Gastro-Esophageal Reflux (Ger)

Gastro-Esophageal Reflux (Ger)


(gas-trow-E-sof-O-gee-ul Ree-flux))


What is GE Reflux

What causes it

What are the symptoms

How is it diagnosed

How is it treated

What are “reflux precautions”

What if my baby needs surgery

What can I do


1.GE Reflux or GER is the backward flow of stomach contents into the esophagus (food pipe).

2.GER happens most often after a feeding but it can happen when your baby coughs, cries or strains.

3.Infants who are born prematurely are prone to GER.


  1. The muscle at the entrance of the stomach (lower esophageal sphincter [sfinc-ter]} is immature and allows food to move back up into the esophagus and occasionally into the throat.
  1. Until this muscle matures stomach contents can flow backward instead of moving forward through the gastrointestinal (GI) tract or bowel
  2. Sometime air bubbles in the esophagus may push liquid up the esophagus and out the baby’s mouth
  3. Sometimes simply too much feeding at one time or feeding too fast can cause the stomach contents to flow back into the esophagus and throat.


  1. Vomiting or spitting with or after feedings is the most common symptom.
  2. Other symptoms may include:
  1. Apnea (no breathing)
  2. Bradycardia (low heart rate)
  3. Repeated respiratory infections, such a pneumonia
  4. Coughing or wheezing
  5. Difficulty or refusing to nipple or breast feed despite crying for a feeding
  6. Crying after a feeding, especially if placed on the back
  7. Choking episodes.


It may be difficult to diagnose GER in babies since they cannot describe what they are feeling.

We look at several different things to make the diagnosis of GER:

  1. Feeding history
  1. The baby’s feeding patterns
  2. The number and consistency of any “spits” (emesis)
  3. Apnea (stops breathing) with feedings or at the end of feedings.
  1. Abdominal X-Ray
  2. Occasionally an Upper GI series is ordered
  1. This is a series of X-Rays done in the MedicalCenter’s X-Ray Department
  2. The x-rays are read (looked at) by a Radiologist—a medical doctor specially trained to interpret (read) medical imaging films such as x-rays. CT scans, ultrasounds and MRIs
  3. Before the x-rays are taken your baby is fed a white chalky liquid, a harmless dye called gastrografin
  4. The x-rays are taken as the dye goes through the stomach or stomach and intestines (GI or gastrointestinal tract) making it easier for the Radiologist to see if there is anything unusual with the baby’s stomach and/or intestines.


  1. Your baby may be placed on medicines to help prevent GER and/or on Reflux Precautions to prevent aspiration (breathing stomach contents into the lungs).

2.The MD/NNP will talk with you about GER and their plan of care for your baby.


These are simple things we do to help prevent the problem of GER and aspiration:

  1. Keep the baby upright during feedings.

  1. Burp the baby in an upright position.
  2. Hold the baby upright for 15—30 minutes after a feeding; do not jostle or jiggle your baby during this time.
  3. Keep the head of the bed up using pillows or blankets under the mattress of the crib. We call this the “anti-reflux position.”
  4. While the baby is still in the hospital and being fed with a tube, the nurse may place the baby on the right side or stomach during feedings.

a.Once the baby is discharged from the hospital, follow the pediatrician’s (the baby’s doctor) recommendations for positioning your baby during and after feedings.

  1. After discharge from the hospital, the baby’s doctor may change the feeding pattern, recommend small, frequent feedings and/or he may add a medication. The baby’s doctor will talk with you about his plan of care for your baby.

7.GER usually resolves on its own when the baby is around 12—18 months of age; but each baby is different.


1.On rare occasion, the ring of muscle between the esophagus and the stomach (lower esophageal sphincter) must be surgically tightened to prevent food or liquid from flowing back (reflux ) into the esophagus.

2.The procedure is known as a Nissan Fundoplication (Fun-dough-ply-kay-shun).

  1. This surgery is very rare—it is reserved for the very few babies with GER severe enough to interfere with their breathing and/or growth
  2. Our Neonatologist will talk with you about the need for surgery.

3.If your baby needs surgery, he/she will be transferred to either DukeUniversityMedicalCenter or The University Hospital at Chapel Hill.

a.If your baby’s surgery is done at another hospital, as soon as your baby’s condition is stable and the doctors are happy with the baby’s progress, the baby may be returned to CapeFearValleyMedicalCenter’s Neonatal Intensive Care Unit.

4.You will be asked to sign consent (give permission) to transfer your baby to the hospital where the surgery will be performed.

a.Once you’ve talked with the doctors there, you will be asked to sign a consent (give permission) for the surgery.

5.The surgery is done in the hospital’s Operating Room (OR) and your baby is asleep for the surgery.


1. Visit your baby often.

  1. Talk to and cuddle your baby.
  2. Learn everything you can about your baby’s care.
  3. Follow “Reflux Precautions” when you visit and feed your baby.
  4. If you have any questions, please talk with your baby’s doctor.

Reviewed/Revised: 01/99…..11/11

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