Regurgitation: causes
Infant regurgitation is largely related to their anatomical and physiological characteristics.
- Topography: the entrance to the stomach is located high (above the diaphragm), while in the supine position the stomach itself lies lower than the antropyloric region.
- Sphincters: the cardiac sphincter is gaping and poorly developed, whereas the pyloric sphincter is well developed and creates resistance.
- Antireflux mechanisms: the angle between the fundus of the stomach and the esophagus (angle of His) is weakly expressed, mucosal folds (valve of Gubarev) are virtually absent, and the crura of the diaphragm do not tightly encircle the esophagus.
In addition to anatomy, neurological factors (perinatal CNS lesions with vegetovisceral dysfunctions) and feeding errors play an important role: overfeeding, too rapid suckling, and air swallowing (aerophagia).
Approaches to managing regurgitation
Treatment should be comprehensive: eliminating the cause, adjusting nutrition, medication, non-pharmacological methods (massage), and specialist consultations.
For breastfeeding:
- The nursing mother should exclude gas-producing foods from her diet. A hypoallergenic diet may be indicated.
- It is essential to strictly normalize the feeding schedule.
- Postural therapy: feeding in a semi-upright position (45–60°), followed by holding the infant vertically for 20–30 minutes.
- If this fails in infants older than 1–2 months, commercial dairy-free rice cereal is added to expressed breast milk as a thickening agent. Refractory regurgitation is not a reason to stop breastfeeding!
For formula feeding:
- Anti-regurgitation (AR) formulas with thickeners are used.
- For profuse regurgitation, indigestible thickeners (locust bean gum) are used. Such formulas should not be given for a long time; once improved, the infant is switched back to standard formula.
- For moderate regurgitation, formulas with digestible modified starches (rice, potato, corn) are prescribed.
Intestinal colic
Colic occurs due to intestinal spasms. In infants, gastric motor function is reduced, peristalsis is sluggish, and the muscular layer of the small intestine is poorly developed. Unlike adults, newborns have a lot of gas in the small intestine, leading to overdistension. Lactase deficiency also plays a role.
Clinical presentation: The infant cries in pain, the face flushes, legs are drawn up to the abdomen, and passage of stool and gas is difficult. Attacks most commonly occur in the evening.
The "rule of threes" is used to make the diagnosis:
- crying lasts at least 3 hours a day;
- attacks recur at least 3 days a week;
- this persists for at least 3 weeks.
Colic begins in the first weeks of life, reaches peak severity by 2–3 months, and resolves spontaneously by 3–5 months. A crucial step is explaining the benign nature of this condition to the parents. The physician must also rule out organic diseases and food allergies.
For colic diagnosis, remember the "Rule of Threes": crying >3 hours a day, >3 days a week, lasting >3 weeks.
Class and exam questions
Why does infant anatomy promote regurgitation?
In infants, the cardiac sphincter is poorly developed (gaping) and antireflux mechanisms (angle of His, valve of Gubarev) are underdeveloped, while the pyloric sphincter is already well developed and creates resistance.
Should a breastfed infant be switched to a special formula for regurgitation?
No, refractory regurgitation is not an indication to discontinue breastfeeding. The problem typically minimizes by the 3rd month.
What types of thickeners are used in anti-regurgitation formulas?
Indigestible thickeners (locust bean gum) are used for pronounced regurgitation, and digestible thickeners (modified starches) for moderate regurgitation.
What conditions must intestinal colic be differentiated from?
First and foremost, partial lactase deficiency and the gastrointestinal form of food allergy must be ruled out.
What else to study on this topic
- Pathogenetic and syndromic pharmacotherapy for regurgitation
- Gastrointestinal food allergy disguised as colic
- Differential diagnosis with partial lactase deficiency
- Therapeutic massage techniques and hydrogymnastics for vegetovisceral dysfunctions
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