Generality
The reflux of the newborn is a phenomenon that occurs in the very first months of life and consists in the ascent towards the esophagus of the food present in the stomach (ie in the stomach).
If reflux is a persistent problem with serious repercussions on the infant (weight loss, recurrent crying, repulsion for food, violent vomiting and with traces of blood, etc.), then at its origin there could be morbid conditions that require a specific treatment.
These morbid conditions include: gastroesophageal reflux disease, esophagitis, allergic gastroenteritis and pyloric stenosis.
What is infant reflux?
The reflux of the newborn is a typical phenomenon of the first 12-14 months of life and consists in the ascent, from the stomach towards the esophagus, of the food ingested with a feeding or a meal.
Sometimes marked by regurgitation up to the mouth (complete with small emissions of food), it is a fairly common condition and only in rare cases a cause for apprehension and alarmism.
If gastric juices also come up with food, we also speak of acid reflux of the newborn, where the word acid refers to the acidity (low pH) of gastric juices.
EPIDEMIOLOGY
Approximately 50% of children within the third month of life manifest reflux phenomena. However, in only a few of these, its occurrence is related to a serious health problem.
Among babies in the 10th month, the percentage of cases of reflux drops to 5%.
Although it occurs very rarely, it is possible that some babies continue to suffer from reflux even up to the 18th month.
Causes
Infant reflux usually arises from a combination of factors.
Surely the most important and influential reason is the fact that the cardia of newborn babies (and up to the 12th-18th month) is still immature and not very functional.
The cardia, or lower esophageal sphincter, is the valve located between the esophagus and the stomach, which regulates the unidirectional passage of food between these two behaviors (the correct meaning is: esophagus → stomach).
Secondly, they can affect the onset of reflux:
- The liquid diet (milk in particular), typical of the neonatal age.
- The formation of bubbles in the stomach that "push" the food present towards the esophagus.
- The excessive speed in drinking by the child.
- An excessive amount of food given to the infant.
The cardia opens only when a person swallows food, that is, when he swallows. At all other times of the day it is closed, so that it is impossible for the contents of the stomach (whether it be food or gastric juices) to go up the esophagus or higher.
WHEN REFLUX IS A SERIOUS PROBLEM
In a small number of cases, newborn reflux is the consequence of some serious or otherwise problematic morbid conditions, such as:
- Allergic gastroenteritis.
The term gastroenteritis refers to an "inflammation of the mucous membrane of the stomach and / or intestine". A gastroenteritis is defined allergic, when the inflammatory process follows an abnormal reaction to a food present in the stomach; reaction typically characterized by: vomiting, diarrhea and skin rash.
In newborns, or rather in children for whom milk is still the primary source of food, allergic gastroenteritis is usually due to an "intolerance towards the proteins of cow's milk (or cow's milk), used instead of mother's milk. - Gastroesophageal reflux disease.
We talk about gastroesophageal reflux disease when the ascent of food and gastric juices present in the stomach is a constant, not sporadic phenomenon (N.B: when it is a sporadic event, we only speak of gastroesophageal reflux).
In the case of newborns, gastroesophageal reflux disease is due to marked immaturity of the cardia. This condition is often observed when the child: was born prematurely; had a low birth weight; was born with a nerve and / or muscle disease, such as cerebral palsy; you are allergic to cow's milk. - Eosinophilic esophagitis.
It is the inflammation of the esophagus (in medicine, the suffix -itis following an organ indicates an inflammatory state) due to an allergic-type reaction (eosinophils are white blood cells also involved in allergic reactions).
Children suffering from this disorder have a "high presence of eosinophils in the esophageal mucosa.
Although they do not yet have firm evidence, researchers believe that the cause of the allergic reaction is a food to which one is intolerant. - The obstruction or narrowing of a tract of the esophagus or stomach (more precisely the pyloric tract of the stomach). It is a condition that is possible in children, but very rare.
If the obstruction or narrowing resides between the stomach and the small intestine, ie at the level of the valve called pylorus, it is also called pyloric stenosis. The presence of a pyloric stenosis prevents the complete passage of food from the stomach to the intestine, ie the complete gastric emptying.
Symptoms and Complications
Although it does not always occur, the most characteristic sign of reflux in the newborn is the regurgitation to the mouth of gastric content.
OTHER SIGNS OF A POSSIBLE REFLUX
If gastric contents do not go up to the mouth but stop in the throat or esophagus, a parent may suspect the presence of reflux episodes in case of:
- Loss of appetite, or poor appetite often accompanied by a sense of repulsion for food.
- Failure of your child to grow or, in the worst cases, loss of body weight.
- Frequent crying, especially after meals and at night, when your baby is lying down.
- Frequent irritability in the child.
- Frequent coughing, even when the newborn does not have any form of cold.
WHEN TO SEE THE DOCTOR?
As mentioned several times, the reflux of the newborn is a condition that, in mild terms, occurs quite frequently, therefore it is to be considered an almost normal phenomenon.
If, however, the child manifests:
- Violent episodes of vomiting, or "bullet" vomiting
- Weight loss or failure to gain weight
- Regurgitation up to the mouth of yellow or green color
- Vomiting with traces of blood or with something reminiscent of coffee grounds (N.B: the presence of blood is consequent to the irritation produced by the gastric juices to the damage of the mucous membrane of the esophagus).
