Gastroesophageal Reflux: A Cause of Breathing Problems

Gastroesophageal Reflux:
A Cause of Breathing Problems

Treating Reflux

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 your child.
  
  
• 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 taking Reglan.

• 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.