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 infant reflux. Show all posts
Showing posts with label infant reflux. Show all posts
Saturday, June 26, 2010
Monday, February 8, 2010
Helping Babies With Reflux
I spend a lot of time at work helping premature or developmentally disabled infants with feeding problems. I have also become a resource for many of my friends with babies who either are known to have reflux or are having feeding or weight gaining issues. One website I have found helpful is:
http://www.coliccalm.com/baby_infant_newborn_articles/acid-reflux.htm
I also like the book Colic Solved by B. Vartabedian, M.D., a pediatric GI doctor who talks about reflux and "colic"
My son had reflux problems even after he was one years of age. Many kids improve with spitting up once they have started solid foods, but some do not. I have previously blogged on how my son had problems gaining weight and was somewhat fussy due to the spitting up episodes; we called him "Milkshake"! Thank goodness for the medicines, positioning, burp cloths, and time!
Remember that a baby doesn't have to necessarily spit up massive amounts to be diagnosed with reflux (GERD). Wet burps, hiccups, congestion, tummy aches/gas, and fussiness can be symptoms too. Overall my son was a "Happy Spitter", but sometimes the acids of the spit-up really hurt his throat and he became fussy. Thank goodness for Prevacid (R)! The Zantac (R) was helpful earlier on, but then not so much later on. But every baby is different. He also took a medicine for motility to speed up the digestion process; this may be needed if the baby is spitting up even 2 hours after a bottle/ breastfeeding.
A big pet peave of mine is when parents don't continue to give their baby the prescribed reflux meds! Maybe they do this because the baby is gaining weight or they didn't think it was helping, or maybe the baby spits up less. But "Hey" maybe the child got better because he had been taking the medicine! But any wet burp is going to irritate the throat, that is why so many of these kids guzzle down a bottle or pull away and don't want to drink. It is also the reason they don't sit up well because they are arching back in pain. Remember to discuss discontinuation of meds with the doctor! Maybe something else could work better or a different dose or giving it at a different time of day. The doctor probably has plenty of swell ideas, but he/she needs to know!
Now I am stepping off of my soapbox and thankful that we haven't needed any burp cloths in my house for the autumn and winter months...yeah! I am passing them along to a dear friend of mine who has a young infant who spits up often! Remember: Spit Happens
http://www.coliccalm.com/baby_infant_newborn_articles/acid-reflux.htm
I also like the book Colic Solved by B. Vartabedian, M.D., a pediatric GI doctor who talks about reflux and "colic"
My son had reflux problems even after he was one years of age. Many kids improve with spitting up once they have started solid foods, but some do not. I have previously blogged on how my son had problems gaining weight and was somewhat fussy due to the spitting up episodes; we called him "Milkshake"! Thank goodness for the medicines, positioning, burp cloths, and time!
Remember that a baby doesn't have to necessarily spit up massive amounts to be diagnosed with reflux (GERD). Wet burps, hiccups, congestion, tummy aches/gas, and fussiness can be symptoms too. Overall my son was a "Happy Spitter", but sometimes the acids of the spit-up really hurt his throat and he became fussy. Thank goodness for Prevacid (R)! The Zantac (R) was helpful earlier on, but then not so much later on. But every baby is different. He also took a medicine for motility to speed up the digestion process; this may be needed if the baby is spitting up even 2 hours after a bottle/ breastfeeding.
A big pet peave of mine is when parents don't continue to give their baby the prescribed reflux meds! Maybe they do this because the baby is gaining weight or they didn't think it was helping, or maybe the baby spits up less. But "Hey" maybe the child got better because he had been taking the medicine! But any wet burp is going to irritate the throat, that is why so many of these kids guzzle down a bottle or pull away and don't want to drink. It is also the reason they don't sit up well because they are arching back in pain. Remember to discuss discontinuation of meds with the doctor! Maybe something else could work better or a different dose or giving it at a different time of day. The doctor probably has plenty of swell ideas, but he/she needs to know!
Now I am stepping off of my soapbox and thankful that we haven't needed any burp cloths in my house for the autumn and winter months...yeah! I am passing them along to a dear friend of mine who has a young infant who spits up often! Remember: Spit Happens
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!"
Wednesday, August 5, 2009
Tips for Helping Babies with Plagiocephaly: Mis-Shapen or Flat Head
One thing I see alot of at work is babies who have a flat head in the back of their head or on one of the sides of their head. If it is severe enough it is called plagiocephaly. Some babies need helmets, others just need exercises and positional ideas given to the parents and caregivers. If the head is just mildly flat in the back, this often improves as the baby spends more time lying on his tummy for playtime and less time sleeping on his back. It may also improve when the baby is encouraged to look each way equally and not just tilt or turn his head to one side.
