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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.
AskDrSears.com is intended to help parents become better informed consumers
of health care. The information presented in this site gives general advice
on parenting and health care. Always consult your doctor for your individual
needs.