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GERD in Infants

GERD (gastroesophageal reflux disease) occurs when the contents of the stomach (including stomach acid) back up into the esophagus, causing the lining of the esophagus to become inflamed and irritated. In infants, the condition is usually the result of an immature digestive system. Most children outgrow GERD by the time they are 1 year old.

Some common symptoms of GERD include frequent fussiness, irritability, or crying after eating; frequent spitting up or vomiting after eating; frequent spitting up in a child older than 1 year; “wet” burping; sleeping problems; and poor weight gain or weight loss. Some babies with GERD have frequent choking episodes or develop chronic wheezing or aspiration pneumonia when regurgitated stomach contents enter the lungs. Some babies also may experience periods of apnea (cessation of breathing), which can be life-threatening. A child with GERD may refuse to eat, or may gag or choke when trying to swallow.

If the problem occurs regularly, talk to your child’s doctor. GERD is usually diagnosed with special X-rays that can show abnormalities in the digestive tract. Sometimes doctors use a test called a 24-hour pH-probed study to measure and monitor the acid levels in the esophagus. Doctors also may perform endoscopy (an examination of the inside of the body using a viewing instrument) to examine the upper part of the digestive tract (the esophagus, stomach, and upper intestine).

To help prevent reflux, feed your baby in an upright position, burp him or her several times during feedings, keep him or her in an upright position for at least 30 minutes after feeding, and avoid feeding him or her within 2 to 3 hours before bedtime. The doctor may recommend that you raise one end of the crib mattress slightly so the baby can sleep with his or her head raised. If you are feeding your baby formula, your doctor may recommend trying a different type of formula. If these changes do not help, the doctor may prescribe medication to reduce the incidence of reflux or help reduce the amount of acid in the child’s stomach. In rare cases, doctors recommend surgery to create a valve at the top of the stomach to eliminate reflux.

Your doctor may recommend that you stop the baby’s usual feeding for 24 hours and substitute an over-the-counter rehydration solution or sports drink to help restore lost fluids and electrolytes (essential minerals that help regulate various body processes). On the second day, replace the solution or sports drink with breast milk, a soy formula, or a lactose-free formula. Give bland, solid foods if the baby has not vomited for 24 hours and can hold down liquids. Gradually return to the child’s usual diet after the diarrhea has stopped.

If a baby has severe gastroenteritis, he or she will be hospitalized and given fluids intravenously (through a vein). In most cases of gastroenteritis, the baby recovers completely, with no lasting effects.

Diaper Rash

Diaper rash (see page 120) is inflammation of the skin on a baby’s abdomen, buttocks, thighs, or genital area that usually results from prolonged contact with urine or feces. Diaper rash can also result from chafing or from a bacterial or yeast infection (thrush; see page 539). Sometimes the condition is an allergic reaction to chemical irritants such as soap, detergent, or fabric softener, or to synthetic materials in disposable diapers.

Symptoms

The main symptom of diaper rash is red, spotty, sore, moist skin in the area that is usually covered by a diaper. The rash is painful and can range from mild to severe.

Diagnosis and Treatment

Diaper rash is easily diagnosed by its appearance and is easy to treat at home. Expose the rash area to warm, dry air for as long as possible throughout the day—take the baby’s diaper off and lay him or her face down on soft towels placed over a waterproof sheet. Clean up any stool or urine immediately, and bathe the rash with warm water and a mild soap. Change the towels as often as necessary. Afterward, pat the affected area dry