Baby crying – could it be colic or reflux?

Babies are good are crying! it is their way of letting you know they are uncomfortable, need food, tired and so much more… and the crying language of your baby needs to be learnt.  When the crying raises questions in you,  we have some answers to some of the most common questions from parents worried that their children may be in abdominal pain, with some possible explanations and treatments to ease symptoms:

My baby is crying all the time and seems distressed – is it colic?

Colic is a term used to describe the discomfort felt by an infant between one – five months and the extreme crying and screaming that happens, usually in the evening.  Medically, there is some uncertainty around the reasons why babies might be experiencing discomfort. Some theories point to a maturity problem of the enzyme lactase, so that a child has gas production due to malabsorption of the sugar in dairy produce, lactose. It is also possible that air swallowing might account for some of the colic.  It is a difficult area, but if there are any significant problems with the children’s health (such as lack of weight gain, unexplained crying or distressed behaviour), these should be investigated for problems such as gastro-oesophageal reflux.

Is there is anything I can do to soothe my baby?

As all parents know, there’s not a “one size fits all” approach to soothing a crying baby, but there are some tried and test techniques you might want to try such as:

• Hold your baby during a crying episode or gently rock over your shoulder
• Prevent your baby swallowing air by sitting or holding them upright during feeding
• Burping after feeding
• Bath your baby in a warm bath

What is reflux?  

Bringing up food is a common physiological process that usually happens after eating in healthy infants, children and young people. It is most common in babies – affecting 4 in 10 infants. “Normal” episodes of reflux are very common in well infants in the first few weeks and months of life, and while they can be very distressing for children and parents, do not require treatment. Many babies with reflux gradually improve as they grow, particularly when they start to eat more solid food and feed in an upright position in a high chair for instance.

What are the signs and symptoms of gastro-oesophageal reflux (GOR)?

The main sign of gastro-oesophageal reflux is frequent spitting up or regurgitation after feeds. This is often accompanied by abdominal pain or general crankiness in the hours after feeding.  You may notice your baby drawing their legs up towards the tummy and pain in the tummy after feeding. Some older babies may refuse feeds, as they associate feeds with pain when swallowing. If any complications of reflux are observed, then this is termed gastro-oesophageal reflux disease (GORD).

This might include: poor weight gain (failure to thrive or also termed faltering growth); have frequent chest infections due to aspirating (breathing in) stomach contents into the windpipe and lungs; anaemia; and excessive distress especially with feeds and at night. The inside surface of the oesophagus may become inflamed due to contact with stomach acid, which may lead to scarring and narrowing.

My baby / toddler is on formula milk – could that be the cause of reflux? 

If your baby is formula-fed, and is distressed by frequent regurgitation, then you should contact your GP or health visitor for advice. A health professional should review your baby’s feeding history and may suggest reducing the feed volumes, but only if it is excessive for the infant’s weight. They should then offer a trial of smaller, more frequent feeds, unless the feeds are already small and frequent, then offer a trial of thickened formula, such as those containing rice starch, cornstarch, locust bean gum or carob bean gum.

Could it be an allergy?

Some babies have symptoms of reflux due to a cow’s milk allergy. If cow’s milk is eliminated from their diet then their sickness and vomiting will reduce substantially over a two-week period. If cow’s milk is eliminated but your baby’s (or child’s) vomiting remains the same, it is extremely unlikely that your baby (or child) has cow’s milk allergy. If you are breast-feeding then this means excluding cow’s milk and sometimes soya from your diet as well.

Are there any medicines I could give my baby to relieve the symptoms?

Sodium alginate (Gaviscon®) works by making the contents of the stomach thicker so they are then more likely to stay in the stomach. It also forms a protective coating over the lower part of the food pipe (oesophagus). In doing so, any stomach contents that rise up into the oesophagus are less likely to irritate the oesophagus and cause symptoms. You doctor may advise you to give this to your baby for a 1-2 week period. Be aware that in some babies it may result in constipation.

Something’s still not right, could it be something more serious?

Parents should be aware of “red flag” symptoms which may suggest more a serious condition, GORD. GORD refers to gastro-oesophageal reflux disease (GORD), which is so severe that complications have occurred and it is likely that medical treatment is required. GORD affects many children and families in the UK, who commonly seek medical advice and as a result, it places a health burden on the NHS. New NICE guidance has just been released which recommends that parents and carers are given advice about GORD and are reassured that in well infants, effortless regurgitation of feeds is very common, this usually begins before the infant is 8 weeks old, but will become less frequent with time and does not usually need further investigation or treatment.

What are the red flag symptoms for GORD?

• Frequent, forceful (projectile) vomiting (may suggest hypertrophic pyloric stenosis -a gastric outlet obstruction – in infants up to 2 months old)
• Abdominal distension, tenderness or palpable mass (may suggest intestinal obstruction or another acute surgical condition)
• Chronic diarrhoea (may suggest cow’s milk protein allergy)
• Bulging fontanelle (may suggest raised pressure inside the head, for example, due to meningitis)
• Rapidly increasing head circumference (more than 1 cm per week) may need investigation in case the pressure inside the head is high for some reason.
• Anaemia
• Associated blood in the vomit or stools

Health care professionals should investigate these “red flag” symptoms further or refer to a specialist to rule out disorders other than GORD. If not treated, GORD can lead to malnutrition in children, cause ulcers in the oesophagus and can have psychological effects on a child’s relationship with food. GORD can be treated well with medication, so specialist referrals should be given to those children whose symptoms persist.

Further information on this and many other gastrointestinal disorders in infants and children can be found at www.paediatricgastroenterologist.co.uk