How to tell if your child has reflux and the tactics to help keep it under control

“All babies have a certain degree of reflux when they are born, especially premature ones”, clarifies pediatrician Mariana Facchini Granato, from Instituto da Criança, Hospital das Clínicas in São Paulo. Most of the time, it is physiological reflux, caused by the immaturity of the digestive system of the little ones, and does not cause greater discomfort. “It is so frequent that we can even say that it is part of normality”, says Antônio Celso Moraes, a nutrologist specialized in gastroenterology, from São Paulo. This type spontaneously regresses as your child grows and can be circumvented with palliative solutions.

In some cases, the specialist may prescribe medication. The most common are antacids and antikinetics (which decrease the time the stomach is full). “But these substances should only come into play as a last resort, as there is a risk of side effects”, says Mariana. Irritation, hectic sleep and colic are some of the damage they bring.

The return of milk is not the only sign of reflux. There are cases where the baby coughs, has wheezing and has difficulty breathing. “The mother may also suspect the problem when the child cries a lot, becomes irritable, restless, sleeps poorly and refuses food. These reactions are the result of discomfort caused by acidity. It is also not uncommon for reflux to be confused with colic”, says Mariana.

It gives my heart a squeeze just thinking about the suffering of the little one. But relax. Experts guarantee that these manifestations are mild and regress as the digestive system matures and your child begins to sit and spend more time upright. “About 67% of babies have reflux between 2 and 5 months. From 6 to 7 months, the incidence drops to 21%, and only 5% of them present the picture after the first year of life”, says gastropediatrician Luiz Henrique Hercowitz, from Hospital Israelita Albert Einstein, in São Paulo.

bent care

When reflux is caused by factors other than the immaturity of the digestive system, however, the symptoms are more intense and do not spontaneously improve after the sixth month. Be suspicious if the baby vomits or regurgitates frequently and in large amounts, is constantly tearful and irritable, has a lot of difficulty eating or sleeping. “These cases require careful investigation, especially if the child starts to lose weight or becomes apathetic”, warns Mariana.

There are other indirect signs that should put parents on their toes. “In the most serious cases of the disease, the baby may have apnea, that is, a rapid stop of breathing during sleep, and pneumonia caused by aspiration of the reflux itself”, explains Moraes. Chest pains, asthma attacks, ear diseases such as otitis, and breathing problems also deserve attention. If reflux is not controlled, damage increases over time. In some cases, even the little one’s teeth are affected, becoming weak and prone to cavities due to constant contact with the acidic pH of regurgitated food.

But these are rare situations, in which reflux can be considered a disease and does not resolve itself. In them, the trigger for the problem is usually a change in the baby’s digestive system, such as a malformation. The intensity of the symptoms and the persistence of the condition are the most obvious signs that the child will need medical follow-up, with the use of anti-reflux medication or even surgery, which does not offer greater risks.

Why did you come back?

We all have a valve between the esophagus and the stomach: it’s the lower esophageal sphincter. When we eat, it closes, preventing food from returning. In cases of reflux, this mechanism does not work properly and, therefore, cannot completely prevent the return of the food bolus. Result: part of what was ingested migrates from the stomach to the mouth, bringing with it gastric juices, which are extremely acidic and cause a burning sensation. In babies, the contraction movements of the esophagus – responsible for pushing food to the right path – are also inefficient, increasing the risk that it regurgitates (or vomits) part of what has been ingested.

anti-reflux measures

Up to 6 months: it is the most critical period because the diet is mainly based on liquids, such as breast milk and formula. The thinner the food, the harder it is to be retained by the esophagus. When breastfeeding or bottle-feeding, keep your child at an angle, with the head elevated in relation to the body. At the end, hold it against your shoulder to burp – eliminating the ingested air reduces discomfort. “The ideal is to keep him upright for half an hour after feeding”, teaches gastropediatrician Luiz Henrique Hercowitz, from Hospital Israelita Albert Einstein, in São Paulo. Another care is to schedule the diaper change before each feeding or an hour later, since moving the baby with a full belly increases the risk of reflux. At bedtime, lay him down inclined, with the torso elevated between 30° and 45°. To do this, place a pillow under the mattress, at the head of the crib. This position encourages the food bolus to follow the natural path. “Laying the child slightly turned to the left side also favors gastric emptying”, guides Hercowitz.

From 6 to 12 months: at this stage, special formulas, with thickeners, can come into play. In contact with the stomach environment, they gain the consistency of a gel, which makes it difficult for them to return. The input of baby food also helps. Pasty and consistent foods naturally combat the problem. “Even better if the mother divides the diet, offering smaller portions of food more times a day. This prevents the stomach from becoming too full and distended, which facilitates reflux”, recommends Antônio Celso Moraes, a nutrologist specialized in gastroenterology, from São Paulo. It is advisable to eliminate from the menu fats, chocolates, citrus juices, soft drinks and yogurts. To sleep, the same precautions as in the previous phase apply.