Signs Your Baby Has Acid Reflux And How To Help

Dr. Richard So:

Welcome to Little Health, a Cleveland Clinic Children's podcast that helps navigate the complexities of child health one chapter at a time. In each session we'll explore a specific area of pediatric care and feature a new host with specialized expertise. We'll address parental concerns, answer questions, and offer guidance on raising healthy, happy children. Now here's today's host.

Dr. Senthilkumar Sankararaman:

Hello everyone. As a parent, you have tried everything such as new formulas, different burping tricks, and waiting 30 minutes after each feed, but your baby is still crying, arching their back, and having trouble sleeping. Is this just normal fussiness or is it the hidden pain of reflux disease? It is stressful when you cannot figure out what's making your little infant so upset. I'm your host, Dr. Senthil Sankararaman, a pediatric gastroenterologist at Cleveland Clinic Children's. On today's episode of Little Health, we are talking about upper GI issues such as vomiting and reflux. We will discuss the signs of pain, the serious stuff like forceful vomiting, throwing up, and what you can do to help your child feel better. Our guest today is my colleague, Dr. Sophia Patel, who's your pediatric gastroenterologist at Cleveland Clinic Children's and director of Eosinophilic Esophagitis program. Welcome to Little Health, Dr. Patel.

Dr. Sophia Patel:

Thank you so much for having me.

Dr. Senthilkumar Sankararaman:

So for our listeners, could you tell us a little bit about your background, both professional expertise as well as where did you grow up and things like that?

Dr. Sophia Patel:

Sure. I trained here at Cleveland Clinic Children's, uh, residency and fellowship. I've been staff now for about 10 years and I mark that 10 years because when I started here I was pregnant with my first child and in September of my first year of staff I had him and he also had reflux. So I can give you a little bit of insight on that. So now he's 10 years old. So I have an older son, Loki. I have a younger son, Niem, who's six. Um, and my husband, um, we all live, uh, together in Westlake, Ohio. And my older son is destined to be in the NBA. My younger son is probably going to be some kind of art director or architect. So, um, and my husband, uh, works at the Cleveland Clinic as well. He's an endocrinologist.

Dr. Senthilkumar Sankararaman:

Let me start with this. So we hear often from a lot of patients and parents regarding acid reflux. So what is acid reflux? Can you help us understand the basics of it?

Dr. Sophia Patel:

For sure. Acid reflux is a process that occurs in everybody's stomach. So the stomach releases acid to help digest food and that's a normal physiologic process. What happens with acid reflux disease or GERD is when the acid becomes more of a pathologic or a problem. So there's too much acid being produced. The acid causes irritation in the lining of the stomach and it can cause gastritis, which is that lining irritation. It can also cause pain or discomfort in the throat and it can lead to pretty typical symptoms like in adolescents have similar symptoms that adults have. So heartburn water brush kind of feels like stuff is coming up, sour stuff in their mouth, throwing up things, or they'll just sometimes just have pain. And often pain is one of the first things that you'll hear from the younger set of kids because they can't tell you that food's coming up or it burns. Infants typically have more non-specific symptoms like throwing up and looking uncomfortable after feeds.

Dr. Senthilkumar Sankararaman:

So can I say then acid reflux is something it's much acceptable and an extreme form of that is more like acid reflux disease,

Dr. Sophia Patel:

Correct? Yes. So acid reflux is what we all have. Acid reflux disease is what causes more of the problems.

Dr. Senthilkumar Sankararaman:

So how we a parent can try to understand what the baby has like a reflux or a reflux disease.

Dr. Sophia Patel:

A lot of what we deal with in GI clinic is more of parents that come in because the problem has been going on for a long time, it's affecting the baby or their child in other ways. Like they're not wanting to eat as well, they throw up more, they complain of pain, um, or they lose weight. Those are all things that would make me more concerned as a parent and usually what patients get brought in by.

Dr. Senthilkumar Sankararaman:

Do you agree that reflux is more common in infants than in older children?

Dr. Sophia Patel:

Yes. Reflux in infants is actually very normal and it's a process that can happen up to eight to 12 times a day. They've done studies where they check to see how often reflux happens in infants and it's very common.

Dr. Senthilkumar Sankararaman:

And when do, uh, most infants outgrow their reflux,

Dr. Sophia Patel:

They usually outgrow by about nine to 10 months, sometimes earlier than that. And that all has to do with the sphincter at the bottom of their esophagus, which is very immature when they're babies and allows a lot of the food and formula to come back up. And so over time that sphincter strengthens and the symptoms usually get better as they get older.

Dr. Senthilkumar Sankararaman:

Let's switching gears a little bit. Um, could you tell us about the reflux disease in older children?

