When does reflux become “gastro-oesophageal reflux disease” (GERD – in the states oesophageal is spelt esophageal) where it needs to be treated with medication and surgery?
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 the majority of the time, has plenty of wet and soiled nappies and is gaining weight it is a completely normal natural 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 (most babies do this – remember we are looking for symptoms that are around 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
- Babies lying on their backs
- Swallowing air (causes distention)
- Teething (baby swallows saliva – its unnatural to have a HUGE amount of saliva in the stomach, therefore baby will vomit it up to get rid of it)
- Colds and a runny nose (baby swallows mucous – same as above)
- Food sensitivity to what mother eats which does follow through into breastmilk
- Overabundant milk supply
- Rapid let-down (baby swallows 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 (small amounts of milk consumed at a time)*
- Ensure a good latch (which minimizes air swallowing)
- Skin to skin contact (this 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 sooth the stomach
- Put baby in a baby carrier or a sling but not in a car chair – this 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 (cows milk, wheat etc.)
- DO NOT THICKEN FEEDS! Baby is not ready for solids anytime before 6 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 reflux on the inside (silent reflux)… this will increase the chance of perforating the oesophagus and the pain is terrible for baby.
If your child is truly diagnosed with GERD (in SA, 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 & PPI (Zantac & Losec)
- Prokinetics (Maxallon)
- Cytoprotective Agents (Alsanice & Gaviscon)
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 your child is operated on.
There is no cure for GERD. 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!
* science tells us that it takes 1.5 hours for a baby to digest breastmilk. So keep your feeding as close to these times as possible to relieve the symptoms of reflux and/or GERD
No comments:
Post a Comment