other causes, measurement of esophageal acidity (pH), and an upper endoscopy using a tube with a camera to collect a tissue sample for analysis.
Treatment – Medication And Surgery
If projectile vomiting carries on after the baby turns one year old, the child experiences trouble breathing, or has not reached the right weight range, your doctor will refer the baby to a pediatric gastroenterologist.
The specialist will take a history involving the answers to the following questions. How often does projectile vomiting happen? Does your baby seem hungry between feeds? When did the reflux symptom start? When did you take your baby off the breast and start bottle feeding? What brand have you been using and has this changed? Furthermore, what is the frequency and volume of feeds? What makes the reflux better or worse?
In most cases where there are no complications, the specialist will avoid medications. However, if feeding strategies haven’t been effective and the child is underweight, refuses the breast or bottle, displays signs of chronic asthma concurrently with reflux, or has esophageal inflammation, the doctor will prescribe a medication that prevents acid from forming. Children younger than a year will be given either famotidine (Pepcid AC) or cimetidine (Tagamet HB). Older babies will receive omeprazole magnesium (Prilosec).
If your baby’s breathing is compromised by pyloric stenosis, or the baby persistently does not gain adequate weight and fails to develop appropriately, surgery will be performed. This involves a tightening of the pyloric valve so that acid does not cause reflux.
How To Feed A Baby With Pyloric Stenosis
These strategies will reduce acid-induced regurgitation. The baby should be kept upright during and for half an hour after feeding thus employing gravity to keep the feed down. Do not bounce the baby around or allow any movement that can cause the food to come up.
Rub the baby’s back to remove wind. This must be done frequently but gently to avoid unnecessary movement. Air trapped in the stomach may cause reflux.
Babies should be given smaller amounts of bottled food. A breastfed baby should be nursed for a shorter time. The same quantity must still be given to the baby every 24 hours, which means that you must feed the child more often throughout the day.
Doctors advise that you put the head of the bed up so that the level is higher than the foot of the bed when you put your baby down to sleep.
GERD and Dysphagia (Infant Reflux)
Gastroesophageal reflux disease is sometimes linked to dysphagia, where a child has problems eating food, choking, and difficulties swallowing. This is more likely to occur in an older child but is something to be aware of. Cases of pyloric stenosis in a child older than a year are rare but do occur.
If your child has difficulties swallowing, professional help is needed, but there are products that can help, such as thickeners from Simply Thick LLC.
Fortunately, most cases of pyloric stenosis spontaneously resolve by the eighth month or sooner. Until then, follow the feeding guidelines above to ensure that your child retains as much of his feed as possible.