Diagnostic Tests

Most infants with reflux will not require any diagnostic tests, with treatment based on the symptoms displayed. However, sometimes diagnostic tests are required for a variety of reasons, ranging from determining the severity of the infant's condition through to ironing out other conditions or factors. Each test provides doctors with different information, so are a useful aid in the diagnosis and treatment of reflux. However none of these, either alone or together, can determine for sure if your child has reflux. Please refer any questions or concerns to your doctor. The most common diagnostic tests for reflux are as follows:

• Barium swallow/Upper GI series - The baby is fed a liquid called barium, while a x-ray machine follows it through the upper intestinal tract.
• Technetium reflux scan - The baby is fed a liquid called technetium, while a camera follows it through the digestive tract.
• Scintigraphy - The baby is fed a liquid or solid that is scanned several times as it passes through the infant's digestive tract.
• pH probe - The baby has a small wire inserted through her nose down to the stomach with a sensor, which detects when acid is refluxed into the oesophagus. It is usually left in for 12 to 24 hours.
• Endoscope with biopsies - a flexible scope is passed down the infant's mouth, allowing the doctor to examine the baby's digestive tract. Biopsies are taken of the linning of the oesophagus to look for signs of inflammation.

Management Strategies

Positioning

This involves a number of techniques and positions aimed to either aid the flow of food by gravity, or to cause the stomach to fall in such a way that it aids in closing the connection between the stomach and oesophagus. Please note that some of these positions may actually worsen the reflux, especially if the baby is allowed to slump as in an infant swing. It is a case of simply determining what works best for you.

• Lay the infant on his left side when settling, as research indicates reflux babies find this the most comfortable. Please use a sleep safety device if trying this method. These are available from most department and baby stores.
• Lay the baby on her tummy with the head propped up 30 degrees. Please don't leave your baby unsupervised in this position.
• Hold baby's head over your shoulder or in an upright position as much as possible, particularly before being put to bed at night.
• Place baby across your arm, with his head near your elbow, and your hand under the crutch, so that he is on an angle with the head at the highest point.
• Sit baby against you in a supported L shape.
• Try a baby swing, rocking chair, pram, car seat, or curved pillow for sitting, with a pillow behind herr bottom to stop her from sliding down.
• Try placing baby's head and shoulders on a support pillow when changing her nappy, and roll her over instead of lifting her legs when cleaning her bottom. Also try changing the nappy before, rather than after a feed when they are more likely to have reflux.
• Try posture feeding, such as holding the baby in an upright or sitting position when feeding. If bottle-feeding, try sitting infant in a high chair, or baby chair while feeding. If breast feeding, try feeding in the twins position or sit an older child up on your lap or by straddling his / her legs around your hips.
• Try feeding while standing up or rocking, or whilst walking around and humming. Take care not to put pressure on the baby's stomach or to let the baby slump.
• Try raising the head of the cot, or the change-table using a phonebook or piece of wood.
• Try a baby sling
• Place on a beanbag or bouncinette, instead of lying down on a mat. Take care that infant is supervised at all times as deaths by suffocation or strangulation have occurred.

Dietary and Feeding Strategies

In general these management strategies are based on the belief, that by thickening the feed, usually by adding a thickening agent, or by introducing solid feeds, you make the feed heavier, and less likely to come back up, thus helping reduce the reflux. In addition, solid foods empty out of the stomach differently, which could be a contributing factor. However thickening the feed can also make the feed harder to clear from the throat once refluxed, intensifying the burning of the throat, so should be used with caution.

On the other hand, there are the strategies based on the belief that reflux is due to an immaturity of the digestive system, so that by making it easier to digest the food, by feeding less, more often, or alternatively more, less often, you help to reduce the symptoms of reflux. Any of these strategies listed below, may also worsen the symptoms of reflux, so it's a case of seeing what works for you.

