Treatment for Infant Reflux Disease

Lifestyle Changes That Can Help Reflux:


Feeding infant smaller meals more often
* Keeping baby upright for at least 30 minutes after feedings
* Elevating the head of the crib 30 degrees.  
Frequently burp baby to minimize gastric pressure that can increase the chances of reflux
* Modify your diet if breastfeeding – certain food (especially acidic) can aggravate reflux such as: caffeine, chocolate, garlic, tomato based sauces, etc.


Formula Change/Thickening
Many children with reflux also have a milk protein allergy or sensitivity.  Making a formula change can also sometimes help with reflux.  Many times an infant is switch to a hypoallergenic formula like Enfamil Nutramigen or Similac Alimentum. Others have to go a step further to a prescription for a very basic formula called Neocate or Elecare.
**Special Note – many insurance companies will pay for both the Nutramigen/Alimentum and Nelocate/Elecare if a Pediatric GI says it medically necessary.   


Some doctors will recommend thickening formulas with rice cereal or with a thickening agent called Simply Thick.  The do this with the idea that if the formula is a thicker consistency thereit will be less likely to come back up. (NEVER do this without DR recommendation and overseeing it.)

There are three main medications used to treat GERD:
Antacids – Antacids work by neutralizing stomach acid. They can provide fast relief from occasional heartburn, but the relief is usually short-term. (liquid Maalox or Mylanta)
H2 blockers – H2 blockers reduce acid production in the stomach by blocking a signal that leads to acid secretion. They can help heal possible damage to the esophagus that may be caused by acid reflux disease. (Ex: Zantac, Prepcid, & Axid)
Proton pump inhibitors (PPIs) – Proton pump inhibitor are usually a very effective treatment for acid reflux disease. They work by turning off some of the “acid pumps” in the stomach’s acid-producing cells. PPIs provide relief of symptoms and also heal any damage done to the esophagus that may be caused over time by acid reflux disease. (Ex: Prevacid, Nexium, & Prilosec)
Other Medications:


Motility Medications 
Some doctors will sometimes prescribe medications to increase the motility of the formula/breastmilk through the digestive tract.   
Reglan – This is another medication that helps speed up the digestion process. However, it is also associated with many side effects, some of which can be serious. (Currently rarely used, and is a last resort) 
Erythromycin This is an antibiotic usually used to treat bacterial infections. One common side effect of erythromycin is that it causes strong stomach contractions. This side effect is advantageous when the drug is used to treat reflux.
Surgery 
Suergery isn’t regularly used to treat infant reflux but under certain circumstance it’s medically necessary.  A nissen fundoplication is the most often surgery performed. With this specific surgery, the top part of the stomach is wrapped around the esophagus forming a cuff that contracts and closes off the esophagus whenever the stomach contracts thus, preventing reflux.

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