Treatment Of Reflux In Newborn Babies
Question: We have a two-month-old baby. She is very spitty since birth. This can happen when I am burping her, or shortly after nursing. She throws up much more than our older son. Sometimes she would choke and milk can come out through her mouth and her nose. She cries a lot; she is most comfortable when being held in an upright position. She is not gaining weight as she should be. Our family doctor said that she has reflux, and started her on a medicine called ranitidine. After a few days, she has improved some. However, I am worried about giving her medicine everyday at this young age. Is ranitidine safe for her?
I believe your doctor is correct in making the diagnosis of reflux. It is also called GERD, or gastro-esophageal reflux disorder. This is actually a fairly common medical condition in newborn babies, and ranitidine is the correct medicine to use. Let me explain to you in more detail.
When we swallow food, it goes through a tube called esophagus that connects the back of our throat with the stomach. At the lower end of the esophagus, there is a sphincter, a muscle ring that guards the opening of the stomach, to prevent food and juice from going backwards. In adults, this sphincter is quite strong and works well most of the time. However, in newborn babies, the sphincter is naturally weaker so that babies can burp easily. Newborn babies swallow a lot of air when they drink milk from their mothers’ breasts or from the bottle. That is why all babies need to be burped frequently when they feed.
When a baby burps, small amount of milk goes up from the stomach to the esophagus. Most of the time, this will result in a small amount of milk in the mouth, and he will spit it out or swallow it back down. However, some babies are born with weaker sphincter than normal. Instead of just a mouthful, these babies can spit up quite a large amount of milk when they burp. The milk can go through the nose and mouth, leading to coughing and choking; occasionally milk can be aspirated into the lungs.
Furthermore, newborn babies start to produce stomach acid within days after birth. This is a natural process; stomach acid kills germs and prevents infection. For reason that is still unclear, some babies seem to produce more acid than others. When stomach acid gets into the esophagus, it can cause irritation and pain. This is the reason why some babies cry excessively when they are burped, when they spit up, or when they lay down. Keeping them upright after feeding for half to one hour can reduce reflux and pain.
When reflux is severe, babies can lose a lot of milk from spitting and vomiting. With less nutrient going through their intestines, they are slower in gaining weight. This can affect their overall development. Choking can be very scary for parents. Some babies can become dusky from lack of oxygen, although aspiration pneumonia is relatively uncommon.
If a baby is just spitty but otherwise healthy, there is really no need to worry or to consider medicine. However, your baby’s reflux is quite severe. Ranitidine has been used for several decades, and has been shown to be extremely safe even in newborn babies. It reduces stomach acid production. When you burp her, there will be less acid coming up to her esophagus. With less acid irritation, she will cry less and has less spitting and vomiting. More milk can stay in her stomach, and she will grow faster.
However, some babies with severe reflux may not respond adequately to ranitidine. In that situation, another class of medications called Proton-pump inhibitors (PPI) can be more effective. It uses a different mechanism to reduce stomach acid. Some babies require a combination of ranitidine and a PPI to control acid production.
It is important for you to work with your doctor to find a medicine that can control most of her reflux symptoms. Once it is under control, your baby will gain weight just like everyone else. The dose of medicine is very much weight-dependent. Therefore, it is important to monitor her weight gain and adjust the dose of medicine regularly, sometimes as frequent as every one to two weeks, to make sure that she has the optimal dose with minimal reflux symptoms.
Many parents also wonder how long they should use reflux medicine. This varies a great deal, from baby to baby. However, most babies improve between 6 to 12 months of age, after they start eating solid food and able to sit up. Having solid food in the stomach will hold the milk there and reduce reflux. The upright position also prevents acid reflux. At that time, instead of increasing the dose of reflux medicine, you can gradually reduce and stop medicine, with the guidance of your physician.
With patience and careful monitoring, most babies will improve and parents can breathe easier and sleep better.