A naturopathic approach to infant GERD/reflux

GER(D) is often the first diagnosis a baby receives, which can make it quite scary.

What is GERD?

GER(D) is gastroesophageal reflux (disease); it’s also called heartburn, reflux, or acid reflux. It occurs when the contents of the stomach reflux up into the esophagus. The pH of the stomach contents is quite low, or very acidic. The acid burns the esophagus, which is built for a much higher pH.  To clarify, a diagnosis of GER means that the symptom of reflux is occurring; a diagnosis of GERD indicates a larger disease process that includes reflux as a symptom.

Why do stomach contents go into the esophagus?

There’s a sphincter there, called the lower esophageal sphincter, whose purpose is to hold the stomach contents in the stomach. (See the picture below- the circle is the lower esophageal sphincter.) Generally, GER(D) occurs because that sphincter starts to fail. (Or sometimes, it occurs because part of the stomach slides up through the diaphragm into the chest region – a hiatal hernia.)

How is treated?

The answer you most commonly find in conventional medicine is a pill that decreases naturally occurring stomach acid. The reflux still occurs, but it’s less acidic, so it hurts less or not at all. The underlying problem is not addressed. Please remember that we need stomach acid to properly digest our food, but we need our food to go down the GI tube, not up it. (Surgery is also a solution for some patients with GERD.)

Often, when doctors are treating babies, they will offer a few coping mechanisms before resorting to acid blocking pills (see “What’s the solution?” below). There is good reason to try to avoid acid blocking medications. A study conducted in 2009 and published in the journal Pediatrics found that babies taking the acid blocker Lansoprazole did not cry less with feedings than the babies taking a placebo. Worse, the babies taking Lansoprazole were more likely to develop lower respiratory tract infections (compared to the babies taking a placebo). This year, a study published in JAMA Pediatrics found that babies receiving acid suppressing medications or antibiotics during the first 6 months of life were more likely to develop allergies, including food and medication allergies and asthma, later in life. The researchers reported that their findings contribute “to the mounting evidence that agents that disrupt the normal intestinal microbiome during infancy may increase the development of allergic diseases.” In other words, altering the bacteria that reside in infants’ guts may affect their long-term health. The researchers advised that these medications only be prescribed when the benefits clearly outweigh the risks.

Why does this happen to babies?

Just as babies’ bodies are immature, so are their sphincters. It seems that for some babies, that sphincter immaturity leads to GER(D), while for others it does not.  Often, as babies get older and more mature, and as they spend more time upright, the symptoms of reflux will abate or disappear.

How do I know if my baby has GER(D)?

Babies with reflux cry a lot. It can be a relief to get a diagnosis to explain all the crying. Some parents of children who cry this much think that they must be doing something wrong, when usually this could not be farther from the truth. Getting the diagnosis of GER(D) can relieve feelings of guilt and put baby on the road to recovery.

What are the other symptoms?

• Spit up and / or vomiting that seems to be painful
• Wet burps or wet hiccups
• Crying associated with feedings
• Arching the back, drawing up the legs
• Poor sleep, pain while lying down
• Refuses to feed or wants to feed very frequently
• “Throaty” noises, choking, gagging
• Frequent upper respiratory infections (i.e. colds) and wheezing (these don’t always indicate GER(D) but may)

What’s the solution?

Here are some general ideas for coping with reflux:

Keep baby elevated:

• Particularly for the first 30 minutes after feedings.
• During feeds if possible (there are breastfeeding holds that allow for this).
• Whenever she seems fussy (this is one of many good reasons for wearing baby).
• Consider elevating baby for sleep: there are wedges that are made just for this.

Make sure it’s reflux, not gas:

• You may need to work with your Naturopathic Doctor to differentiate between the two.
• The treatments are different, and these two problems are often confused.
• Carminatives (herbs used to treat gas, like colic drops or Gripe Water) can make GER(D) worse.
• Some babies do have both GER(D) and gas.

Feed smaller meals more often.  In the case of an over-supply of breastmilk or an over-active let-down problem, work with a lactation consultant.

Make sure you are burping her.

Keep smoke exposure down:  nicotine can make reflux worse.

What about naturopathic medicine?

Naturopathic medicine may offer your baby complete relief from reflux.

Reflux in breastfeeding babies can sometimes be attributed to a food that mom is eating.  Finding and eliminating that food can eliminate the reflux completely.  Very often, the culprit is coffee (even decaf), but it could also be chocolate, dairy, spicy foods, or citrus.  Other foods to consider are: soy, peanuts, eggs or tomato sauces (especially in large quantities).  Less commonly it is a food not listed here, so it can be a bit harder to figure it out.  Once the culprit is removed, reflux symptoms generally disappear within just a few days, though dairy elimination may take as long as 2 weeks to see a difference.  As a nursing mom, you do have to be extremely careful about eliminating any food from your diet as you can easily become nutrient or calorie deprived.  Please see your naturopathic doctor for personalized guidance with this and for specific treatment information; I do not advise anyone to do elimination diets without professional guidance.

If your baby is formula fed, you may find that changing formula brands will help (formulas differ slightly from each other in their protein ratios).  If changing formula brands does not help, your child’s provider can help you navigate the world of elemental formulas.  These are formulas that are partially pre-digested.  I do not advise switching to these without guidance from a provider, and I almost never advise soy formula.

Digestive enzymes for a breastfeeding mom can also decrease symptoms in baby (probably because some gets through to baby and helps her digest the milk more fully). Craniosacral Therapy can be very helpful.  Finally, there are supplements that can be administered directly to baby that are helpful (please see your naturopathic physician for advice on this).

More resources:

Dr. Sears

Boston Children’s Hospital