• Babies are not born with an antacid deficiency

    by Juliana Nahas, MD
    on May 7th, 2018

Why does my baby have reflux?

 

In Recent years, there has been an increase in infant GERD or Reflux symptoms to epidemic proportions. Typically pediatricians treat with antacids without testing, unless the baby is not growing well. But what could be causing this rapid rise in GERD? After all, we don’t want to treat a baby like a small adult. Drugs have unwanted side effects, and antacids, in particular, suppress acid production in the stomach and the GERD symptoms. That can lead to malabsorption syndromes, because we need the acid for digestion and breakdown of the food we eat. Proton pump inhibitors (PPI’s) inhibit the absorption of key vitamins and minerals, like the B vitamins, Folate, B12, vitamin C , Iron , Calcium and Magnesium, to name  a few. This can have huge repercussions on the baby’s brain development, leading to a number of behavioral disorders, eczema, obesity and diabetes according to several studies.

Also this approach does not look at the underlying problem or causes that resulted in the reflux. The Gold standard test in conventional pediatrics is to get a 24 hr PH Probe study. This is a very cumbersome test and has to be done in the hospital. There is an another test, a Barium Swallow test that can also be done alternatively as an outpatient,  but it is reserved for babies who are not growing in order to minimize radiation exposure from the Xrays.

Reflux is a symptom of impaired lower esophageal sphincter tone. With increased stomach pressure ( for example : when baby overeats, or bends the legs up) ,the stomach contents flow back up to the esophagus, sometimes causing the spit up, and sometimes, only causing gagging or coughing ( silent reflux).

Possible causes of infant reflux include:

-SIBO (small intestinal bacterial overgrowth) which produces gas and bloating putting pressure on the lower esophageal sphincter and make it open inappropriately. Also dysbiosis, or overgrowth of harmful bacteria anywhere in the gut can cause the same effects.

-Food sensitivities or allergies: babies may be sensitive or allergic to formulas, or foods that mothers are eating that pass into the breastmilk. For example, if a mother eats spicy foods or caffeine, the baby might be really colicky. The two most common food triggers for reflux include wheat protein and dairy proteins in mother’s diet. Standard formulas contain these ingredients as well, so talk to your pediatricians about specialized hypoallergenic formulas if your baby is having reflux.

- Antibiotics during the pregnancy can change the mother’s gut and vaginal microbial flora. When the baby passes through the birth canal, it acquires some of this flora that colonizes its intestines. So if the mother’s gut flora is not optimized, the baby can have digestive issues.

-C/section deliveries are another threat to the baby’s gut microbiome, because the baby is first exposed to hospital bacteria, which, as we know, can be quite harmful.

Best ways to reverse and prevent reflux:

-During pregnancy: Mothers need to optimize their gut health, by eating a healthy balanced diet, avoiding food intolerances, and taking prebiotics like Prebiogen , or  potato starch and probiotics like Prescript-Assist, or by eating fermented foods like kefir, sauerkraut ,kimchi beet kvass.

-Breastfeed: breastmilk is the optimal prebiotic, and probiotic food for infants. Evolution, or Nature, has taken care of that for us. The prebiotic molecules selectively stimulate the growth of the ideal flora: Bifidobacteria species, which is one of the most beneficial bacteria for the gut. Some formulas are adding these prebiotics which is a smart move, so if breastfeeding is not possible, look for that on the formula label.

-Probiotics: Especially formulas containing Lactobacillus Reuteri, and Bifidobacterium Infantis, help to shift the infant gut microbiome overtime, and optimize the gut flora balance away from the harmful species. Some brands also contain colostrum, which may be ideal for formula fed babies. It is recommended for at least the first 3 months of life, but there is no time limit. Check out Ther-Biotic Infant powder which has the prebiotics and probiotics together in my online dispensary.

-Hypoallergenic formulas: If babies cannot breastfeed for some reason, choosing a hypoallergenic formula that avoids gluten, casein, soy or corn products may be necessary. Talk to your pediatricians so you can explore the best option for your baby. Also avoiding cereals and early introduction of solid foods may be important.

- When the baby starts to eat solid foods, start with a hypoallergenic anti-inflammatory diet, with plenty of vegetables and fruits, lean proteins, healthy oils, and as little wheat containing grains and processed flour foods as possible. Eggs can be tricky, so if the baby doesn’t tolerate them initially, try again in a month after they have sampled other foods.

-If a baby has moderate to severe reflux symptoms, we may need to support them with antacids for a short period of time, 2-4 weeks, while we implement the above approaches, since that is the road to optimizing the baby’s gut microbiome and avoiding long term complications.

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If you have specific concerns or questions about this topic and your baby, please consult one of our pediatric providers for a more customized service.

Author Juliana Nahas, MD Pediatrician at Covington Pediatrics

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