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Reflux in infants
Possetting in young infants is the term used to describe the repeated, effortless regurgitation of small quantities of milk and stomach acid into the mouth after feeding, often when being winded,[Neuhauser EDB, 1947; Forshall I, 1955; Plarre FE, 1972] and can occasionally continue until the next feed.[Weldon AP, 1972] It is a common problem affecting a large proportion of infants under the age of 3 months and often continues into early childhood. Some infants are particularly susceptible to possetting, especially if they are very hungry prior to a feed or swallow more air than normal as they feed. In some babies it is merely the appropriate response to overfeeding.
Causes of possetting
In recent years, the availability of lower oesophageal pH monitoring has demonstrated that the underlying cause of possetting in most infants is GORD – namely, a weak or immature LOS.[Hillermeier AC, 1996] The LOS normally closes once the food has entered the stomach to prevent its backward movement, or reflux, into the oesophagus. However, in babies, the LOS may not always function properly, causing reflux of the stomach contents and resulting in possetting. Consequently, possetting occurs more frequently in newborn babies (approximately four in 10) than in older infants and children, and is found even more frequently in premature babies. The number of episodes of reflux decreases through the first and second years of infancy and complete recovery occurs in the majority of cases.[Hillermeier AC, 1981; Vandenplas Y, 1994]
Complications of possetting
Possetting causes no significant degree of pain or discomfort, and is no cause for concern if the baby is happy, feeds well and gains weight, and serious underlying pathology is present in only a small minority of cases. However, GORD in infants may not always be entirely straightforward and related symptoms might include excessive irritability, sleep disturbance, respiratory symptoms and failure to thrive. In a minority of infants, reflux may be sufficiently frequent to result in oesophagitis.[Vandenplas Y, 1993]
Fortunately, in the majority of infants, possetting is self-limiting, resolving spontaneously within the first year of life as the infant starts to eat solids and spends more time in an upright position. Nevertheless, it can result in obvious distress for the child and anxiety and feelings of inadequacy and guilt in the parents.
It is not only of psychological benefit to the parents to treat possetting, but it is also of significant benefit to the infant, since 1 in 10 babies left untreated may go on to develop more serious complications, such as dehydration and oesophagitis, due to the persistent exposure of the oesophagus to acid and other gastric contents. In most cases, although the condition is distressing, if the baby is developing and gaining weight as expected by the parents and health visitor, there is little cause for concern. In rare circumstances, however, infants may present with more sinister alarm symptoms that will necessitate GP referral.
Once the presence of these alarm symptoms has been ruled out, appropriate measures and treatment options can be recommended.
