Expert / 11 May, 2021 / Dr José Maia e Costa
Wondering how to wean a reflux baby?
As the time comes to consider weaning a baby into solids, parents worry about what to introduce first and when should that be done. For some of them, the situation might be slightly more complicated, as their child suffers from reflux. Often this leads to the suggestions a child might need to be weaned earlier to try and help decrease symptoms. But is this really the case? For us to have a clearer idea of what is involved, let’s first address the main problem.
Gastro-Oesophageal Reflux. It is likely one of the most common causes of concern for parents of infants/newborns. In simple terms, it is the passage of the stomach content into the oesophagus. The LES (lower oesophageal sphincter) is not yet competent in preventing that passage in young children. Signs can sometimes be hard to understand, as not in all cases you will see the feed coming out or reaching the mouth.
This is what is commonly called “Silent Reflux”.
GORD/GERD (depending on whether English or American English), or GastroOesophageal Reflux Disease, is when reflux gets more severe and treatment is needed. There are common behaviours that can be taken into account, to make that diagnosis, though all need to be put into context as not always it means the child has reflux.
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If we look at the incidence of this condition, it would be easier to understand the outcome.
Something to bear in mind is that a significant proportion of GOR in infants might be associated with a milk allergy:
Do we always need to investigate and/or treat? Not at all. In reality, most cases just need conservative measures. Treatment is needed only when it becomes more severe and starts affecting the child.
The most common conditions that suggest investigations are:
If you are worried and see any of the symptoms described above, go to your GP, and he/she will address those issues and eventually refer to a Paediatrician, a Paediatric Allergist or a Dietitian.
If your child has significant symptoms and treatment is needed, what are the choices?
If the reflux is associated with a delayed kind of allergy (what is known as non-IgE mediated), then the choice is dietary therapy, which a Paediatric Dietitian should guide, and eventually a Paediatric Allergist.
There is something essential to remember:
Do not try medication for colic, as evidence suggests they are of no use. Often, it is either coincidental improvement or even the placebo effect on parents, as they feel something is being done.
Well, if you want your child to grow better, and be healthy, then weaning is extremely important. And the main reason we need to think of is that a child doubles in size in their first year of life. The other stage in one’s life, with exponential growth, though not nearly as great, is the one associated with puberty. From the age of four to six months, both breastmilk and bottle milk no longer be enough for their nutritional needs. But the age at which weaning should be started is still a reason for many debates. Of course, there is still the aspect of allergy prevention in mind.
Unless your child is at risk of developing allergies, weaning should be started at 6 months of age, as per current recommendations.
Only when your child falls into one of these groups:
If you look closely, there is no reference to reflux as being one of the reasons.
The straight and easy answer is NO. Often I hear parents telling me they were told weaning early would help with reflux. And it seems the reasoning for this is that solids are thicker and heavier, so they are harder to “go up”. In reality, this does not happen. What will contribute to a decrease in reflux is the improved efficacy of something called the “lower oesophageal sphincter” (LES).
Allow me first to explain what a sphincter is. In simple terms, it is a bundle of circular muscles surrounding a passage, an opening or a tube. And we have plenty of them in our body.
In the LES case, it works like a tie knot, and it becomes more efficient as the core muscles (abdominals and so on) also become stronger. This will happen as the child starts walking and carries on for a few years more. Associated with this improvement in tone, we need to add the shear effect of gravity to the stomach contents.
Therefore, the general advice of starting with fruits and vegetables, one each time and on different days, still holds on.
After that, comes the natural progression to potentially more allergenic food to increase prevention against the development of allergies. For those, current advice says to start with egg and peanut first. Wheat, sesame, fish, meat and tree nuts should be introduced straight after.
1. LEAP Study (Lack et al., Dec06 – May09)
2. EAT Study (Lack and al., Jan08 – Aug15)
3. LEAP-ON Study (Lack et al., May11 – May14)
4. Historical Overview of Transitional Feeding Recommendations and Vegetable Feeding Practices for Infants and Young Children: Nutr Today. 2016 Jan; 51(1): 7–13.
5. American Academy of Pediatrics Committee on Nutrition. In:Pediatric Nutrition Handbook. (editions from 1979 to 2014)
6. Timing of Allergenic Food Introduction to the Infant Diet and Risk of Allergic or Autoimmune Disease: A Systematic Review and Meta-analysis. JAMA. 2016;316(11):1181-1192. doi:10.1001/jama.2016.12623
7. BSACI: Early feeding guidance for Health Care Practitioners.
Article by José Maia e Costa MD FRCPCH, The Children’s Allergy, and Facebook.
Consultant Paediatrician in Allergy
Lead Clinician for Paediatric Allergy
University Hospitals Coventry & Warwickshire
PGCert Allergy (Imperial College, London)
PGCert Paed Allergy (Universidade Católica, Lisbon)
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