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 isnormal – but there are situations where onecan make it worse:
* Formula feeding overfills the stomach andis not absorbed as easily as breast milk
* Babies lying on their backs for extendedperiods of time
* Swallowing air which causes distention
* Teething which causes baby to swallowsaliva – its unnatural to have a large amountof saliva in the stomach, therefore baby willvomit it up to get rid of it
* Colds and a runny nose which causes babyto swallow mucous
* Food sensitivity to what mother eatswhich does follow through into breastmilk
* Overabundant milk supply
* Rapid let-down causing baby to swallowlots of airWhat can we do to assist in making this alittle easier, before we go the medicationor surgery route?
* Frequent nursing which ensures smallamounts of milk consumed at a time.Science tells us that it takes 1.5 hours for ababy to digest breast milk. So keep yourfeeding as close to these times as possibleto relieve the symptoms of reflux and/orGERD
* Ensure a good latch which minimizes airswallowing
* Skin to skin contact encourages frequentnursing and will calm your baby when itpanics from possetting
* Upright nursing and posture for mom
* Baby can also sleep on its stomach duringthe day if it is going to be SUPERVISED thewhole time, this will also soothe thestomach
* Put baby in a baby carrier or a sling butnot in a car chair which makes the problemworse because it compresses the digestivetract
* Encourage comfort suckling at the breast
* Eliminate tobacco and caffeine from yourdiet
* Consider mother to child allergies (cow’smilk, wheat etc.)
* DO NOT THICKEN FEEDS! Baby is not readyfor solids anytime before six months.
This isnot as harmless as it seems and studies areshowing that doing this is causing lungcomplications in some children. It works ina sense that there is less spitting up, butthe baby still has internal reflux (silentreflux)… this will increase the chance ofperforating the oesophagus and the pain isterrible for babyIf your child is truly diagnosed with GERD(in many countries, doctors will just callit reflux – but it needs to be medicatedwhen it is TRUE GERD) there are ways totreat 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 willperform a procedure called “Floppy NissenFundoplication”. In some hospitals they arenow doing this via laparoscopy but thisdoes not reduce the risk that your child willneed to go under general anaesthetic and itis major surgery. Please get a secondopinion before surgery is considered.There is no cure for true GERD, though manychildren grow out of reflux. Medication andsurgery only serve to hopefully ease thepain and symptoms.In conclusion, is spitting up bad? No, Godcreated babies this way. The majority of thetime, it’s just a laundry problem!
Melissa Jacobs is a Certified Birth and Post-Natal Doula(South Africa).