Some parents have found that fruit juice, acidic drinks, or cows milk formula can worsen the problem, and food intolerances may occur alongside reflux. Reflux in some instances is a symptom of food intolerance. If you suspect that some foods worsen your child's condition, please refer to our information on food intolerance. Switching from formula to formula though, often only provides a placebo effect, which is temporary, lasting only one to two days. Switching from breastfeeding to formula in an effort to manage reflux should only be done so if advised by a paediatric gastroenterologist, as research indicates that breast milk is better for these babies. The strategies are as follows:

• Introduce solid foods, such as rice cereal, or finger food for older infants
• Use a spoonful of solids after the milk feed to help keep the food down.
• Introduce solids after the last feed before you put the baby down for the night.
• Thicken feeds with a thickening agent if breastfeeding, as advised by your doctor.
• Feed the baby about an hour before settling them to sleep at night, so that the food has been digested and cleared from the stomach before he goes down to sleep.
• Try to get your baby into a feed, play, sleep, routine, so that the reflux has passed before bedtime.
• Try feeding your baby smaller amounts more often, so the stomach has less to digest, thus in theory making it easier to digest. For example, if feeding three hourly, try feeding less every two hours. However this may cause the baby to be more distressed, due to hunger, which can make the reflux worse.
• Try feeding more, less often so the baby has to digest the food less often. For example if feeding three hourly, try feeding four hourly. Again this may cause your baby to cry because of hunger, which can fill his stomach with air, causing him to grunt and strain, worsening the reflux.
• Avoid fatty, spicy, acidic foods or juice drinks, as these can aggravate the reflux
• If you find some foods worsen your child's condition, please refer to our section on food intolerance and seek medical advice.
  
  

  Handy Hints for feeding
  
  For difficult feeders
  
  Feed while standing and rocking, walking around, sitting and rocking, humming, singing, "sshing", or any monotonous rhythmical pattern.

  • Have a dummy in, take it out and quickly replace it with the breast, teat or spoonful of solids.
  • Feed when baby is half asleep, e.g. immediately on waking, or rock baby to sleep before feeding.
  • Use distractions whilst feeding and when infant is about to vomit (some parents can tell before their infant vomits), e.g. shake threaded beads, mobiles, animal sounds, beetle clicker, television.
  • Feed in a quiet room or with soft background music. Even talking may disturb this baby;
  • Some breast-feeding mothers find feeding lying down helpful with less distractions (restful too). Keep baby upright after the feed.
  • Feed during the night while baby is asleep (avoid turning on lights, changing or disturbing baby unduly).
  • Some find feeding quickly helps, others find taking your time is best.
  • Continual feeding - don't stop to burp in between the feed.
  • Some babies like only one flavour at a meal. Others feed better if you change flavours several times.
  • Do not worry if your infant will only take a limited number of different foods, this will improve as the child gets older and the reflux becomes less frequent.
  • Some infants improve with early introduction to solids. Others do not cope with solids at all and are happier on milk alone.
    If baby is distressed and continues to fight feeds, return to your doctor.

  
  For comfort feeders
  
  These babies want to suck all day. Many mums have found this very tiring. This situation can be improved by getting a comfort feeder into a routine. Or perhaps you could try to gradually increase the time between feeds.

  • Feeding too often, e.g. hourly does not give sufficient time for the stomach to empty, thus increasing the incidence of reflux.
  • Handy hints for home and cleaning
    Try putting a cloth or folded nappy under the infant's head when he is sleeping, then you will only have to change this cloth after each spillage instead of the bed linen.
  • Keep an ice cream container handy to catch the vomit. Some parents and children mange to do this quite well. Alternatively, use a hard plastic bib with a trough to catch spills.
  • Lay towels on the floor near cot (for vomit overflow) to protect carpet. Put a washable mat down in the playpen. A cloth / sheet over the feeding chair can save extra cleaning of upholstery and carpets. 'Scotch Guarding' furniture may prevent staining as does quick cleaning with some cleaners (natural organic cleaners seem to work well). Beware, some medications stain the carpet if the baby vomits them up.
  • Less stress is caused if you feed on a washable floor, or perhaps outdoors for a change.
    
  • Removable trays on highchairs are handy to empty and clean if the infant has vomited.
  • Can you afford a cleaning person or nappy service?