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 Posted: Fri Aug 31, 2007 10:41 pm Post subject: JULY FEATURE ARTICLE |
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Gastro-Oesophageal Reflux in infants
Quite a lot of babies these days are diagnosed as having Gastro-Oesophageal Reflux or just “reflux” as it its commonly known. It is defined as the spontaneous passage of part of all of the stomach contents (comprising food and stomach acid) into the oesophagus. The term reflux covers such a broad range of severity and the symptoms can vary so greatly. The child can experience anything from “silent reflux” (no vomiting at all, just regurgitation into the throat, this can be quite painful and can sometimes cause choking) to projectile vomiting of whole feeds (besides being very messy, this can lead to dehydration and failure to get vital nutrition). From experience I know that reflux can be quite overwhelming for a new parent and distressing for even the more experienced parent.
Reflux is caused when the sphincter (valve) doesn’t shut properly to keep the food from returning up the oesophagus. The oesphagus passes through the diaphragm (the muscle that separates the chest cavity from the abdominal cavity) and the diaphragm muscles act as a valve, sometimes though it isn't as strong as it should be and this causes reflux.
Most babies “grow out” of reflux once their digestive system matures, the diaphragm isn't fully developed when they are young but can gradually get stronger with time. All babies with reflux will require some assistance to help with their symptoms (I will discuss this more fully below) and some may also need additional help with medication. Occasionally though a child does not “grow out” of the problem or may suffer from complications and may require surgery.
It is also important to note that not all vomiting or irritability is necessarily caused by reflux, it is important to seek the advice of a medical professional for a proper diagnosis to be sure.
Common Symptoms of Reflux
Some of these (not necessarily all) can be signs that your baby has reflux (both silent and common/vomiting):
* Excessive (often inconsolable) crying especially after feeds
* Snack feeding (the baby feels that continual sucking relieves the pain)
* Frequent vomiting or projectile vomiting (common reflux)
* Irritability and poor sleeping patterns
* Back arching, grimacing and signs of pain
* Hoarseness when crying
* Bad or acid breath
* Frequent (often vigorous) sucking of dummy, hands or fists
* Gulping, coughing and swallowing, usually with pain signs
* Frequent hiccups (from excessive air being gulped) and sometimes flatulence as well
* Gagging, choking and excessive drooling
* Fussy feeding or the other way around, some babies aren’t happy unless they are feeding
* Congestion or appearing to have a cold
* Try not to let your baby get overtired, this usually makes reflux tougher to deal with.
Further notes in relation to the symptoms listed above:
* I am cautious to put lack of weight gain as babies with “silent” reflux tend to feed more if anything so this isn't applicable for them. Those that frequently vomit and/or projectile vomit do tend to have weight issues though.
* Usually the signs worsen on laying the baby down.
* There are other symptoms that may occur such as clinginess and food aversion etc, as these are vague and could be caused by so many ailments, I have left them off the list.
* I also wanted to point out that silent reflux isn’t less severe than common reflux, it just causes different issues. It can actually be more damaging as the food contents stay in the oesophagus longer and often takes longer to diagnose, as the symptoms aren't quite as obvious.
Management of a Reflux baby
There are some things you can do to help alleviate the symptoms for your baby, most if not all of the items listed below will assist your baby to be comfortable. Every baby is different, what works for one may not work for another, it’s very much a matter of experimentation to see what will work for you. These tips are based on my experience and advice I was given, they are not meant as a replacement for medical advice:
* Keep your baby upright for at least 20-30mins after feeds, this gives the baby a chance to digest their food at least in part before you lie them down.
* Rockers and slings etc are fabulous for enabling you to be “hands free” whilst still keeping baby upright. Once my little one was older I found that he loved his Jolly Jumper as it allowed him to be upright on his own (on bad days the “jumping” wasn’t such a good idea, but on good days it helped a great deal).
* Feeding upright or even just keeping their head higher than their body, although some babies don’t feed well this way and unless the problem is extremely severe, babies are usually fine whilst they are sucking.
* Using a “reflux wedge” on the change table during change times.
* Changing your baby before a feed rather than after.
* Using a “reflux wedge” (my husband made a wooden “ramp”) under the mattress in babies cot works well, this did cause a problem once our child could stand though as the sides of the cot were too low, so then we used the next method.
* Putting something under the legs at the head of the bed (my husband made a stand that the legs could sit on securely), to angle the whole bed.
* Using either Thickener in expressed breast milk or using an “AR” (anti reflux) thickened formula can also help (you will need a teat with a faster flow when using AR or thickener).
* Try not to overfeed the baby. Its tempting once they throw up to feed them again, this is not always wise, sometimes a doctor might recommend smaller feeds more often. Please check with your medical professional for advise on this issue.
* A dummy can be a great help, the continual sucking helps baby to keep everything down.
* Depending on the baby, frequent burping during feeds can help.
* This may seem obvious, but avoiding vigorous movement with your baby after a feed. The same for tummy time, it’s best left until the stomach is empty.
* Once the baby starts solids it can improve the symptoms a little (seek medical advice if starting solids before six months)
Conclusion
Reflux babies are highly dependent little individuals, it can be quite a frustrating road to be on, advice can be so conflicting at times, use what works for your baby and don’t feel guilty about ignoring advice that doesn’t, they are all so very different. I know at times it can be difficult but please know that you are not alone. It can be quite upsetting when things don’t seem to be going “right”, you aren't doing anything wrong ((hugs)). Most importantly please take care of yourself, its so common for the parents to put so much focus on their baby and forget themselves, if you aren’t coping well seek medical advice and the advice of other parents who are going through or have gone through what you are experiencing, this can be invaluable. Sometimes putting your baby in their pram and going for a walk helps you both to “get some fresh air” and calm down a bit, the distraction can help you both. I found that talking helped a great deal, even calling a friend and connecting with the outside world made life more bearable. Every day is a new day, what works one day wont necessarily work the next, don’t feel that you are doing something wrong, just realise that babies can have good and bad days. I wish you all the very best on this journey, it’s a difficult one I know, sometimes it doesn’t feel like it but there is light at the end of the tunnel.
Article written and compiled by Kara.
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Kind regards,
The Management
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