Infant Milk Reflux: Causes and Solutions

Milk consumption issues?

I would like to ask the doctor… My child is almost two months old; often after drinking milk, one or two hours later, they will spit up.
Sometimes they vomit a thick, phlegm-like substance that seems to be partially digested milk.
What could be the reason for this?

Xiao Zhen, 30~39 year old female. Ask Date: 2016/08/25

Dr. Xiao Kaiwen reply Pediatrics

A two-month-old infant has a small stomach capacity, and the muscles at the gastroesophageal junction (the lower esophageal sphincter) are not yet fully developed, making it difficult to maintain a tight closure.
Additionally, since the infant is primarily consuming liquid milk, it is normal for them to experience some spitting up.
As long as the infant is growing and developing normally, this is acceptable.
It is also normal for the spit-up to resemble partially digested milk and have a phlegm-like consistency.

Reply Date: 2016/08/25

More Info

Infant milk reflux, often referred to as gastroesophageal reflux (GER), is a common condition in infants, particularly those under the age of one. It occurs when the contents of the stomach flow back into the esophagus, leading to symptoms such as spitting up or vomiting after feeding. This can be concerning for parents, especially when they observe their child expelling milk or a thick, phlegm-like substance shortly after feeding.

Causes of Infant Milk Reflux
1. Immature Digestive System: Infants have an underdeveloped lower esophageal sphincter (LES), the muscle that prevents stomach contents from flowing back into the esophagus. As the infant grows, this muscle matures, and reflux symptoms often decrease.

2. Overfeeding: Feeding an infant too much milk at once can lead to reflux. The stomach may become overly full, increasing the likelihood of contents spilling back into the esophagus.

3. Positioning: The position in which an infant is fed can also contribute to reflux. Feeding an infant while lying flat can make it easier for milk to flow back up. Keeping the infant upright for a period after feeding can help reduce reflux episodes.

4. Food Sensitivities: In some cases, an infant may have a sensitivity to certain proteins in formula or breast milk, which can exacerbate reflux symptoms. This is particularly relevant for infants who may have a cow's milk protein allergy.

5. Swallowing Air: Infants often swallow air while feeding, especially if they are feeding quickly or are fussy. This can lead to gas and discomfort, contributing to reflux.

Solutions and Management
1. Feeding Techniques: To minimize reflux, consider smaller, more frequent feedings rather than larger ones. This can help prevent the stomach from becoming overly full. Additionally, burping the infant during and after feedings can help release any trapped air.

2. Positioning: After feeding, keep the infant in an upright position for at least 30 minutes. This can help gravity keep the milk in the stomach and reduce the likelihood of reflux.

3. Dietary Adjustments: If the infant is formula-fed and reflux is a concern, consult with a pediatrician about trying a hypoallergenic formula or one designed for sensitive stomachs. If breastfeeding, consider evaluating the mother's diet for potential allergens.

4. Consulting a Pediatrician: If reflux is severe, persistent, or accompanied by other symptoms such as poor weight gain, irritability, or respiratory issues, it is essential to consult a pediatrician. They may recommend further evaluation or treatment options, such as medication to reduce stomach acid.

5. Monitoring Growth: Most infants with reflux continue to grow and thrive despite the condition. Regular check-ups with a pediatrician can help monitor the infant's growth and development, ensuring that reflux is not impacting their overall health.

Conclusion
Infant milk reflux is typically a benign condition that many infants outgrow as their digestive systems mature. While it can be distressing for both the infant and the parents, understanding the causes and implementing strategies to manage reflux can significantly alleviate symptoms. If concerns persist, seeking guidance from a healthcare professional is crucial to ensure the infant's health and well-being.

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