胃食管反流What is Reflux?

Breastfeeding your baby with gastroesophageal reflux.
母乳喂养胃食管反流的宝宝

立颖 译 Shiuh-jane，Daisy 审校

Gastroesophageal reflux is the medical term for milk and stomach acid backwashing out of the stomach into the throat. Reflux is also called wet burps or spitting-up.
胃食管反流是医学术语。意指奶和胃酸从胃里反冲出来到了喉咙。胃食管反流又称有液体上涌的打嗝或吐奶。
The valve between the stomach and the esophagus is only supposed to open when your baby swallows or burps. Reflux happens when the valve doesn’t close tightly or opens for no reason.
食管括约肌就是连接食管（食道）和胃的一个瓣膜，仅在孩子吞咽和打嗝的时候开启，当它没有关闭或者无故地开启时会发生溢奶。
English (Stomach + Esophagus+ Backwash) = Latin (Gastroesophageal reflux)
英语（胃+食管+反流）=拉丁语（胃食管反流）

Any baby on this spectrum can benefit from the ideas in this publication.
有下列问题的宝宝可以从本出版物中受益。

1. Most babies have occasional episodes of reflux every day. This is perfectly normal and doesn’t usually cause any problems for the baby.
大多数宝宝每天都会有偶发性的溢奶，这种情况很正常而且也不会引发其他的问题。
2. Some babies spit up large amounts after every meal. You and your doctor will want to watch your baby carefully for signs of trouble.
2.有些孩子在每顿之后都会大量吐奶。你和医生要小心地看护婴儿，及时发现问题的征兆。
3. Some babies experience problems when the stomach acid burns the delicate lining of the throat or airway or the baby can’t gain enough weight. This is called Reflux Disease.
3.当胃酸灼伤娇弱的喉咙或气管，或孩子增重不足，这样的问题才被诊断为胃食管反流。

Reflux Symptoms
If your baby experiences any of these problems, please discuss them with your doctor so you can work together and prevent them from becoming serious.
胃食管反流症状
如果你的孩子有以下这些问题，请同你的医生进行讨论，以便你们能一起努力，避免问题变得更加严重。
• Spitting up large quantities very frequently or hours after eating
•饭后几小时内，大量呕吐或吐的很频繁。
• Vomiting (more forceful than spitting-up and usually emptying the stomach)
•  呕吐（比吐奶更强烈，会把胃吐空）
• Painful crying after wet burps or spitting-up
•吐后或打嗝后严重的哭闹
• Crying, fussing or arching the neck and back during feeding
•在喂奶过程中哭闹、烦躁、弓着颈背
• Baby seems reluctant to nurse or pulls away from the breast
•宝宝好像不想吃奶或从乳房上移开
• Unusual eating patterns, constant feeding or feeding only when sleepy
•不常采用的喂养方式，不间断的喂养或者只能在犯困后喂养
• Noisy breathing or congestion
•呼吸有杂音或鼻塞
• Breath-holding spells, skipping several breaths
•呼吸不畅
• Frequent gagging, coughing, choking or sneezing
•频繁的作呕、咳嗽、喘不过气、喷嚏
• Poor weight gain, falling to a lower weight percentile
•体重增加太少，降到较低的百分位
• Frequent throat infections, red throat, colds, ear congestion or infections
•经常咽喉发炎，嗓子红肿，感冒、耳朵充血或中耳炎
• Any serious respiratory problems such as bronchitis, pneumonia, asthma
•严重的呼吸问题，如支气管炎、肺炎、哮喘
•Breath that smells sour/acidic
•呼气发酸
• Frequent hiccupping and burping
•频繁的连续打呃、打嗝
• Waking suddenly with painful crying, unusually poor sleeping habits
•孩子哭闹着突然醒来，不常见的不良睡眠习惯
When a baby has acid backwashing from the stomach into the esophagus, this can cause throat pain. The pain can range from minor to severe. It may last for a few minutes or all day.
当孩子的胃酸反流到食管，可能导致咽喉的疼痛。这种疼痛可能很轻微也可能很剧烈，可能持续好几分钟或一整天。

When a baby has throat pain, it can affect nursing.
孩子如果有咽喉疼痛，可能会影响哺乳。

Pattern #1  Babies with reflux who nurse for comfort:
• Many babies with reflux find that breast milk is soothing on their sore throats. Breast milk helps wash the acid back down into the stomach.
• She may nurse constantly all day and night.
• She may want to nurse after every wet burp or spit-up.
• She may gain a lot of weight until the pain is gone.
模式1 给胃食管反流的孩子喂奶会让他们舒适
•给那些胃反流的孩子喂母乳，更适合于他们受伤的咽喉。喂奶有助于让胃酸下流到胃。
•孩子可能需要全天候的喂奶。
•孩子每次打嗝或小吐后都需要喂奶。
•在此情况下，宝宝可能依然正常地增加体重。

