Reflux 101
Gastroesophageal Reflux Disease (GERD) in infants

SYMPTOMS:
Baby may have all or some combination of the following:

- pain, irritability, constant or sudden crying, "colic"
- frequent spitting-up or vomiting (large amounts or small amounts - or "silent reflux," where baby does not spit up at all)
- vomiting or spitting-up more than one hour after eating
- not outgrowing the spitting-up stage
- poor sleep habits, frequent waking
- pain while lying flat
- "wet burp" or "wet hiccup" sounds
- recurrent or persistent hiccoughs
- chronic dry cough
- gassiness: from gulping air while crying and eating too voraciously
- apnea - voluntarily holding breath while eating or sleeping, air then comes rushing in with an audible wheeze (and if eating, choking and gagging following apnea)
- constant eating and drinking (swallowing temporarily relieves the pain)
refusing to feed, arching back, crying on breast or bottle even though hungry
- poor weight gain; weight loss; failure to thrive in extreme cases
swallowing problems, gagging, choking
- hoarse voice
- frequent red, sore throat
- ear infections
- constantly running nose; sinus infections
- bad breath, tooth enamel erosion
- excessive salvation, drooling
- peculiar neck arching, Sandifer's Syndrome
- respiratory problems; pneumonia, bronchitis, wheezing, asthma, nighttime cough, apnea, aspiration, noisy or labored breathing (extreme cases)
- eating disorders (extreme cases) - baby forgets how to eat and needs to be re-taught



WHAT IS IT?
When stomach acid flows into the esophagus it can cause a burning sensation called "heartburn." If the acid causes reddening and swelling of the esophagus, this is called esophagitis. Esophagitis can be quite painful and can reduce the desire to eat. Severe esophagitis can lead to bleeding from the inflamed portion of the esophagus. Scar tissue can also form inside the lower esophagus if swelling has been present for a long time. When the scar tissue forms it reduces the size of the esophageal opening and makes swallowing difficult. This type of scar is called a stricture.

WHAT CAUSES IT?
The most common cause of reflux is an improperly functioning ring of muscle called the lower esophageal sphincter (LES) where the stomach and esophagus join. The LES normally opens to allow swallowing, belching and vomiting and then closes immediately. If this sphincter stays relaxed, or relaxes periodically, the food and stomach acid can escape back into the esophagus.

WHAT HELPS?
Positioning. Theoretically, a reflux baby is most comfortable lying on the tummy at a 30-degree angle, a position in which the stomach falls forward. Though not all babies take to this position. Elevated 30 - 45 degrees, not a high as 60 degrees, on the back is also helpful. Sleeping in a car seat, if comfortable. Swing also helpful at times, though sometimes babies slump in swings, causing more pain. Any position where the torso is straight and not slumped or in a C-shape is desirable. Avoid the slumped position. To burp a reflux baby, try sitting the baby up, if he or she can hold himself/herself upright well, or try standing up or moving forward on the chair, and hold baby tummy to tummy, chest to chest, so that the torso is straight up and down. Do not burp baby curled over your shoulder. This position pushes the stomach up into the esophagus, causing pain. Elevate the crib mattress - use foam positioning wedges and rolled up blankets to prevent angling to the side, and a longer, sling-type blanket under baby's knees and tucked into the sides of the mattress to prevent sliding down. Or you can buy special sheets with pockets to help with this, see PAGER Home. Elevate the changing table and keep baby elevated while playing. Onestepahead.com sells a foam crib wedge that is good for floor play and changing tables (for sleeping, it's best to elevate the entire mattress).

For premies or babies with severe reflux, a positioning cushion with straps called a TravelBud may be helpful (used often in hospitals for premies/reflux babies/special needs babies). See: Travelbud Infant Support System for Infants and Toddlers, Premature Infants and Infants with Special Needs They can custom fit the TravelBud for your baby. Can be used for car seats, swings, changing tables, on the floor, etc to keep baby in the most helpful position.

Changing formula, if baby is bottle-fed. Eliminating dairy and other allergens from mother's diet if breastfeeding (common allergens: dairy, tomatoes, sugar, yeast, wheat, nuts, soy)

Adding cereal to bottles for feeding, or purchasing formula thickened with rice starch. This may help keep formula or breastmilk down.

Feed a reflux baby smaller amounts more often. Hunger causes discomfort and eating larger amounts causes greater amounts of spitup.

Frequent burping, every 1-2 ounces or every few minutes, at least.

Elevate the baby for at least 20 minutes after feeding, preferably longer. Keep baby elevated or upright as much as possible.

Infant massage.

Using a pacifier.

Medications. Most popular: Zantac - at maximum dosage, inhibits 80% of stomach acid production. Side effects: minimal, including headache when first used. Liver damage, but is reversible and usually affects those with unhealthy lifestyles (and I doubt your baby smokes or eats greasy food!) Takes at least a week for full effectiveness, stops working over time for some babies. Stronger medications like Prilosec can inhibit 100% of stomach acid production. Antacids like Mylanta may be prescribed to neutralize stomach acid. For babies who are not gaining weight due to large amounts of spitup, a medication like Reglan may be prescribed. Reglan helps the stomach empty its contents faster. Use with caution, there cane, in rare cases, be some serious side effects, and it should only be used for a limited time with infants.

Surgery.

TO CUDDLE A REFLUX BABY:
Lie back at about a 30- to 45-degree angle, and have baby lie on his/her tummy on your chest. Have baby lie with the upper half of the body face down on your lap - at about a 30-degree angle. Have the baby lie in an elevated position, lie beside him or her and cuddle. Carry upright, tummy to tummy.

WHEN DOES REFLUX END?
Very generally speaking, reflux is often significantly better by 6 months, nearly gone by 12 months, and usually disappears altogether by 18 months. Though of course there are exceptions

Good reflux links:

http://www.people.virginia.edu/~smb4...reflux/ger.htm
PAGER Home

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