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Reflux, or gastro-oesophageal reflux (GOR), can affect up to half of babies aged 0-3 months. It occurs when the stomach contents are brought back up into the oesophagus or mouth

Symptoms

• Frequent regurgitation and/or vomiting
• Troublesome crying/irritability
• Back arching during/after feeds. Uncommon symptoms include constant coughing and frequent chest, ear and sinus infections.

Causes

The main cause is an immature lower oesophageal sphincter muscle that allows stomach contents to pass back into the oesophagus. As this muscle matures, the frequency of reflux reduces and usually disappears by 12-14 months of age.

Treatment

New guidance from the National Institute for Health and Care Excellence (NICE) advises:

• If breastfeeding, a healthcare professional should review mum's technique
• If formula feeding, a healthcare professional should review the baby's feeding history and then reduce the volume of milk, if excessive for the infant's weight. A trial of smaller, frequent feeds can be offered, if appropriate, followed by a trial of thickened formula milk.

Formula milks for reflux

For infants on formula milk, a healthcare professional may recommend a specialist milk, such as Aptamil Anti-Reflux, Cow & Gate Anti-Reflux or SMA Staydown. Formulated with cows' milk, these products:

• Are casein-dominant, so they take longer to digest
• Contain either a pre-cooked starch or a gum-based thickener (e.g. carob bean gum) that thickens before feeding. The viscosity is maintained and increases in the stomach, making it less likely that the feed will be brought back up
• Can be used from birth until 12 months of age.

N.B. Because of their thickening agents, formulas for reflux and regurgitation typically have different make up instructions to standard formulas.

Feed thickeners, such as Cow & Gate Instant Carobel, increase the viscosity of a feed, which may prevent it from coming back up. These can be added to expressed breast milk or cooled, boiled water and given as a paste before and during a feed. Alternatively, they can be mixed with formula and fed through a teat with a larger hole.

If a specialist milk for reflux has been tried for a few weeks without success, refer the customer to a pharmacist or GP because the cause of the reflux may be an allergy to cows' milk, in which case a GP may recommend an extensively hydrolysed formula. Alginatecontaining sachets, which can help to prevent reflux, may also be prescribed as an alternative to thickened feeds.

N.B. If vomiting occurs with other symptoms (e.g. diarrhoea and a fever), refer to a pharmacist/GP.

Further information:

• SMA: Bringing up milk
• Aptamil Professional: Managing reflux