Gastroesophageal Reflux

Hi Lisa,

My 3 month old has been 'snuffly' since birth, her nose has never been never runny but just seems blocked. She has been into hospital as in the early weeks she found it hard to breathe and had a ct scan on her sinuses which showed nothing. I changed her formula to a thickened formula as she used to bring up a lot of her milk after feeds. This has helped and she only spills a little now but her nose even though better seems to always be blocked with thick clear mucus which dries out. Could it still be reflux that’s causing her 'snuffles' and should I investigate it further and get a second opinion from a pediatrician or will she grow out of it?

Thank you,

“snuffles mum”

Dear “Snuffles mum”,

I’m sorry to hear that your little one has had such a difficult time with her nose. The good news is that her CAT scan was normal which rules out any anatomical problems, masses or infections. You did mention that your daughter has Gastroesophageal Reflux (GER), and that the symptoms seem to be improving. Gastroesophageal Reflux certainly can cause infants to have a stuffy, congested nose.

Infants typically have a lot of problems when their nose is stuffy and congested even if they do not suffer from GER. A stuffy nose affects their feeding and breathing dramatically since infants are obligate nose breathers. (1) The best thing that you can do at this point to help her nose is to make sure the house is not too hot, keep your daughter's head elevated, use a cool mist vaporizer and use saline nose drops to keep the nasal secretions loose.

GER is very common in infancy. It affects approximately 50% of infants younger than 2 months old and up to 70% of infants by 4 months old.(2) GER is defined as the retrograde passage of gastric material into the food tube. (3) Infants can develop esophageal symptoms from GER which are caused by inflammation and hypersensitivity to the gastric contents. Infants can also develop symptoms outside of the esophagus which are caused by direct acid-induced injury and stimulation of airway reflexes. (4)

The typical symptoms experienced in infancy include irritability, recurrent and persistent vomiting and regurgitation (reflux into the mouth and swallowed again).(5) Symptoms outside of the esophagus can include; sore throat, hoarseness, wheezing, chronic cough, recurrent pneumonias, Asthma, dental erosions, laryngitis(inflammation of the voice box), Sinusitis, Pharyngitis (throat infection), Otitis media (middle ear infection), failure to thrive, Sandifer’s syndrome and vomit with blood in it. (5,6) When these problems occur, an infant is considered to have Gastroesophageal Reflux Disease (GERD). (5)

The good news is that symptoms of reflux usually resolve spontaneously by age one. (5) In the mean time the measures that can be taken to help your daughter’s reflux include; thickening her formula, elevating the head of her mattress 30 degrees, avoiding position changes for 30 minutes after a feeding, avoid moving your daughter after feedings, plan diapering and play time so that it does not occur after a feeding, avoiding exposure to second-hand cigarette smoke, avoiding allergic foods and feeding her hypoallergenic formula. (4,5) When elevating an infant's head it is importatnt not to use pillows. Instead put a folded blanket under the mattress. Acid blocking medications may be recommended, especially when symptoms outside of the esophagus occur. (5)

By controlling your daughter’s GER symptoms, you may be able to control her nose symptoms. Since GER may cause other problems such as ear infections and respiratory infections it is important that you follow up with your daughter's Doctor if new symptoms develop. As long as she presently doesn’t have other symptoms such as fever, problems moving her bowels, difficulty gaining weight, coughing, change in the quality of her cry, stridor (high pitched inspiratory sound), wheezing or problems breathing, it sounds reasonable to wait it out at this point.

Your daughter’s GER symptoms and nasal symptoms are expected to improve with age. If at any point her condition seems to worsen you should bring her in to see her Pediatrician and a specialist if your Pediatrician feels that it is necessary.

If you are interested in other Pediatric Advice stories covering this topic:

Newborn Congestion

Infant Vomiting

Vomiting and Weight Loss

Baby with Cold Symptoms

I hope your daughter's "snuffles" go away real soon.

References:
(1)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:1168-1171.

(2) Nelson SP, Chen EH, Syniar GM, Christoffel KK. Prevalence of symptoms of Gastroesophageal reflux during infancy. A pediatric practice-based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med. 1997. 151(6):569-572.

(3)Gold BD. Gastroesophageal reflux disease: could intervention in childhood reduce the risk of later complications? Am J Med. 2004. 117(Suppl 5A):23S-29S.

(4 )Rudolph CD, Mazur LJ, Liptak, GS. North American Society for Pediatric Gastroenterology and Nutrition. Guidelines for evaluation and treatment of Gastroesophageal reflux in infants and children: recommendations of the North American Society for Pediatric gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr. 2001. 32(Suppl 2);S1-31.

(5 )Suwandhi E, Ton M, Schwarz S. Gastroesophageal Reflux in Infancy and Childhood. Pediatric Annals. 2006. 35(4):259-266.

(6)Christensen M. Gold B. Clinical Management of Infants and Children with Gastroesophageal Reflux Disease: Disease Recognition and Therapeutic Options. Presented at: The 2002 ASHP Midyear Clinical Meeting; Dec 9, 2002: Atlanta.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice For Infants