Reflux In Premature Babies

Key points about reflux in premature babies

• reflux is very common in premature pēpi and rarely causes harm
• most premature pēpi with reflux do not need tests or medicines
• to keep your baby comfortable, the healthcare team may consider feeding or positioning changes
• pēpi should always sleep flat on their backs at home
• reflux gets better as your baby grows

What is reflux?

Reflux is when milk and other stomach contents move back up into the food pipe, or oesophagus. The medical name is gastro-oesophageal reflux, or GOR.

Reflux may cause milk to come back into your baby’s mouth. This is sometimes called spilling. Reflux is effortless and is different from vomiting, which is forceful.

Reflux is very common in premature pēpi. It is usually a normal part of development and gets better as your baby grows.

Reflux that causes problematic symptoms is called gastro-oesophageal reflux disease (GORD).

For more general information see the page on reflux.

Reflux In Babies & Children

Causes of reflux in premature babies

A ring of muscle between the stomach and oesophagus helps keep milk in the stomach. In premature pēpi, this muscle is still developing and relaxes often.

Reflux is also more likely because premature pēpi:

• have a liquid diet
• spend a lot of time lying down
• may have a feeding tube passing through the muscle between the oesophagus and stomach
• receive large amounts of milk compared with the size of their stomach

Reflux is more likely after a feed because the stomach is fuller.

Symptoms and signs of reflux

Most reflux does not harm premature pēpi.

Your baby’s healthcare team may consider whether reflux is causing problems if your baby:

• has ongoing feeding difficulties
• has poor growth
• arches their back, appears unsettled or shows discomfort around feeds

Some pēpi have pauses in breathing or a slow heart rate and in rare cases reflux can make this worse.

Some signs of reflux can be similar to those of a cow’s milk protein allergy. Your baby’s healthcare team will consider all possible causes if your baby has ongoing symptoms.

Diagnosing GORD in premature babies

Most premature pēpi with reflux do not need tests.

If your baby has symptoms that may suggest GORD, the healthcare team will assess them. They will check their feeding, growth and overall health. They will also consider whether another condition could be causing the symptoms.

Managing reflux in premature babies

Most reflux does not need treatment. It will get better as your baby grows.

If reflux appears to be causing problems, your baby’s healthcare team may adjust how your baby is fed. Depending on your baby’s needs, they may consider:

• giving smaller amounts of milk more often
• giving tube feeds more slowly
• burping your baby after feeds
• removing any air from your baby’s feeding tube
• offering a dummy during tube feeds

Where possible, holding your baby during feeds may help.

These approaches do not help every baby. Your baby’s healthcare team will monitor your baby and discuss options with you.

Positioning may affect how often reflux happens. In some neonatal units, a baby may sometimes lie on their tummy while closely supervised and monitored. This position is only used in hospital.

Raising or propping the head of a cot does not help reflux and is not recommended.

Safe Sleep For Your Baby

Medicine

Most premature pēpi with reflux do not need medicine.

If the healthcare team believes reflux is causing problems, they may discuss the option of medicine with you.

The healthcare team may prescribe an antacid medicine such as Gaviscon Infant. It thickens the stomach contents, which may reduce reflux. It’s not suitable for every baby.

Omeprazole reduces the amount of acid made by the stomach. It does not stop milk from moving back into the oesophagus. There is limited evidence that it improves reflux symptoms in premature pēpi. Reducing stomach acid may also increase the risk of infection.

The healthcare team will carefully consider risks and benefits and discuss options with you before giving your baby medicine.

Surgery for severe GORD

Surgery for GORD is very rare.

The healthcare team will only consider surgery if GORD is causing serious complications. This includes complications like:

• milk spilling into the lungs during feeds
• poor growth

Safe sleeping for premature babies with reflux

When your baby is ready to sleep without continuous monitoring, they should sleep flat on their back. They should sleep on a firm, clear mattress. This includes when your baby is at home.

Do not place your baby on their side or tummy to sleep. Do not raise the head of their cot or use pillows, wedges or sleep positioners.

Talk to your baby’s healthcare team if you have questions about reflux, feeding or safe sleeping.

Safe Sleep For Your Baby