My son had a flat spot in the back of his head for the first few months of his life. And even though I laid him down on the floor to play on his tummy, he still had a flat head. It eventually worked itself out, but it is not as round as mine. My husband has a mildly flat head in the back so maybe it is hereditary that both of my children have this same head shape as their dad. But I somewhat blame his case of infant reflux. His reflux was so severe that he went from the 75th percentile for weight at one month of age down to the 25th percentile by 3 months of age. He was on 2 reflux medicines by 4 months of age. But prior to this, he had to be left upright beyond the suggested 15-20 minutes after being fed. Sometimes he would vomit up massive amounts of liquid even 1 hour later...later found out he also has a motility problem. He would choke in his sleep even when placed on a mattress that was inclined at bedtime and naptime. So, I put him in this soothing glider that is at the same angle as a bouncy seat but snuggles the baby in it with more curviness for the head. I hate that he had so much pressure on his head, but I could never have fallen asleep wondering if my son was going to aspirate on his spit up, and possibly lose conciousness, turn blue, or worse, die. Unfortunately, I have seen too many bad situations at work when a baby has severe infant reflux. So, the flat head is the price we had to pay.
Some tips on helping with the head shape for a baby with plagiocephaly, flat head, or just mis-shapen:
My son had a flat spot in the back of his head for the first few months of his life. And even though I laid him down on the floor to play on his tummy, he still had a flat head. It eventually worked itself out, but it is not as round as mine. My husband has a mildly flat head in the back so maybe it is hereditary that both of my children have this same head shape as their dad. But I somewhat blame his case of infant reflux. His reflux was so severe that he went from the 75th percentile for weight at one month of age down to the 25th percentile by 3 months of age. He was on 2 reflux medicines by 4 months of age. But prior to this, he had to be left upright beyond the suggested 15-20 minutes after being fed. Sometimes he would vomit up massive amounts of liquid even 1 hour later...later found out he also has a motility problem. He would choke in his sleep even when placed on a mattress that was inclined at bedtime and naptime. So, I put him in this soothing glider that is at the same angle as a bouncy seat but snuggles the baby in it with more curviness for the head. I hate that he had so much pressure on his head, but I could never have fallen asleep wondering if my son was going to aspirate on his spit up, and possibly lose conciousness, turn blue, or worse, die. Unfortunately, I have seen too many bad situations at work when a baby has severe infant reflux. So, the flat head is the price we had to pay.
Some tips on helping with the head shape for a baby with plagiocephaly, flat head, or just mis-shapen:
- Let the baby play on the floor on his tummy multiple times a day for at least 5 minute increments. If he dislikes this position, then get down to talk or play with him as well as leave toys nearby.
- If his head is flatter on one side of the head than the other, then all throughout the day, do things with him that require him to look to each side. Examples include switching the end that his head is on in the crib or diaper changing table, alternate which hip or shoulder he is being carried over, move the bouncie seat or infant swing to different places in the room so he has to look different directions.
- Introduce infant massage to relax the muscles. Often when the child is favoring one side of his body over the other side, then he gets tightness in the neck or shoulder muscles. Infant massage also helps with improving the sensation to the side of the body that is less favored.
- Have your doctor assess the baby's muscle tone. If the baby has low muscle tone (AKA hypotonia), he may need a physical or occupational therapy evaluation. The low muscle tone may impact his gross motor skills such as rolling and crawling, his feeding skills, and his fine motor skills to reach and grasp for toys. Some babies may also have muscle weakness, torticollis (tight sternocleidomastoid muscle- (SCM)), neurological impairments, or otherwise tight muscles. If this is the case, then therapy may help with preventing bad movement patterns and hopefully lessen developmental delays, but seeing a specialist such as a neurologist may be a good thing in order to know the reason why this is happening.
- Do not leave the baby in positional devices that do not properly fit him and do not leave him in there for long. Many babies I work with that have leg tightness or weakness on one side are left in stand-up bouncers, swings, car seats, & bouncie seats WAY too long. They should only be in the briefly unless there is a reason such as a car ride, sleep, etc. I can definately tell you that 30 minutes for a 6 month old baby to stand up in a "Jumparoo" or "Johnny Jump Up" doorway bouncer is WAY too long, especially when he is not even angled in it correctly.
- Offer toys to each side of the baby such as in the high-chair, car seat, on your lap as he is sitting upright, or lying on the floor.
- Encourage the baby to ly on his side on both sides and to roll to each side (at an appropriate age)
- Give the reflux medicines as prescribed to you by the doctor. Remember that just because your baby needs to stay upright doesn't mean he stays in a device, you can hold him upright for the 15-20 minutes post-feeding.
- If improvements are not seen, please discuss this with your pediatrician as your baby may need a helmet to help with the head shape.
Hopefully, once your baby is sleeping less, playing more, and even crawling, the head shape will improve.
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