Pattern #2  Babies with reflux who feel pain when they nurse:
• This baby will probably behave in ways that confuse her mother. When she is hungry her tummy wants food, but if her throat is sore from acid she might not want the milk to touch her throat. She is confused and is not sure whether to eat or not.
• She may fuss and act hungry but refuse to eat until she is starving.
• She may eat very fast, but stop after only a few minutes.
• She may become afraid of eating.
• She may eat better when she is sleepy because she feels less pain.
• She may have poor weight gain until the pain is gone.
模式2  给胃食管反流的孩子喂奶会让他们疼痛
•孩子的做法使得母亲很困惑。因为他饿了，所以想要吃奶，但是喉咙由于胃酸的影响造成的疼痛，又不想奶碰到喉咙。孩子也很迷惑不确定是否吃奶。
•孩子可能很烦躁，表现是饿了，但拒绝吃奶直到非常饿了才吃。
•吃得很快，几分钟就停。
•孩子可能会变得害怕进食。
•犯困时候疼痛的感受更少，所以吃奶吃得更好些。
•除非疼痛过去，否则体重会一直不增加。

Tips that minimize reflux episodes:
• Use breastfeeding positions that don’t put pressure on the baby’s stomach. When her tummy is being squeezed, the milk comes back up more easily.
• Use breastfeeding positions that keep your baby’s head higher than her stomach. She may also prefer to keep her right ear up. This keeps the top of the stomach higher than the milk in her stomach.
缓解胃食管反流的方法
•采取不会给孩子胃压力的姿势来喂奶，孩子的胃受压迫的时候，奶更容易反流。
•喂奶的姿势一定要保持孩子的头高于胃。孩子可能更愿意让右耳朵向上。这样做可以让胃的顶部高于胃中奶的位置。
•If your baby chokes during the let down, try positions that let her face your body, not the ceiling. These positions allow her to release the breast and let some milk dribble out of her mouth when the flow is too fast. You can also try taking her off for a few seconds and pressing your breast with your palm to slow the milk flow a bit.
•如果奶来的时候宝宝呛奶，就试着让孩子面对你的脸，而不是天花板。这样的位置会让孩子松开乳房，当奶流太大时候，让奶从嘴里流出来。你也可以试着停几秒钟，用手掌施压于乳房，让奶流得慢一点。
• Encourage your baby to nurse frequently and take small amounts at a time. Overfilling her stomach makes the milk come back up easier.
• Nursing at one breast per feeding can help your baby avoid overfilling her stomach. It also helps her get a balance of foremilk from the front of the breast and hind milk from deeper in the breast. Both are important to good nutrition. If she nurses frequently and takes small amounts, you can try switching breasts every few hours.
•增多喂奶的次数，每次少量。过量的喂奶会让奶更容易溢出来。
•每次喂奶用一侧乳房有助于避免过量的问题。也有助于让孩子得到更均衡的前奶和后奶。此二者皆是重要的营养素。如果哺乳频繁且摄取量少，你可以尝试着几个小时换另外一侧乳房。
• Make sure that your baby is latched onto your breast properly so that she doesn’t swallow air. When air comes up, it can bring up milk.
• Good burping is very important to minimizing reflux. You may find that you need to burp her before, during and after nursing. You need to get the air up right after meals—before the stomach mixes acid into the milk.
• Your baby should never be exposed to second-hand smoke. Smoke greatly increases reflux.
• 确认宝贝已经含好了乳头，不会吞咽空气。空气排出时会带动乳汁。
•喂奶后给孩子拍嗝很重要，有助于减少胃反流。你可能已经发现在喂奶的过程中和喂奶之前后，你需要让孩子打嗝。喂奶后，你需要立即─在胃酸混入奶之前让空气排出。
•确保宝宝不处在二手烟的环境下，烟会加剧宝宝的反流
• Loosen your baby’s diaper and try not to put pressure on her tummy after meals.
• Keep your baby upright after meals—30 minutes for breast milk and longer for other foods.
• Don’t jiggle or bounce your baby after meals.
• Your baby may sleep better at night when the head of her bed is elevated.
•松开宝宝的纸尿裤，饭后不要压孩子的胃。
•让孩子饭后直立─喂母乳后30分钟，如果是其他食物则需要直立的更久些。
•饭后不要摇晃宝宝。