- Respiratory difficulties
- Blood in the stool
- Vomiting from the age of 6 months
- Strong repulsion for food
it is advisable to contact your pediatrician immediately and request an appointment to investigate the situation.
In fact, the aforementioned manifestations could be the signal of morbid conditions - such as gastroesophageal reflux disease, eosinophilic esophagitis, pyloric stenosis, etc. - which have also reached an advanced / severe stage.
COMPLICATIONS
In addition to a slowdown in growth and respiratory problems, reflux in the newborn seems to be one of the causes that, in adolescents, in certain individuals, triggers gastroesophageal reflux disease.
However, it should be noted that researchers do not yet have precise evidence regarding this possibility.
Diagnosis
To understand the extent of reflux (that is, whether or not it is a serious problem), the pediatrician must have the baby undergo a thorough physical examination, during which he examines the baby and asks the parents about the symptoms or signs observed up to that point. moment.
If no particular problems emerge (such as for example the drop in body weight, etc.), the diagnostic process can be considered already concluded: the child, in fact, is healthy and within a few months will no longer present any disturbance.
If, on the contrary, the physical examination reveals the presence of complications, it becomes essential to carry out more in-depth diagnostic tests, including:
- The ultrasound of the tract corresponding to the esophagus / stomach.
- Laboratory tests of various types.
- Monitoring of esophageal pH (or pH-metry).
- An x-ray of the gastrointestinal tract (or "barium meal").
- An "endoscopy of the upper digestive tract.
ULTRASOUND
Ultrasound is a widely practiced diagnostic imaging test because it is harmless and sufficiently comprehensive.
For its realization, an ultrasound probe is used which, placed on the patient's skin, allows the visualization of the underlying organs and tissues, thanks to images projected on a suitably connected monitor.
Ultrasound of the gastroesophageal tract can clarify whether the patient suffers from pyloric stenosis or other similar problems.
LABORATORY EXAMS
The laboratory tests consist in the execution of analyzes on urine and blood samples.
Their execution serves to identify some causes that can induce vomiting or weight loss. They are also useful for the purpose of a differential diagnosis, that is, when evaluating any conditions with symptoms similar to the one suspected.
MONITORING OF ESOPHAGEOUS pH
Monitoring esophageal pH, or pH-metry, is the measurement of acidity levels within the esophagus and stomach.
For its realization, it is necessary to insert a special probe, which is inserted into the nose and then slowly led up to the two compartments of the digestive system mentioned above. At the end of the tube, a small sensor (an electrode) capable of recording the acidity level and report it on an external device (to which it is obviously connected).
For adults, the pH-metry is not painful, but it is annoying when the doctor inserts the tube (an anesthetic is used for this); in newborns, it is difficult to determine what its execution causes, however it generally does not involve any complications.
Particularly useful in cases of suspected acidic gastroesophageal reflux, the examination can last several hours (usually 24 hours) and requires the infant to be hospitalized (for pH monitoring).
RADIOGRAPHY OF THE GASTROINTESTINAL TRACT
The x-ray of the gastrointestinal tract can provide important information regarding the health of the internal walls of the stomach and intestines (initial part).
It is also called "barium meal" because, to improve the vision of the affected portions, the radiologist administers a liquid containing barium sulphate to the patient (N.B: the liquid is white and has a milky appearance).
X-rays of the gastrointestinal tract are also particularly useful when there is a suspicion of an obstruction between the stomach and intestines (pyloric stenosis).
ENDOSCOPY OF THE UPPER DIGESTIVE TRACT
It is called endoscopy, or endoscopic examination, the diagnostic procedure that involves the observation of the internal parts of the body, by means of an instrument called an endoscope.
An endoscope is a long, thin and flexible tube, equipped at one end (the one inserted into the body cavities) with a light source and a camera (NB: the camera is connected to an external monitor, on which the images appear. of the observed area).
Upper digestive tract endoscopy allows visualization of the esophagus, stomach and initial intestinal tract; if there are narrowings or inflammatory states (for example oesophagitis), these are easily identified.
Furthermore, the procedure has another advantage, which the previously described tests do not have: the possibility of collecting a sample of suspicious cells (biopsy), for a future histological laboratory examination.
Treatment
In most cases, the reflux of the newborn requires simple (but effective) measures, rather than particular therapeutic treatments, such as:
- Small (i.e. in small quantities) and frequent meals
- Moderate the rate of food administration
- Several stops during the meal, to allow the "infant to" burp "
-
Keep the baby upright, both during and after each meal
If these remedies are ineffective (because behind there is a gastroesophageal reflux disease, etc.), or if the presence of an allergy to cow's milk is confirmed, more specific treatments must be used. Indeed, in the most complicated cases, surgical practice becomes necessary.
MEDICINES AGAINST REFLUX
If the infant's reflux is chronic and prevents the baby from growing, the doctor may prescribe the administration of drugs such as ranitidine and / or omeprazole.
Ranitidine is an antagonist of histamine H2 receptors, with the function of inhibiting acid production by the stomach (thus avoiding a massive production of gastric juices).
On the other hand, omeprazole is a proton pump inhibitor, which - like ranitidine - reduces the production of acid in the stomach.
