Burping and reflux of infants: what are the solutions

by Marie Mos December 19, 2020

Spitting up is one of the small, usual hassles of infants (up to 4 in 10 babies suffer from it regularly). But what is the difference between regurgitation and gastroesophageal reflux disease, and when to start worrying?

I - How to distinguish them?

Usually, the common regurgitation occurs right after a bottle, in the form of a burp, and is painless. It is a physiological mechanism that allows the little one to evacuate the excess air swallowed at the same time as the milk. Whether your baby is breastfed or bottle fed, he will burp immediately after a feed or a few minutes after. Sometimes even while breastfeeding, baby fidgets and seems uncomfortable; Burping him during a feed will allow him to release the swallowed air and continue drinking more easily. The baby stays in a good mood and can even continue to drink normally when this happens during the feeding.

Regurgitation usually consists of saliva and gastric juice (it does not contains only a small amount of milk), and does not affect baby's growth. Nothing to do with vomiting, which is an active return of gastric contents, which are much more abundant and which spring up with effort, in particular contractions of the abdominal muscles. The baby is always a little drooling or spitting up and it is estimated that about 70% of infants have three or four regurgitations per day, until the age of four months and that they are still 24% having it, until the age of four months. at the age of seven months. In most cases, the baby who spits up is a baby who is doing well, and growing quite normally. In the case of gastroesophageal reflux, the regurgitation (not necessarily more abundant) occurs several hours later and can cause pain to the baby. They sometimes occur during a sudden change of position.

You should only worry about them if they are accompanied by:

Painful manifestations, wriggling.
Bad latch on the breast or bottle.
Access of pallor.
With or without vomiting.
Trouble sleeping.
Baby weight loss.
Baby irritability, crying a lot and drinking badly.

In these cases, we must suggest gastroesophageal reflux. Only the doctor can establish the correct diagnosis by carrying out additional examinations, if necessary.

II - The causes

We can distinguish three main causes, mechanical or physiological.

In babies, the cardia is still immature: it is the (small) sphincter which is located between the esophagus and stomach and that prevents milk from rising, or food reflux. As soon as the child stands up more often, around 9 months to 1 year of age, he will stop regurgitating. Warning ! These refluxes are to be distinguished from vomiting caused by an overflow: they are done without effort and without pain.
In proportion to its small size, an infant eats fluid in very large quantities! A three-month-old baby absorbs around 750 ml of fluid per day, weighing six kilograms. Transposed on an adult of 60 kilos, this amounts to 7.5 liters of liquid, per day! Enough to regurgitate!
The infant spends a lot of time lying down, which may also explain the small lifts. These episodes of regurgitation tend to disappear as soon as the child receives a more solid diet and is more willing to stand in an upright position.

III - How to help him to burp?

The most popular methods simple is to press baby on his shoulder, in an upright position, gently rubbing his back for a few minutes. Otherwise, place him in a sitting position on his knees with one hand against his back, and the other under his chin, so that his head remains upright. Or, lay him face down on his knees and lightly pat him on the back. Remember to put a cloth under his chin so as not to stain his clothes!

What if the burp doesn't come? Burp can occur right after a meal, but also later or not at all. If the baby hasn't burped after 10 minutes, there is no point in waiting: burping is okay! Some babies, swallowing less air because they are breastfed, hardly ever do.

Did baby fall asleep without burping? Bedtime, because if he needs to do one, it will act in the next few minutes. If so, just give him a hug to give him a wonderful burp, and off you go to bed!

IV - Prevention

Raise its cradle slightly, so that its head is raised above his stomach (by about 30%).
Place it, during the day, in a reclining seat , or in a high chair if they are old enough to sit.
Split his meals by making him take 3 or 4 breaks to allow him to burp and evacuate the air.
Put a touch of a little kuzu in your bottle: it is a starch (from a root ), with a neutral taste. We thicken it in a pot of water before adding it to baby's bottle.
Do not over tighten layers and clothing, so as not to increase abdominal pressure.
Thicken the contents of the bottles with a little cereal for baby ( not before 4 months, or even 6 months), if its releases are significant and persistent. There are also anti-reflux milks. Finally, if the child is old enough to eat it, try more solid foods (by watching his stool: if he is constipated, he could be dehydrated).
Anti-reflux milks: these are milks thickened using a thickening agent: carob flour, precooked starch rice or precooked corn starch. They are not always remarkably effective, but give them a try. Be careful, they tend to constipate.
Ventilate living rooms , especially the baby's room and above all, do not smoke in the presence of the baby: passive smoking decreases the tone of the baby. lower esophageal sphincter!
For older children: remove the orange juice in the morning which promotes acidity and contractions of the esophagus.

V - When to see your doctor?

If some babies regurgitate more than others, while the child is in a good mood, continues to gain weight and still has a well-colored complexion, there is no need to worry.

However, especially during the first 2 months of life, any child who vomits profusely and squirting should be seen by a doctor to eliminate the risk of an anatomical abnormality, such as pyloric stenosis (that is, a narrowing of the valve at the outlet of the stomach). Other, more rare, abnormalities may occur, and vomiting of bilious (yellow) fluid is a sign of a more serious problem that requires prompt consultation.

Consult if prevention techniques do not improve regurgitation and the child:

Lose weight.
Ispale (especially on the mucous membranes (lips, conjunctiva) and lack of tone.
Suffers from frequent, easy and abundant regurgitation after meals and during sleep.
Shows signs of esophagitis (crying during feedings, painful attacks, traces of blood in regurgitation), in In this case, the acidic gastric fluid rises in the esophagus and creates inflammatory phenomena there.
Presents respiratory problems, that is to say, if there is a physical repercussion, linked to wrong roads (swallow askew).
Suffers from discomfort.

You should know that gastroesophageal reflux is more common in premature infants, in children operated on for esophageal abnormalities, and in those who suffer from lung problems, hypotonia or problems with psychomotor development.