Many of you will have experienced the difficulties of a child with gastro-oesophageal reflux (GOR), as it affects up to 50% of otherwise healthy, full-term infants. It can be very distressing and painful for infants and equally distressing for parents to hear their baby cry for hours on end and have difficulty with feeding.
But what is GOR and what can help improve the symptoms?
What is GOR?
GOR is defined as the passage of stomach contents into the food pipe (oesophagus). It is a normal physiological process occurring several times per day in healthy infants, children and adults.1 It occurs readily in infants because the muscle of the food pipe is very relaxed in many babies and this allows acid from the stomach to flow back up into the food pipe. This causes a burning sensation and can cause irritation of the tissue in the food pipe, which can feel sore or painful.
Gastro-oesophageal Reflux Disease (GORD) in infants occurs if GOR is severe and occurs with other symptoms such as failure to gain weight, distressed behaviour, difficulty swallowing and unexplained crying.
It should be noted that GOR and GORD is more common in premature babies and those with neurological disorders as they could have some problems using their muscles and nerves.
Is breast best?
GOR and GORD can occur in both breastfed and formula fed babies. Studies suggest that formula fed versus breastfed babies do not differ in the frequency of GOR but breastfed babies may have a shorter time of reflux episodes.
What about thickener?
Research shows that thickening baby formula can be “moderately effective” in reducing the symptoms of GOR/vomiting in otherwise healthy infants. However, thickening can only cause a decrease in visible reflux (ie. vomiting) but it does not decrease the frequency of reflux episodes.2 Thickening a formula can also increase coughing and some infants may develop diarrhoea. I would advise caution and not to attempt this without the help of your GP and a Registered Dietitian.
What about formula type?
For most babies, the symptoms of GOR do not decrease when changing from one milk formula to another or to a soya formula. However, in babies who present with vomiting, GOR may be associated with a cow’s milk protein allergy. In this case, a two to four week trial of a special formula which has the protein broken down into smaller pieces (called an ‘extensively hydrolysed formula’) may be beneficial in formula fed babies. Contact a Registered Dietitian if you think your child has a cow’s milk allergy. My email address is firstname.lastname@example.org if you would like to contact me.
Are children with GOR/GORD susceptible to feeding difficulties?
The evidence in this area is inconsistent to demonstrate whether children with GOR suffer more from feeding difficulties or not. One study showed that feeding problems affecting behaviour, swallowing and food intake affect children with GORD, who also displayed a lack of development of age-appropriate feeding skills.3
- Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2009 Sep 9.
- Practice-based Evidence Nutrition (pennutrition.com)
- Mathisen B, Worrall L, Masel J, Wall C, Shepherd RW. Feeding problems in infants with gastro-oesophageal reflux disease: a controlled study. J Paediatr Child Health. 1999 Apr [cited 2009 1 Dec];35(2):163-9.