Treatment

Baby

The information provided on Crying Over Spilt Milk is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician. Please do not change your child’s medical treatment without first consulting their health professionals.

You need to take your baby to a doctor for a proper diagnosis if you think they may have gastric reflux and it is a problem.

Information on medications is intended to be used for informative purposes only and not be interpreted as: professional advice for treatment; or a recommendation for a specific treatment, product, course of action or healthcare provider. 
In providing this information, Crying Over Spilt Milk Gastric Reflux Support Network New Zealand for Parents of Infants and Children Charitable Trust is not recommending the use of medications in the treatment of GORD in Infants and Children, nor advising against treatment if it is deemed necessary by a registered health professional.  Please do not discontinue your child’s medications against medical advice.
Please note that GRSNNZ does not provide advice on dosages of complementary or conventional medications.

Uncomplicated Gastric Reflux

Spilling or regurgitation are common in an infant due to an immature sphincter at the top of the stomach / bottom of the oesophagus (lower oesophageal sphincter).  The baby may be a bit unsettled and may have periods of crying.  Crying in a normal infant with Gastric Reflux will usually peak in the second month and settle around three to four months.  They may have short bouts of painful crying associated with a spill, but this crying is not prolonged. Spilling may also disturb sleep.  Gastric Reflux does not need to be treated with medication.

Many parents find it difficult to hear these things are ‘normal’ as the parenting journey they are experiencing differs greatly from what they expected, you are not alone in these feelings.  The constant mess, cleaning, laundry etc. can lead to tiredness, isolation and impact your mental wellbeing.

GR Diagram
Laryngopharyngeal Reflux

Silent Reflux is a term that we are no longer using due to the confusion it causes – Laryngopharyngeal Reflux is the correct term.  The stomach contents go up the oesophagus and into the throat, but are not consistently vomited or spilt.  It may or may not cause concerning symptoms.

Gastro-oesophageal Reflux Disease (GORD)

GORD occurs when stomach acids are “refluxed” into the oesophagus/throat and cause inflammation and discomfort/pain, or other complications such as feeding or breathing problems.  There may or may not be spilling or vomiting.

GORD is relatively rare and can be managed in a variety of ways depending on cause and severity.  Treatment can include diet, upright positioning, parenting techniques and as a last resort medications.  Not all cases of GORD will need medical treatment and there is a move away from prescribing for GORD by many Health Professionals unless there appears to be significant pain, severe complications, growth issues or difficulties feeding.

If GORD is severe, complicated or ongoing, investigations may be required.


Medications
Gastric reflux suppressants

Gaviscon (Trade Name) –
Use:
 Gastric reflux suppressant
Side effects: Include constipation.
Warning: Gaviscon Infant is “Not for infants under 1 year except under medical supervision.”   Do not use Gaviscon Infant with AR (thickened) formula or other feed thickeners.
https://www.healthnavigator.org.nz/medicines/g/gaviscon-infant/

Acid reducing medications

Omeprazole (Generic Name)
Losec, Omezol Relief, Dr Reddy’s Omeprazole, Omeprazole actavis (Trade Names)
Use: 
Proton pump inhibitor
Omeprazole turns off most of the pumps that are responsible for stomach acid production. It may take a week or more to see any improvement after starting Omeprazole, as although the acid production is reduced almost immediately it can take longer for any damage (inflammation) in the oesophagus to heal. Omeprazole does not have any direct effect on spilling/vomiting.
Side effects: Side effects are rare, but more common with very high doses (nausea and headache).
Warning: A study has shown an increased risk of community acquired pneumonia and there is an increased risk of gastroenteritis due to decreased gastric acid. When trying to stop or wean Omeprazole, there can be a rebound acidity which can make it difficult to discontinue.
NB:
 Omeprazole stops the acid pumps producing too much acid. Acid is released into the stomach in response to a meal. For this reason, if Omeprazole is prescribed once daily in capsule/granule form, it should be given before the first feed of the day.
NZF – Omeprazole for GORD

Motility Medications

Domperidone (Generic Name)
Motilium (Trade Name)

Promotes emptying of the stomach and also aids in the pressure of the valve (ring of muscle) at the top of the stomach. These actions combine to reduce the amount of food and the ability of the valve to keep the remaining food in the stomach.
Domperidone NZF Patient Information


Surgery

Surgery is the last resort for severe GORD either with complications or ongoing GORD that is not able to be controlled with medications.


Useful Information:
Acknowledgements
  • GRASP (former New Zealand support group)
  • GSK NZ
  • Rochelle Wilson (GRASP National Coordinator 1995 – 2001).
  • Dr Rodney Ford, Paediatrician, http://www.drrodneyford.com/
  • Reckitt Benckiser (New Zealand) Ltd
  • Jennifer Howard (GRSNNZ National Coordinator 2001 – 2013)

© Crying Over Spilt Milk Gastric Reflux Support Network New Zealand for Parents of Infants and Children Charitable Trust (GRSNNZ) February 2022. Updated by Roslyn Ballantyne (RN), Trustee and Jenny Overwater, National Coordinator.
Page may be printed or reproduced for personal use of families, as long as copyright and Crying Over Spilt Milk‘s URL are included. It may not be copied to other websites or publications without permission and acknowledgement.