The Truth About Reflux
Why are so many babies being diagnosed with GER?
by Kate Tuttle
September 25, 2009
"After months of smelling like curdled milk, I knew something had to be done," says Jane, a Midwestern mother of two sons. Her first had nursed and gained well, a fat, happy baby. But her second, also breastfed, never seemed to gain weight and spit up after every feeding. To cope with the baby's constant spitting up, Jane and her husband tried the solutions most parents do: "He used to sleep in his car seat by the bed so he could keep his food down. I tried simethicone, but that didn't work."
So what did? Time. "He eventually grew out of it at about six to eight months," Jane says, "but he still seems to have a somewhat sensitive stomach."
Her story is a familiar one. Gastro-esophageal reflux, or GER, is among the most commonly diagnosed health problems in babies, and the condition has spawned a growing industry in products and medications intended to cure or at least alleviate the symptoms. Faced with babies who spit up seemingly constantly, parents are moved to buy hammock sleepers, positioning wedges, and a medicine cabinet full of drugs, from gas-absorbers like simethicone to proton pump inhibitors like prevacid. But do they work? And is GER a real problem for most babies who receive the diagnosis, or a relabeling of a physiologically normal process that children outgrow with no ill effects?
Dr. Alice Newton, a pediatrician at a suburban practice outside Boston, sees a lot of babies with reflux. "I would say at least 40% of babies have reflux to some extent, but not all of those babies have symptoms so severe they need to be treated," she says. "Some babies spit up a little bit, feed just fine, aren't irritable, and don't have the symptoms or the medical problems that we treat, which are esophagitis or gastritis."
For those five to ten percent of babies who have more severe problems, Dr. Newton says, "the medicines that we have at our disposal often work well enough that many infants never need to be referred to a GI specialist." What makes the difference between the kind of baby referred to as a "happy spitter" and one whose parents seek medical attention? "What we look for is a baby who seems more irritable, often the grandparents might say the baby has colic. Sometimes they spit up even hours after they're feeding. They seem hungry but when they start feeding they seem uncomfortable, so they take a break because it hurts to swallow."
The holy grail, for parents whose babies are not happy spitters but irritable criers, is a day or night without inconsolable wailing.
The problem, she says, is anatomical: "What we know about most babies is that the muscle which is called the esophageal sphincter between the esophagus and the stomach is kind of loose, and so in many babies there seems to be a little bit of regurgitation. In babies with reflux it's more pronounced and they get burning and erosion of the mucous membranes of the esophagus and the stomach."
The prescription, for most babies, is some kind of medication — among the most common are Zantac and Prevacid. And for many parents, a mad dash to the stores, both online and in town, that sell an array of pillows, wedges and other positioners intended to keep babies more or less upright after a feed, and more or less elevated during sleep. The holy grail, for parents whose babies are not happy spitters but irritable criers, is a day or night without inconsolable wailing.
Although reflux is itself a relatively new concern for parents, the crying that may associate with it is not. As Dr. Newton points out, many grandparents will diagnose a hollering, miserable baby with another, older malady: colic. Defined as crying that lasts three hours a day, three days a week, for three weeks, colic is among the oldest medical problems ever described, and one of the most significant stressors a new family can face.
The relationship between reflux and colic is a fairly controversial topic among doctors, it turns out. "Many people do feel, if they have colicky babies, that it's something related to the baby's digestive system," says Dr. Newton. "It's so simple to treat reflux generally, and it saves the parents, you know, three months of a very difficult time with their infant."
On the other hand, if you ask Dr. Colin Rudolph, pediatric gastroenteroloigst, author of Rudolph's Pediatrics and a professor of pediatrics at the Medical College of Wisconsin, he'll present a different point of view. "There's no relationship between colic and reflux," he tells me, adding that recent data "demonstrates that infant irritability does not generally get better by treatment of reflux, even though it's a common indication for reflux treatment. If you read most of its what's out there, that's a radical concept."
©2009 Kate Tuttle and Babble
About the Author
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Kate Tuttle is a writer and editor raising two children just outside Boston. |
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