Gastroesophageal Reflux: A Cause of Breathing Problems
A Cause of Breathing Problems
In most cases, a baby's reflux will get better on its own. This
often happens between 6 and 12 months of age, when the baby sits
up more often and eats more solid foods. But reflux may last longer
than a year. Some children may develop reflux when they get older
or never outgrow it. Some infants who have wheezing caused by reflux
may get asthma. Also, colds and other respiratory infections might
make reflux worse.
Common treatments for reflux include:
- Positioning: Infants with reflux should not be slumped
in an infant seat. This increases the pressure in their stomachs
and could worsen reflux. Some infants do best when lying on their
stomach. It may help to raise the head of the crib slightly. The
American Academy of Pediatrics suggests that most babies sleep
on their backs because it may lower the chances for SIDS (sudden
infant death syndrome), but an exception is made for children
with reflux. Ask your doctor if this position is recommended for
- Diet: Many people think spitting up and other problems
that may be due to reflux are caused by allergies or milk sensitivity,
yet that is often not the problem. If your baby's formula was
changed and it has helped, you should stick with it. Most infants
with reflux are better off if they drink less fluids and take
more solids. Babies who drink formula should drink no more than
one can of formula (26 to 32 ounces) each day. It is best to give
it in small amounts (four to six ounces each feeding). It also
helps to thicken the formula with rice cereal (one tablespoon
per ounce of formula). You may need to make a larger hole in the
nipple. If you are breastfeeding, please continue to do so. Ask
your doctor about adding solids to your baby's diet. Older children
should avoid spicy foods, caffeinated drinks (including sodas
and tea) and chocolate.
- Medications: Medication is the most common treatment
for reflux. Some decrease stomach acid, while others help the
stomach empty more quickly.
Medications commonly prescribed for reflux are:
Zantac (ranitidine) is the drug most often used to decrease
stomach acid. It comes as a liquid and is given two to four
times each day. It has no major side effects.
Prilosec (omeprazole) may work better to decrease stomach
acid and is given one to two times each day. It only comes in
capsule form. The capsule can be opened and the powder sprinkled
into food. This drug has no major side effects.
Reglan (metoclopramide) helps the stomach empty more
quickly. It is taken four times each day, 15 to 30 minutes before
each meal and at bedtime. Rarely, Reglan may cause side effects.
Young infants may have tense or stiff muscles. Children with
epilepsy seem to have a greater risk of having seizures when
- Surgery: Children who still have severe breathing problems
in spite of taking medication may need surgery to control reflux.
In those very few children who do need surgery, the most common
surgery is called a Nissen fundoplication. With this surgery,
the top part of the stomach (the fundus) is wrapped around the
bottom of the esophagus to create a collar. Then every time the
stomach contracts (squeezes), the collar around the esophagus
squeezes to prevent reflux.