Management

What can be done?

It is important to reassure parents that they are doing nothing wrong; however, there are recommended steps that they can take to minimise the discomfort and distress experienced by the baby and themselves. Many infants, who are regurgitating, even frequently, do not need medical treatment.

An approach to managing possetting in babies
FIGURE 1 – An approach to
managing possetting in babies
(click to enlarge)

Once the presence of these alarm symptoms has been ruled out, appropriate measures and treatment options can be recommended (Figure 1).

Simple measures to help mild-to-moderate reflux in infants:

  • The maintenance of posture of the infant is essential.[Weihrauch, 1985] A more upright posture helps keep the acid contents in the stomach and, therefore, relieves any pain from a potentially inflamed oesophagus and reduces the likelihood of possetting
  • The infant should be supported in an upright position whilst feeding and for at least 45 minutes after feeding to bring up wind
  • The infant should be handled very gently after feeding and during winding, avoiding vigorous patting or rocking. Different positions for feeding can help reduce the infant’s chance of possetting
  • The infant should not be overfed
  • Smaller more frequent feeds should be given
  • As little air as possible should be swallowed during feeding by ensuring that the bottle is tilted so that the teat is full
  • Never allowing anyone to smoke near the infant
  • After possetting, the infant will be hungry and thirsty so should be given plenty of water or a little food so that they do not become dehydrated. Feed thickeners and anti-reflux milks containing thickeners are not indicated in healthy infants who regurgitate, but can be considered in infants with persistent symptomatic reflux impacting on nutrient intake
  • Sleeping the infant on their side ensuring that their head is raised above the level of their feet may help to keep the milk down.

Pharmacological treatment of possetting in infants

Although possetting rarely requires investigation, it does require treatment. This is because 1 in 10 infants develop complications such as weight loss, dehydration and oesophagitis. There is also a risk of the feed entering the lungs and causing breathing problems.

Simple behavioural techniques can first be explored, but if no resolution is obtained, specially formulated infant reflux suppressant such as Gaviscon Infant may also be useful in management of this problem.

Gaviscon Infant is a sugar-free reflux suppressant which is proven to reduce the frequency and degree of possetting. The naturally derived sodium alginate stabilises stomach contents to reduce the problem of regurgitation of feeds. Gaviscon Infant can be administered to breast-fed infants as well as bottle-fed infants.

Management of reflux disease in adults traditionally takes a step-up or step-down approach, where antacids,[Vandenplas Y, 1997] alginates, H2-receptor antagonists[Faubion WA, 1998] and proton pump inhibitors (PPIs) are used sequentially to achieve effective symptom relief.

Occasionally anti-reflux surgery may be required. Although these agents can be used in children with more serious disease, their use in infants is generally not recommended.

Thus, these medications should only be used on medical advice and if reflux has resulted in significant problems, such as oesophagitis or ulceration.

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