Reflux or gastro-oesophageal reflux (GOR) is a normal physiological process that happens after feeding in healthy infants, children and young people. When GOR does not respond to simple treatment, or is associated with other symptoms, such as cow’s milk allergy, or becomes persistent and severe, it is referred to as gastro-oesophageal reflux disease (GORD). GORD is more common in premature infants, children with neuro-disabilities, but also occurs in obesity and young teens. Children and teens with atopic conditions such as eczema or asthma who have cow’s milk sensitivity respond well to a cow’s milk exclusion with resulting improvement in symptoms of GORD.
Early infancy 0-6 months
At least 40% of infants effortlessly regurgitate after feeding and this resolves spontaneously in the vast majority of infants around their first birthday. During exclusive milk feeding, it may be helpful to feed smaller volumes more frequently or to use a thickened feed under guidance from your GP or registered dietitian. When introducing complementary foods, at around 6 months of age, babies are generally sitting up and rolling over; muscles are becoming stronger and control is better. So it is on the inside of the body too, with the sphincter muscle at the top of the stomach – called the oesophageal sphincter – becoming stronger and tighter, with better control of the stomach contents. Throughout the weaning process, for the infant with simple reflux, the presence of solids in the tummy is helpful, both due to the reduction on milk volume and because e the stomach muscles have work to do.
Later infancy 6-12 months
For infants whose GOR is has become persistent and/or severe, and requiring various treatment, it is more common for those infants to take longer to accept solids and they may become more sensitive to textures. Careful management with responsive feeding, texture and fluid management alongside medical treatments, is required for infants who may otherwise become aversive to feeding due to discomfort or pain. Often those infants actually prefer solids to milk, and so getting the balance of solids and milk, meeting needs with other good sources of calcium when milk intake drops. Some older infants do become highly selective about texture and which foods they will eat; and so they not might not be as adventurous as their peers. Keep gently offering newer foods alongside more familiar and acceptable foods as the grow into toddler-hood.
Conditions related to GORD
Reflux is a symptom of non-IgE cow’s milk allergy both in infancy and in older children, with persistent and severe reflux causing inflammation in the oesophagus, from the presence of acid refluxing from the stomach. Any untreated GORD, irrespective of it’s cause, can result in blood loss from upper gastro-intestinal tissues, leading to iron deficiency anaemia. These events are often associated with varying degrees of food aversion and in more extreme cases faltering growth. Feeding difficulties is part of this overall picture with discomfort/pain, food refusal and growth faltering which can become troublesome for some infants and toddlers.