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婴儿吐奶和胃食管反流病

日期 2020-01-06

何种吐奶值得关注?
 — 健康的婴儿在吃奶后也常会吐奶,大多无需治疗即可渐渐缓解。
人们有时会将此称为“胃酸反流”,即正常情况下应处于胃内的酸液反流进入食管 (将食物从口运送至胃的管道)。但婴儿吐出的奶中有时不含胃酸。
如果孩子吐奶较多,但其他方面表现得健康而快乐,则很可能为“单纯性反流”,是一种很常见的正常现象。但有些婴儿的反流可引起问题,即“胃食管反流病”,英文简称GERD。

我的婴儿有发生GERD的风险吗?
 — 一些婴儿较容易发生GERD,如有下述情况的婴儿:
●出生过早(在足月前3周或更早出生)
●身处于有香烟烟雾的环境
●有某些健康问题,如唐氏综合征、脑性瘫痪或者其他的脑部或脊髓问题

GERD有何症状? 
— 经常吐奶并不意味着GERD;所有婴儿都会时而哭闹、烦躁,不一定代表异常情况。
患有GERD的婴儿可能出现:
●拒绝进食
●哭泣和拱背,好像在经受疼痛
●反流时呛噎
●剧烈呕吐
●体重没有正常增长

我的孩子应该就诊吗? 
— 如果您的孩子经常吐奶且有上列任意症状,请告知医护人员,他们可进行体格检查,也可能实施某些检查来判断孩子的症状是由胃酸反流还是其他情况引起。
单纯性反流一般不引起疼痛,通常不需要治疗。如果您的孩子经常哭泣或者有睡眠困难,医护人员可帮助确定这是正常现象还是由GERD或其他问题引起。

我能做些什么来帮助孩子改善症状吗?
 — 能。若婴儿经常吐奶或看似不舒服,您可:
●喂食后帮孩子保持立位–如果您在喂食后让孩子趴在您肩上并将其静静地竖抱20-30分钟,可能会减少其吐奶。拍嗝通常也能预防吐奶。喂食后立即把孩子放于婴儿座椅上并不能改善反流,实际上还可能让其加重。此外,不要强迫孩子进食。
应让孩子仰卧睡觉,而非侧卧或俯卧,无论其是否经常吐奶,该睡姿都最为安全。
●戒烟–您或您家里其他人吸烟可加重孩子的反流情况,并可使婴儿和儿童发生其他健康问题。在户外也应让孩子远离香烟烟雾。
●不含奶和大豆的饮食–一些婴儿难以消化牛奶或大豆制品。如果您进行母乳喂养,也可从您的饮食中去除奶和大豆。然后观察孩子的胃酸反流是否在数周后改善。如果孩子饮用配方奶粉,有一些不含牛奶和大豆的品牌可供您选择。大多数难以消化奶或大豆的婴儿在长到1岁时即不再存在该问题。
●增加食物粘稠度–在奶中加入婴儿谷物以增加奶的粘稠度可能有助于改善胃酸反流,燕麦谷物往往较宜。

GERD如何治疗? 
— 大多数吐奶较多的婴儿无需药物治疗,且药物并不总能改善反流。如果您尝试了上述方法而孩子仍有易激惹或进食不足等症状,医护人员可能会建议尝试药物治疗。
 
 

When is spitting up a problem? 
— Healthy babies often spit up milk or formula after eating. Most babies grow out of it without treatment.
Sometimes people use the term "acid reflux" for spitting up. Acid reflux is when the acid that is normally in the stomach backs up into the esophagus. (The esophagus is the tube that carries food from the mouth to the stomach.) But baby spit-up does not always contain stomach acid.
If your baby spits up a lot, but seems otherwise happy and healthy, he or she probably has what is called "uncomplicated reflux." This is normal and very common. But in some babies, reflux can lead to problems. When this happens, doctors call it "gastroesophageal reflux disease" or "GERD."

Is my baby at risk of getting GERD? 
— Some babies have a higher risk of getting GERD, including those who:
●Were born prematurely (3 or more weeks before the due date)
●Are around cigarette smoke
●Have certain health problems, such as Down syndrome, cerebral palsy, or other problems with the brain or spinal cord

What are the symptoms of GERD?
 — Spitting up a lot does not mean your baby has GERD. All babies also cry and act fussy sometimes, and this does not always mean something is wrong.
In babies who do have GERD, symptoms might include:
●Refusing to eat
●Crying and arching the back, as if in pain
●Choking on spit-up
●Vomiting forcefully
●Not gaining weight normally

Should my baby see a doctor or nurse? 
— If your baby spits up a lot and has any of the symptoms listed above, talk to a doctor or nurse. They can do an exam, and might decide to do some tests to check whether your baby's symptoms are caused by acid reflux or something else.
Uncomplicated reflux does not usually cause pain, and usually does not need treatment. If your baby cries a lot or is having trouble sleeping, their doctor or nurse can help decide if this is normal or caused by GERD or some other problem.

Is there anything I can do to help my baby feel better?
 — Yes. If your baby spits up a lot or seems uncomfortable, you can try:
●Keeping the baby upright after eating – Your baby might spit up less often if you calmly hold them up on your shoulder for 20 to 30 minutes after a feeding. Burping your baby often can help, too. Putting the baby in an infant seat right after feeding does not help with reflux, and can actually make it worse. Also, don't try to force your baby to eat when they don't want to.
Always put your baby to sleep on their back (not the side or stomach). This is the safest position for sleep, whether or not your baby spits up a lot.
●Quitting smoking – If you smoke, or if anyone in your house smokes, this can make your baby's reflux worse and can cause other health problems for babies and children. Keep your baby away from cigarette smoke when you are out of the house, too.
●A milk-free and soy-free diet – Some babies have trouble digesting cow's milk or products made with soy. If you breastfeed your baby, you can try removing all milk and soy from your diet, too. Then see if your baby's reflux improves after a few weeks. If your baby drinks formula, there are special brands available that do not contain cow's milk or soy. Most babies who have trouble with milk or soy outgrow the problem by the time they are 1 year old.
●Thickened feeds – Adding baby cereal to your baby's bottle to make the milk thicker might help with reflux. Oat cereal is often a good choice.

How is GERD treated? 
— Most babies who spit up a lot do not need medicine. Plus, medicines do not always make the reflux better. But if you have tried the ideas above, and your baby is still having symptoms like acting irritable or not eating enough, your baby's doctor or nurse might suggest trying medicine.

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