GER: A Hidden Cause of Colic

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.