Tips that minimize the pain:
• Some babies feel less pain when they are entertained. She may eat better in public or when you sing and talk to her.
• Some babies feel less pain when they are sleepy and eat better when they are half-awake. Tell your doctor if your baby seems to be in so much pain that she won’t eat if she is fully awake.
• Your baby may need to be held and comforted nearly 24 hours per day. There are many tricks that you can learn from other moms. Slings, front packs and cosleeper beds can be helpful.
纾解疼痛的要诀：
•宝宝高兴的时候疼痛会不敏感。在公众场所，你唱歌给他听或和他说话的时候，他可能吃得更好。
•宝宝困倦的时候和半睡半醒的时候，感受到的疼痛减少，吃得比较好。如果你的宝宝醒着的时候因疼痛而不进食，一定要告诉医生。
•宝宝可能需要一直抱着和24小时的密切关注。你可以从其他妈妈那里学到更多的技巧。背巾，婴儿背袋以及可合并式的婴儿床均有所帮助。

Can mom’s diet affect reflux?
You may find your baby has more reflux on certain days. You may suspect this happens after you eat certain foods. Some babies do have reflux because of food sensitivities or allergies.
A few mothers find that eliminating foods can help their baby. But many mothers never find a specific food that makes a big difference.
Elimination diets can be frustrating and confusing because it can take days for an offending food to be eliminated from breastmilk and a several more days till your baby feels better. Elimination diets require a lot of planning and patience.
妈妈的饮食会影响宝宝的胃食管反流吗？
你可能发现了在特定的日子里宝宝更容易胃反流。你可能猜测，在你吃了特定食物后反流更容易发生。一些孩子的确因为过敏的食物更容易反流。一些妈妈发现剔除相关的食物对孩子有帮助。但是大多妈妈并未发现某个确切的食物会造成胃反流加重。
剔除特定食物会带来迷惑感和挫折感，因为去除不好的食物的影响需要数日，直到孩子感觉好点又需要好几天。剔除特定食物需要大量的计划和耐心。

Medication
If the doctor prescribes medicine, use it properly. Some medicines for reflux work best when taken at a specific time of day or on an empty stomach. Measure it carefully and store it properly. Don’t stop the medicine until the doctor says that your baby no longer needs it. It can take two weeks for the medicine to start working and several months for her throat to heal completely. If the first medicine doesn’t work for your baby, ask for a different brand. It can take several tries to find the medicine that works best for your baby. The dose may need to be adjusted every time your baby gains 1–2 lbs/0.5–1 Kg。
使用药物
如果医生开药了，一定正确使用。一些治疗胃反流的药在一天的某个特定时间用最有效，或者是空腹使用最好。用量和保管都要注意。在医生说宝宝可以不再用药时方可停止用药。可能需要2周左右药才能见效，再过几个月孩子的咽喉完全治愈。如果第一个药不起作用，换一个其他品牌的。可能需要尝试几次才能找到最合适你家宝宝的药。用药量要根据宝宝的体重，每1–2 lbs/0.5–1 Kg调整一次。

Coping
If your baby has pain due to reflux, she may need all of your attention 24 hours a day. It may be difficult or impossible for you to do chores or work until your baby’s pain is under control. It can help to talk to other mothers of high-need babies or babies with reflux. They know what you are experiencing and can offer support and practical tips. You will probably need help from your family, friends and neighbors. Make sure they understand your baby is in pain and needs special care. Be sure to get enough sleep, fluids, nutritious food and “down time” so that you can continue to make milk for your baby.
对策
如果你的宝宝由于胃反流导致了疼痛，他需要你一天24小时的关注。除非宝宝的疼痛得到控制否则你很难做家务或者工作。与其他全职照顾高需求或胃反流孩子的妈妈交流会有帮助。他们了解你所经历的，能提供支持和实际技巧。你可能需要来自家庭、朋友和邻居的帮助。确认他们明白你的孩子的痛苦，需要特殊关照。保证自己有足够的睡眠，摄取充足的液体和有营养的食物，还有“停工时间”，以便持续产奶给宝宝吃。

Non-nutritive sucking
Many babies with reflux find that sucking their thumb, a drained breast or a pacifier feels comforting. Having something in her mouth may also help your baby produce more saliva which soothes her throat. If your baby spits-up onto your breast, be sure to wipe the acid off right away.
Be cautious of introducing pacifiers —they are shaped differently from a breast and encourage your baby to move her tongue and jaw a different way. When she returns to the breast, she may not remember how to suckle from it properly.
没有营养素的吸吮
很多有胃反流的孩子喜欢吸吮大拇指，吸干了的乳房或者安抚奶嘴都可以让孩子感觉舒适。让孩子嘴里有点东西有助于让孩子产生更多的唾液，而唾液可以让咽喉更舒服。如果你的宝宝朝你的乳房溢奶，一定要立即擦掉。给予安抚奶嘴时要小心─它在设计的时候是区别于乳房的，并鼓励宝贝用不同的方式来活动舌头和下颌。当宝贝转向你的乳房吃奶的时候，可能会忘记如何正常吸吮。

