Reflux is very common and occurs in 70-85% of babies during the first two months of life. It can cause excess gas, spitting up, crying, pain, weight loss, sleeping problems and colic. When your baby has a lot of gas or pain he will often arch his back and cry and at times, seem inconsolable. In order to appropriately treat these symptoms, we need to consider all the factors in play.
First let’s look at your baby’s gut. It is not fully developed at birth and has very few bacterial populations. When your baby goes through the birth canal, your vaginal flora (bacterial population) colonizes his mouth and gut. If your baby is born by C-section, he doesn’t have this benefit, and therefore grows a different population of bacteria. Once your baby’s gut is colonized, different strains of bacteria grow based on what he is fed (breastmilk, type of formula, etc). The particular strains then feedback to determine how foods are digested.
For most babies, breastmilk is most easily digested because it has the right amount of carbohydrate, protein and fat. It also has living cells and certain carbohydrates that feed healthy gut bacteria. The foods you eat also end up in your breastmilk and therefore can affect your baby. Certain foods, such as broccoli and garlic, are known to increase infant gas and reflux. Allergenic foods – such as eggs, gluten and excess sugar – are also culprits. Cow’s milk protein allergy is very common and associated with nearly half of infant reflux, whether it is given through formula or transferred through your diet.
If you are supplementing with formula, also consider that soy formula contains excess estrogen and is a common cause of allergies. Perinatal medications given to you or your baby, such as antibiotics and reflux medication, can kill or otherwise wipe out nearly all the bacteria in your baby’s gut.
A very common cause of infant reflux happens when your baby has a high palate (roof of the mouth). Usually, a high palate also results in a shallow latch because your baby cannot open his mouth wide enough to fill the palate with breast tissue or regular bottle nipples. In this scenario, every time he swallows, he takes in a large gulp of air. Correcting a shallow latch or using a Haberman bottle nipple (one used for babies with cleft palate) to fill the palate usually resolves the reflux.
Unfortunately, the first line of treatment for infant reflux is often medication, such as Zantac, Prilosec, Nexium or Prevacid. These medications often do not relieve symptoms and come with side effects. Medication should be the last resort for babies with gas and colic and only used after all other causes are considered and resolved.
Reflux can also occur from other genetic, developmental and anatomic causes, but these are rare.