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:
http://www.zerotothree.org/child-development/health-nutrition/29-3_pulsiferanderson.pdf
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.
Showing posts with label baby reflux. Show all posts
Showing posts with label baby reflux. Show all posts
Saturday, June 26, 2010
Friday, December 4, 2009
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!"
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!"
Subscribe to:
Posts (Atom)
Posts
