Saturday, June 26, 2010

Reflux (GERD) in Babies & Young Children

I've blogged more than once on my personal experience of having a baby with severe reflux. But when I saw this article I just knew I had to post it and review my story once again:

My now 24-month old son took two reflux medications up until the age of 14 months. But lets rewind all the way back to the beginning. Starting at about one week of age he started spitting up a lot and when I laid him down in his bassinett he would cough on the spit up...quite scary, because I was afraid he would aspirate and die! So, I elevated the bassinett, added a wedge, and that still didn't work. The only way he could sleep without "choking on his spit up" was to lay on my chest as I was in the reclining chair or in a reclined bouncy seat. So starting around 3 weeks of life he started Zantac, an antacid. That medicine made him less grouchy, but he still refluxed up massive amounts of breast milk (he never had formula). In fact, we nick-named him Milkshake! Then, the pediatrician switched him to Prevacid, a proton-pump inhibitor, and my son did better with that medicine but still spit up alot, but at least he was a happy spitter. If it weren't for his sudden decrease in weight gain at that point we wouldn't have been worried. I pumped breast milk and was making plenty, so that wasn't the problem. Since his sister had food allergies and his bottom was red alot, I took him to see the allergy doctor hoping to get some answers. The doctor said he had to wait until my son was 6 months old to do formal food allergy testing, but until then I was to not eat the common culprits of eggs, dairy, and nuts. Guess what, my son spit up WAY less after I quit eating those foods! By the way, his food allergies were way more than those three and still are, but those were the biggies. Yet one other problem still remained, he would spit up even two hours after a feeding; so that suggestion of elevating/positioning the baby for 30 minutes after a feeding didn't work for us. The pediatrician then put my son on erythromycin, an antibiotic, as a prokinetic to speed up the motility of the stomach emptying into the intestines. He gave me the choice of Reglan or Erythromycin and I chose the later because of so many of my patients having lots of side effects on Reglan. Well, this medicine made all of the difference in the world. He started gaining weight and spitting up less, but still did spit up some. At this point, we were only using 2 burp cloths a day, whereas in the beginning we would go through no less than 5 or 6 a day! But soon after we introduced baby cereal and pureed food. I was hoping this would help him spit up less, but it didn't, and in fact, he spit up more. It wasn't until after my son was walking that we could go days without the medicine and him be okay. I think between gut maturity, age, and muscle strength of the abdomen he finally got better. Having said all of that, I do believe that for many babies, one medicine or positioning helps. For others they get better when cereal or purees are introduced. I'm sure much of my son's problems were the food allergies. Not too many of my patients have as bad of a case of GERD as my son, and thank goodness! Poor child couldn't sleep flat until 5 months of age! Every time I tried, he coughed, gagged, spit up, cried, and couldn't fall asleep. So glad that his head shape didn't suffer too much from sleeping for so many months in positioning devices! I contribute that to all of the sidely, tummy time, and upright sitting he did during his waking hours! Although I like this article I linked to at the top, I also like the book "Colic Solved" by Bryan Vartabedian, MD, because it explains things in simple language yet it is thorough and an easy read.

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