Gastroesophageal reflux (GOR) occurs when swallowed foodstuffs move back up into the oesophagus (throat). It may occur with or without vomiting and sometimes pain (heartburn). Reflux occurs frequently in infants and can be normal with no adverse symptoms or side effects. Posetting or spitting up of feeds is also normal and usually resolves in healthy infants by 12 to 14 months of age.
Gastroesophageal reflux disease (GORD) on the other hand is when reflux starts causing symptomatic problems and side effects for an infant. These problems include oesophagitis (heartburn exhibited by back arching), discomfort and unhappiness, food refusal, weight loss and poor growth.
Reflux happens if the valve between the oesophagus and the stomach relaxes. Food and gastric juices therefore move up out of the stomach into the oesophagus. This happens for various reasons and occurs in both breast and formula fed infants. If the reflux is causing problematic side effects for an infant then identifying the cause and eliminating it is beneficial.
A food allergy is a reaction to the proteins found in foods. The most common food allergy in infants is to dairy. Allergic reactions cause a variety of symptoms involving the respiratory tract, skin or gut.
The symptoms of an immediate allergic reaction (IgE) are predominantly respiratory or skin related. Blood tests and skin prick tests can be done to confirm an IgE food allergy.
Delayed allergic reactions (Non IgE) cannot be tested for. Diagnosis of this allergy is based on history and a trial of avoidance of the suspected food. The symptoms of a non-IgE food allergy predominantly involve the gastrointestinal tract and include; reflux (back arching), vomiting, abdominal pain, diarrhoea, constipation, discomfort, and food refusal. Avoidance of the food can result in a complete resolution of an infants' symptoms.
If a non-IgE allergy to dairy is suspected then a trial of a dairy exclusion is warranted. Parents will notice a change in their child within the first week of starting the exclusion and will know whether it is the dairy that is causing their child's symptoms. Please speak to a dietitian specialized in paediatrics for advice.
Exclusion diets are possible for both breast and formula fed infants. Breast milk and dairy proteins are however different; a child will not react to breast milk proteins, despite a dairy allergy, but dairy proteins eaten by a mum can pass through into her breast milk in small quantities. In sensitive infants they can cause reactions. Mum must therefore exclude dairy from her diet.
Standard infant formulas made from cow's milk are unsuitable for infants with a dairy allergy (IgE and non-IgE). An extensively hydrolysed (pre-digested) formula must be used. If infants still react to these, they must be changed to a completely digested (elemental) formula. Soya based formulas are not indicated in infants under 6 months; they can be used, if tolerated, from 6 months.
When an infant with a dairy allergy starts to eat solids, this must be dairy free. Infants can be challenged with dairy when older as life-long dairy exclusion is unlikely to be necessary.