Reflux and GERD
In many countries worldwide reflux is over diagnosed. Unfortunately parents don’t really have an understanding of what real reflux is and so they medicate or operate before trying to fix the problem holistically.The majority of babies posset, and many of that majority spit up quite a considerable amount.
When does reflux become “gastrooesophageal reflux disease” (GERD – in the USA oesophageal = esophageal) where it needs to be treated with medication andsurgery?
Babies spit up because they have small stomachs and because they have a weak or under-developed gastro-oesophogeal sphincter. As long as baby is happy for themajority of the time, has plenty of wet and soiled diapers and is gaining weight, it is a completely standard expected thing.It becomes a medical problem when the ‘spit-up‘ contains stomach acids, baby doesn’t sleep, the baby is in pain and always inconsolable, arches back and neck (though most babies do this, we look for symptoms that are present for the majority of the time), spits up blood, breathing problems and the baby is not gaining weight at all.Babies who don’t vomit can also have reflux.When GERD is present without vomiting or spitting, it’s referred to as silent reflux. Symptoms would be as above.
As mentioned before, most of the time it is normal – but there are situations where one can make it worse:
- Formula feeding overfills the stomach and is not absorbed as easily as breast milk
- Babies lying on their backs for extended periods of time
- Swallowing air which causes distention
- Teething which causes baby to swallow saliva – its unnatural to have a large amount of saliva in the stomach, therefore baby will vomit it up to get rid of it
- Colds and a runny nose which causes baby to swallow mucous
- Food sensitivity to what mother eats which does follow through into breast milk
- Overabundant milk supply
- Rapid let-down causing baby to swallow lots of air. What can we do to assist in making this a little easier, before we go the medication or surgery route?
- Frequent nursing which ensures small amounts of milk consumed at a time.Science tells us that it takes 1.5 hours for a baby to digest breast milk. So keep your feeding as close to these times as possible to relieve the symptoms of reflux and/or GERD
- Ensure a good latch which minimizes air swallowing
- Skin to skin contact encourages frequent nursing and will calm your baby when it panics from possetting
- Upright nursing and posture for mom
- Baby can also sleep on its stomach during the day if it is going to be SUPERVISED the whole time, this will also soothe the stomach
- Put baby in a baby carrier or a sling butnot in a car chair which makes the problem worse because it compresses the digestive tract
- Encourage comfort suckling at the breast
- Eliminate tobacco and caffeine from your diet
- Consider mother to child allergies (cow’s milk, wheat etc.)
- DO NOT THICKEN FEEDS! Baby is not ready for solids anytime before six months. This is not as harmless as it seems and studies are showing that doing this is causing lung complications in some children. It works in a sense that there is less spitting up, but the baby still has internal reflux (silent reflux)… this will increase the chance of perforating the esophagus and the pain is terrible for baby. If your child is truly diagnosed with GERD (in many countries, doctors will just call it reflux – but it needs to be medicated when it is TRUE GERD) there are ways to treat it, there are the following options:
- Antacids (Telement Drops)
- H2 Blockers and PPI (Zantac and Losec)
- Prokinetics (Maxallon)
Cytoprotective Agents (Alsanice andGaviscon)Surgery is the last possible step – they will perform a procedure called “Floppy Nissen Fundoplication”. In some hospitals they are now doing this via laparoscopy but this does not reduce the risk that your child will need to go under general anaesthetic and it is major surgery. Please get a second opinion before surgery is considered.There is no cure for true GERD, though manychildren grow out of reflux. Medication and surgery only serve to hopefully ease the pain and symptoms.In conclusion, is spitting up bad? No, God created babies this way. The majority of the time, it’s just a laundry problem!
Melissa Jacobs is a Certified Birth and Post-Natal Doula (South Africa).