Each week the Preemie Resource Blog will look at one issue that effects preemies and their parents.This week we will discuss reflux, one of the most common issues among premature babies. Read Stacy's story about her son's struggle with reflux.

 

REFLUX

Reflux is one of the most common but least diagnosed issues with preemies. I’ve found that many doctors do not want to start a medication regimen for preemies in the NICU. What that means is that many babies go home and continue to suffer out loud or in silence.

If you have ever had reflux or heartburn, you can imagine what a little baby is feeling every time they eat. I remember crying 8-10 times a day- every time my son ate. It was heartbreaking to have to feed him when he was in so much pain. Then the spitting up got worse. I was told; “babies spit up.” This was not a baby just “spitting up”. 

WHAT IS GER?

“GER is Gastroesophageal Reflux. Gastro means stomach, and esophageal refers to the esophagus, the tube inside the throat that connects the mouth to the stomach. A muscle at the top of the stomach (also called the Lower Esophageal Sphincter or LES) naturally opens and closes to allow swallowing, burping, and vomiting. Refluxing occurs when the stomach acid and partially digested food flow back up through the LES into the esophagus. All children and adults will naturally reflux throughout the day, especially after eating. However, if the muscle opens too frequently and refluxing occurs too often, complications can develop.

Premature infants have an increased risk of developing GER. There are several medical conditions that can cause reflux, but in preterm infants, the most common causes are immature muscles and abnormal breathing from chronic lung disease. If the lower esophageal sphincter is weak or underdeveloped, it can remain open when it should be closed, letting the stomach contents flow back up the esophagus. When an infant or child breathes abnormally because of chronic lung disease, the muscles used for breathing work harder. As these muscles work hard to breathe, they can pull on the muscles near the top of the stomach, stretching the sphincter and causing it to remain open.

When the stomach contents flow inappropriately up into the esophagus they bring acid from the stomach. As the acid irritates the tissue inside the esophagus, it becomes inflamed and reddened. This condition is called esophagitis. Esophagitis is painful, similar to the pain of heartburn. This is why an infant will refuse to eat or stop eating - she is protecting herself from the pain of the acid touching the damaged tissue. If the reflux is severe, the stomach contents may go high enough into the esophagus to be aspirated or spilled into the lungs causing choking, color changes, frequent respiratory infections, apnea (breathing slows or stops) and/or bradycardia (slowed heart rate).”

SYMPTOMS:

As I said, “babies spit up” but reflux is much more than that. Here are some common signs and symptoms:

•     spitting up frequently (more than 2 times a day);

•     fussy often throughout the day (specifically before, during or after eating)

•     refusing to eat,

•     fighting eating;

•     taking only small amounts of formula or food, regardless of the amount of time since the last feeding;

•     back arching during feedings;

•     bradycardia;

•     choking or apnea during or after eating;

•     skin color turns pale or grayish during or after eating;

•     poor weight gain; and/or frequent respiratory infections.

Many parents say, "She acts like it hurts to eat" or "It just seems like she is in pain."

My son would spit up every time he ate, even if he was held upright for an hour after he ate. He refused to eat and would only eat a small amount every 2 hours. He would arch his back and cry and scream. It broke my heart because he was a happy baby when he wasn’t eating or refluxing. Although his weight gain was slow, he was always gaining so the doctors weren’t concerned. But mother’s intuition told me that it was more than just spitting up. Eventually, my son spit up so badly that he stopped breathing and my husband and I had to bulb syringe him until color came back to his face. It was after that point that we finally got our diagnosis.

For more on reflux--how is it diagnosed, treated, and other how helpful information--click here