Identifying Problematic Reflux Symptoms in Infants

I have written before about my now 17 month old son's case of infant reflux. It was not a fun experience. But it is behind us for now. He has officially been off of all medications for four months...yeah! We can no longer call him "Milk shake", but we have plenty of other nick names we call him!

What is reflux? Well, all babies spit up somewhat and when stomach contents come back up, it is called reflux. It is only a problem if it happens excessively which can erode the lining of the esophagus as well as hindering weight gain or creating quite a fussy baby.

I am writing about reflux again, because I want to discuss symptoms of infant reflux that often go unnoticed. So often the clients I work with have feeding problems that are made worse by their reflux. Many of the obvious signs are excessive spitting up, poor weight gain, and one of two feeding patterns, either being a "grazer" or a "guzzler". For some reason kids who don't excessively spit up, but just have wet burps, seem to not come under the radar. They may have other symptoms such as arching, pulling back from the nipple, chronic congestion and cough, gas, and constipation, but because they don't have massive spitting up episodes, the reflux goes unnoticed. Often, you can see a baby swallow the stomach contents that have been refluxed up, but they just didn't spit it out. This causes pain in the throat. Too bad some of these babies are not on an anti-acid such as Prevacid (R) or Zantac. They typically become happier babies once placed on such medications, and even sleep a lot better too.

Another common problem, which was a problem with my son, is motility. This is the rate at which the stomach empties and the contents move through the intestines. My son would spit up massively 2 hours after a feeding. It was such a problem before he was put on an additional medication for motility, that he had to sleep in a bouncer seat for a few months. Even when I inclined the mattress in his bassinett or crib, he would cough and choke on his spit up. He would get a hoarse voice, cry, arch his back, and become fussy. Yet when he was placed upright, he didn't have these symptoms and he went back to being happy and calm. I was told to keep him upright for 30 minutes after a feeding, but that was not long enough for him! Another symptom of the motility problem was massive gas. Somehow my son would pass gas and we would all look at each other in amazement that a baby had tooted so loud...the gas was as loud as a fraternity boy after eating pizza and drinking beer all weekend! Because of the gas and excess air, he wouldn't take but 4 oz. at a time even at 7 months of age, because his stomach was already feeling full. Finally, once he became more mobile by crawling, cruising, and walking, he took 6-8 oz. during one feeding. Needless to say, he was gaining weight but at a slower rate than expected. Now, this may be okay for my son because other than multiple food allergies, he has no other medical problems. But what about the kids I work with that have heart problems and other medical diagnoses. So often, these kids can't afford to not be gaining more weight.

Often these babies are labeled with colic and not given medicine. The parents just live with a fussy baby in hopes that the child will grow out of it around 12 weeks of age. Now, that may be the case, but maybe not. If it is reflux, not colic, once again they may grow out of it, but may not. A baby who doesn't calm when being held may have more than just colic. The pain could be gas, reflux, ear infections, etc. Try massaging the belly in a clockwise direction and also strokes that start at the bottom of the sternum and end at the naval; this way if it was gas, you are massaging it out.

Another thing to note is that changing formula usually does not make a difference. It may make a difference for a baby who also has a food intolerance to soy or dairy. Also, using these bottles that reduce gas only make a minimal difference. They help because then the baby takes in less air...unless he/she is a massive guzzler, then it really doesn't matter which bottle or nipple is used.

One other clue that a baby has a reflux problem is anti-histamines or other similar medications don't decrease the congestion, and in fact they may make it worse. That's because the wet burps are contributing to the congestion, not an allergic response to allergens or because the baby has a cold or other virus. The wet burps, leave acid behind on the throat which makes the body create more mucus leading to a nasal drip. This in turn leads to a hoarse voice, which can become even worse when the baby wakes up screaming in the middle of the night because of the pain.

Sometimes introducing baby food helps, but not always. My son spit up the baby food, which meant either me or the furniture was going to be wearing the food he ate within the next half hour of him eating it...yuck! But I do know that adding baby cereal or food helps with some babies reflux symptoms because it adds to the weight of the contents and may lessen the acidity.

These babies should spit up less when in side lying or in tummy time than when lying on the back, due to the position of the stomach. However, having said that, some babies with reflux spit up in any position other than upright. I do believe that not every baby needs medicine, but if every other trick in the book has worked, then why not try it!

I'll end by saying I was always jealous of those ladies who would laugh at a baby shower as the pregnant person opened a package of burp cloths as a gift. These ladies would say something like "You don't need that. In fact, my babies never spit up, I never used burp cloths at all."...of course, I'm thinking "If your baby is anything like mine, you'll need ten more packages of burp cloths!"