GER: What it is, What to do, FAQ’s
GER: A Hidden Cause of Colic
GER: How Breastfeeding Helps
GER Resources
GER: A Hidden Medical Cause of Nightwaking

Once upon a time a fussy baby was labeled with "colic," which is really a five-letter word for "the doctor doesn't know why." New insights into the cause of colicky behavior and frequent, painful nightwaking episodes reveal that oftentimes babies hurt because of some underlying medical problem. In fact, in our practice we have replaced the term "colicky baby" with "the hurting baby," which motivates the parents and the doctor to keep searching for the cause. One of the most common hidden medical causes of colic is a condition known as gastroesophageal reflux (GER), in which irritating stomach acids are regurgitated into the esophagus causing pains that adults would call "heartburn." GER is caused by a malfunction of the valve- like muscles between the stomach and the esophagus. Besides triggering colicky behavior, GER is a subtle cause of unexplained bouts of wheezing or asthma in infants and children.

Clues that your baby suffers from reflux:

• Painful blasts of crying (more than the usual baby cries)
• Frequent spitting up (but not always)
• Inconsolable bouts of abdominal pain
• Painful bursts of nightwaking
• Fussiness, particularly after eating
• Arching or writhing as if in pain
• Seems to be more comfortable when carried upright, sleeping on the stomach, or sleeping propped up at a 30-degree angle.
• Frequent, unexplained bouts of wheezing and chest infections and episodes of apnea
• Sour breath; throaty noises (Note: Baby may have many or only a few of these signs)

If you suspect GER, mention this possibility to your doctor. The diagnosis is usually made based on the history given by the parents. A doctor can confirm the diagnosis by placing a string-like tube into baby's esophagus (only minimally uncomfortable), leaving the tube in place overnight, and measuring the amount of stomach acids regurgitated into the esophagus. If the reflux is severe, your doctor may prescribe medicines that lower the amount of stomach acid produced and accelerate stomach emptying. Besides these medications, try these home remedies to ease your baby's discomfort:

• Keep baby upright and quiet for at least thirty minutes after feeding.
• Offer smaller, more frequent feedings.
• Wear your baby in a carrier as long as possible. Carried babies cry less. Babies reflux more while crying.
• Breastfeed. Studies show that GER is less in breastfed babies.
• If you are bottlefeeding (and if recommended by your doctor), thicken baby's feedings with one or two tablespoons of rice cereal to each 8-ounce bottle.
• Discuss with your doctor the safest sleeping position for your baby. Babies with severe reflux sleep best on their stomach and propped up at a 30-degree angle by elevating the head of the crib. (Babies without reflux should be put down to sleep on their backs.)

From one-third to one-half of all babies have some degree of reflux during the first three months, yet the good news is that most infants outgrow reflux around seven to nine months of age.

Breastmilk is known as the "easy in – easy out" food. It's easier to digest and makes easier- to-pass stools. Whey, the predominant protein in breastmilk, forms an intestine- friendly, soft, easy-to-digest curd, unlike the rubbery, harder-to-digest casein curd formed in the digestion of most formulas. Tiny tummies like breastmilk. It's digested more quickly, and is less likely to come back up. It doesn't leave permanent stains on clothes either.

While all babies spit-up a bit, some regurgitate excessive amounts of milk, because of a condition called gastroesophageal reflux (GER). Normally, the circular band of muscle where the esophagus joins the stomach acts like a one- way valve, keeping milk, food, and stomach acids from backing up into the esophagus when the stomach contracts. When it doesn't do its job and these acids enter the esophagus, the result is an irritation that adults would call "heartburn." In many infants, it takes six months to a year for this muscle to mature enough to prevent this regurgitation, or reflux. GER occurs less often in breastfed infants because breastmilk is emptied twice as fast from the stomach and because breastfed babies tend to eat smaller meals that are more appropriate in size. It's less likely to be regurgitated than slow-to-digest formula with its tough casein curds.

"At age five months and four pediatricians later, Jacob was diagnosed with gastroesophageal reflux. I am forever grateful I did not give up! The goal of one of Jacob's reflux meds was to help digestion, so he would not reflux. What could be better for him than the most easily digested food for babies…mom's milk! When the specialist first met Jacob, he was shocked to see him looking so happy. He told me that most babies with that degree of reflux failed to thrive and were very sickly. I am convinced that Jacob did not fail to thrive because he was nursed."

P.A.G.E.R. – The Pediatric/Adolescent Gastrointestinal Reflux Association. A non-profit organization offering support and information from other parents coping with the heartache of reflux. P.O. Box 1153 Germantown, MD 20875-1153, (301) 601-9541 or (760) 747-5001, www.reflux.org.