Breast is best
Continue breastfeeding as long as you can. In the past, mothers were told that formula is best for babies with reflux but research has shown that breastmilk is easier to digest for most babies. Many babies with reflux who are switched to formula don’t tolerate the typical formulas and end up drinking amino acid based formulas which are extremely expensive. Milk from bottles often flows faster so she may overfill her stomach when drinking from a bottle. It may take several weeks for you and your baby to develop a breastfeeding rhythm. Some days, your milk may be excessive and overfill her tummy. Other days, she may spit-up and want to feed again so often that your breasts have trouble making enough milk. Usually, this evens out with time. Some mothers learn how to pump and store extra milk on the days that they make too much. The pumped milk can be offered from a spoon or cup when your baby needs it.
母乳是最好的
尽可能持续母乳喂养。过去，妈妈们被告知，配方奶对于胃反流的孩子是最好的，但现代研究发现母乳更容易消化。很多因为胃反流问题改吃配方奶的孩子都难以忍受普通的配方奶，最后不得不吃非常昂贵的给予氨基酸的配方奶。瓶装奶流动太快，当孩子吃瓶装奶的时候，容易造成胃太满。你和你的宝贝需要几周的时间来确认一个喂奶的节律。有时候，你的奶可能会太多，超过他的胃。其他时候，他可能吐一点，需要再喂奶，以致你的乳房需要制造足够的奶水给孩子。总得来看，孩子吃到的奶量是足够的。有些母亲学会了用吸奶器把奶挤出来，储存多余的奶。当孩子需要的时候用勺子或者杯子再喂给她。

Reflux Rollercoaster
Babies with reflux may have good weeks and bad weeks. Your baby’s reflux may be worse when she is teething or has an illness such as a cold or ear infection. Some babies who take medicine may need a bit extra when the reflux flares up. Ask your doctor about adjusting the dose if you see this pattern. Reflux is often the worst at four to six months of age. As your baby’s digestive system matures, the top of her stomach will stay shut better. Often babies improve at six months when they learn to sit upright and start eating solid foods. There is often more improvement at nine months when they learn to stand up. Reflux usually improves a lot when your baby starts to walk and is upright most of the day. Only a few babies continue to have problems with reflux after age two.
胃食管反流“过山车”
有胃反流的宝宝有安适的时候，也有难过的时候。当孩子出牙或生病、感冒或耳朵发炎的时候可能情况会更坏。当胃反流加重的时候，孩子需要增加点药量。如果你看到了此状况，一定要咨询你的医生调整药量。4~6个月的孩子胃反流可能会更严重。随着消化系统的成熟，他胃部的顶端会更好的闭合。6个月大的孩子开始学习坐立，开始吃些固态食物，情况会好转。9个月的时候，当他们学会站立，情况就更好了。当孩子学习走路，大部分时间可以直立的时候，胃反流情况更加好转。只有很少的孩子在2岁后还有胃反流的情况。

Easy ingredients to avoid:
• Caffeine—even the small amounts in “decaf” coffee
• Alcohol—even in cold medicine
• Tobacco and nicotine
• Tomatoes in all forms
• Oranges, lemons, limes, grapefruit, strawberries, kiwi and other acidic (sour) fruits
• Broccoli, cabbage, cauliflower, peppers, onions, garlic, cucumber skins, beans and other veggies that tend to make people burp or have gas.
• Peppermint and spearmint.Wintergreen may be OK.
• Chocolate. White chocolate may be OK.
• Peppers and hot spices.Herbs may be OK.
• Fish
• Shellfish
• Nuts
避免食用：
咖啡因—即使是少量的脱咖啡因咖啡
酒精—即使在感冒药里
烟草和尼古丁
橙子，柠檬，酸橙，柚子，草莓，猕猴桃等酸性水果
西兰花，卷心菜，花菜，辣椒，洋葱，大蒜，黄瓜皮，豆类和其他易使人打嗝或胀气的蔬菜
薄荷和留兰香—-冬青是可以的
巧克力——–白巧克力是可以的
辣椒和辛辣的食物—–香料植物是可以的
鱼类
贝类
坚果类
These ingredients are harder to avoid and often hidden in common foods—even medicines and vitamins. If you decide to eliminate these foods, please work with a doctor or nutritionist to be sure you are getting a balanced diet.
• Milk
• Wheat
• Soy
• Corn
以下成分很难避免，因为他们通常存在于常见食物中甚至在药品和维生素里也有。如果你决定剔除这些食物，请与医生或者营养师沟通确保你的饮食均衡。
•牛奶
•小麦
•大豆
•玉米

References:
La Leche League International The Womanly Art of Breastfeeding, 8th edition, 2010, pages 163,
383-84, 416-17 or
The Ger Group, reflux.org
© October 2010, La Leche League International
No. 10342
This informational sheet may not be reproduced in any manner without written permission from La Leche League International.
For more information
llli.org