Dr. Sophia Patel:

Yes. So acid reflux in older children often has to do with the foods they're eating, how they eat when they eat. Um, overeating can make things worse. Certain foods like acid containing foods like citrusy fruits, um, spicy foods, carbonated beverages, soda, caffeine, more heavier foods, which are kind of a little bit more typical in our American diet, can tend to trigger more acid symptoms. Uh, many kids these days, we were just talking about how uh, sports play a big role in some kids', uh, lives and they don't get to eat dinner until very late. So if you're eating late at night right before you go to bed, that can also make symptoms worse. Overeating and also not being physically active can also make acid reflux symptoms worse too.

Dr. Senthilkumar Sankararaman:

The other thing Dr. Patel, oftentimes parents say that the kids are having vomiting, but when you request to like show your video what's going on, it looks more like a reflux. So in other words, how do you help us understand the differences between reflux and vomiting?

Dr. Sophia Patel:

Vomiting is what, what we define as vomiting is when you are actually having the symptom of your stomach emptying out. So you're throwing up food or whatever the stomach contents are acid reflux, it feels like vomiting but oftentimes it doesn't exit out. Um, I dunno if I'm explaining that as well as I could, but typically it's more like vomiting into your mouth and then it's a very small amount and usually it's um, acidic tasting and then it kind of goes back into the stomach. But vomiting can be a symptom of reflux as well, so it can all kind of go together.

Dr. Senthilkumar Sankararaman:

So it seems like I'm understanding reflux could be more effortless [Yes.] And more spontaneous. [Exactly.] Whereas this is more active and kind of like forcefully. [Yes. Forceful. Exactly.] Good, good. So with the reflux, what are the red flags that parents can identify that this is not just simple reflux, this is more suggestive of reflux disease and they should come to the gastroenterology or to medical appointments much earlier?

Dr. Sophia Patel:

So one of the biggest things that we see patients for are issues with eating when they have trouble with eating, how they were eating before, appetite changes, uh, if the reflux is actually vomiting, if there's any blood in the vomit that's very concerning. Um, severe pain leading to problems again with eating or drinking and the pain can be one of the biggest triggers that we see most often.

Dr. Senthilkumar Sankararaman:

Yeah, or like if they... [Weight loss.] Weight loss, yeah. If they're throwing up excessively, that could... Will a reflux disease cause pain for babies?

Dr. Sophia Patel:

Yes, it can cause pain.

Dr. Senthilkumar Sankararaman:

So what are the simple non-medical steps parents can take at home to reduce reflux?

Dr. Sophia Patel:

So in infants we often talk about trying to space out their feeds, trying to feed smaller volumes more often. So two ounces every two hours. Um, sitting them upright after feeds for about 30 minutes can also help with reflux symptoms. In older patients, we typically have the families limit more chronic acid inducing foods. Um, I know a lot of kids like fruit. Um, so if your kids like fruit but they're eating a whole container of raspberries, then limiting that to smaller quantities including limiting juice, uh, lemonade, orange juice and things like that can really be helpful. And also decreasing the amount of like greasy or fried foods that they have. While your air fryer might be helpful in decreasing the amount of oil that you use to cook things, those foods are often pre fried and so that they are actually much oilier for your kids as well.

Older patients, similar things. So limiting more of those acid inducing foods. Trying to limit eating so close to bedtime, which I know is also difficult because a lot of teenagers like to stay up late and eat all night. So limiting a little bit of that can certainly help too. And you know, more simple things would be, again, the dietary changes and we often recommend those first and later on they may need a little bit more help with just more common over the counter medications, which we can talk about as well.

Dr. Senthilkumar Sankararaman:

The other popular question we get often is like, should I thicken my baby's milk or formula with rice cereal or oatmeal? Things like that. What's your opinion on that?

Dr. Sophia Patel:

Yes, I think thickening is safe if done in the correct way in a two month old, you don't wanna thicken their formula because they're probably not going to be able to tolerate the swallowing part of that because it can lead to episodes of choking because the formula is too thick. But when your infant is old enough, you can administer them oatmeal or rice cereal via spoon and then give them a bottle afterwards and that'll kind of help keep the formula in their stomach. I don't like adding the cereal into the bottle because it's an increased risk of a choking hazard, but if they're old enough to have rice cereal or oatmeal, which is usually around four months, um, it's safe to administer that as well.

Dr. Senthilkumar Sankararaman:

Good. And when is it the time to see a specialist, a gastroenterologist compared to just staying with primary care doc?

Dr. Sophia Patel:

Yeah, I think that's a great question. You know, pediatricians are so well versed in acid reflux and spitting up in babies that I think the time that's the best time is really whenever the parent feels that it's something that they wanna talk or discuss further or they need more time to talk about it. We do have a lot more time typically than the pediatrician does also, you know, if they've tried a few things, they didn't work either over the counter or by prescription, you know, we always have things that we can talk about or discuss, uh, especially like anatomically if there's something wrong, if there's something else that we're looking for, um, we have other tests that we can perform as well. Um, but your pediatrician is gonna be, you know, the first and the best step. If you do feel like, you know, the symptoms are not improving or your baby's not gaining weight or not growing, those are the times that I think it's a good plan to come and see the gastroenterologist.

Dr. Senthilkumar Sankararaman:

So say like you are getting a patient from your primary care pediatrician who has been treating with acid suppression medication for a while, but the reflux symptoms are not getting under control. Could it be still reflux or would you consider other options or other diagnosis for this child?

Dr. Sophia Patel:

Absolutely. So in younger infants we definitely consider many things. Um, one of the second most common things we see in infants who are spitting up is a milk protein intolerance. So sometimes changing formula can be helpful. Um, I wouldn't do that without the guidance of your pediatrician or a gastroenterologist, um, because that makes things very confusing for us. Um, when they've gone through like multiple formulas and things like that.

In older patients, we do worry that when you have acid reflux along with other symptoms, so if you have a large family history or a his personal history of allergies, food allergies, eczema, when you have acid reflux symptoms, sometimes they can overlap with a disease that I often take care of called eosinophilic esophagitis. And that's something that we can diagnose by doing an endoscopy. And in older patients you wanna also make sure that they're not developing other long-term complications from acid reflux like ulcers or peptic ulcer disease, duodenal ulcers, um, and other things such as that.

Dr. Senthilkumar Sankararaman:

Thank you. And, um, if they say if they need medications for acid reflux, um, such as acid blocking, uh, medications, are they safe for infants and children?

Dr. Sophia Patel:

Yes. Uh, fortunately we have a, a large amount of acid suppressing therapy that is very safe to give to infants, to kids, to teenagers. Uh, many of them are available over the counter in infants. Uh, we typically start with a H2 blocker like famotidine and those medications often work very well for reflux in infants and for patients who have a little bit more difficulty, we'll often change to proton pump inhibitors. In those cases, if we're considering other diseases, we try not to keep patients on proton pump inhibitors for too long because of their long-term side effects that we know from different studies that we wanna try to avoid. But the goal is to keep the patients on it for a period of time where we can heal the tissue and decrease their acid production and then hopefully stop the medication and not have to be on it for a long period of time.

Dr. Senthilkumar Sankararaman:

Thank you. The next question seems like it's probably for all of us, how can parents cope with stress and anxiety that come with your baby who spits up constantly or is chronically fussy?

Dr. Sophia Patel:

That is a really good question and you'll remember that I talked about my now 10-year-old who was born when I was staff and he was a really difficult baby. And some babies are very hard and I I'm here to commiserate with you parents because that was me. It's very hard to...

Dr. Senthilkumar Sankararaman:

That's all all of us, right?

Dr. Sophia Patel:

Exactly. It's very hard to have a baby, especially your first baby, um, who is very fussy and um, things that can help, especially in infants. A good pair of noise canceling headphones. Um, more knowledge and talk about with your pediatrician, especially about colic and infants and how common that is because some of what you're experiencing may not always be just acid reflux. It's worth it to try to treat it. Um, and sometimes if that doesn't make a difference and it may not be acid reflux causing the issue, it might be more of a colicky issue. But I was here to commiserate with the families, make sure you have a good support system, hand them off to grandma, get a few hours out at Target <laugh>, get a good pair of noise canceling headphones and God bless all of you.

Dr. Senthilkumar Sankararaman:

<laugh>. So now moving a little bit lighter, uh, part of the podcast. What is your most favorite food?

Dr. Sophia Patel:

Oh my, um, I'm gonna say my most favorite food, and this is very specific. Uh, it's the type of Indian food called Biryani. And um, my mom makes a really good biryani love, a good biryani. Um, American food. I would say my favorite would probably be like a Burger <laugh>.

Dr. Senthilkumar Sankararaman:

Good choice. And um, could you tell us one favorite thing you would like to do in Cleveland?

Dr. Sophia Patel:

Oh yeah. There's so many things in Cleveland to do. One of my favorite things to do is to ride my bike in the fall and um, we have a nice little bike trail around our neighborhood, so that's one of my favorite things to do.

Dr. Senthilkumar Sankararaman:

Yeah, that's one of mine too. Yeah.

Dr. Sophia Patel:

I love it. <laugh>. Yeah.

Dr. Senthilkumar Sankararaman:

Thank you so much Dr. Patel. Your valuable insights are so helpful for our family. We really appreciate it.

Dr. Sophia Patel:

Thank you Dr. Senthil. I appreciate you too.

Dr. Senthilkumar Sankararaman:

Dealing with upper GI issues is hard, messy work, but it gets better as Dr. Patel was alluding to. Focus on making simple consistent changes one at a time at home. And always know the key signs that tell you it is the time to call your doctor and discuss further. If you would like to schedule an appointment with Cleveland Clinic Children's Pediatric Gastroenterology, please call us at 216.444.KIDS. Let me repeat that. 216.444.KIDS. That is 216.444.5437. Thank you so much for listening to this.

Dr. Richard So:

Thanks for listening to Little Health. We hope you enjoyed this episode. To keep the little health tips coming, subscribe wherever you get your podcasts or visit clevelandclinicchildrens.org/little-health.