For Part 1 of this series,
click here
HOW IS GER DIAGNOSED?
If your infant or child has any of the above
symptoms and you are concerned that she may have reflux, talk with your pediatrician
about having her evaluated. GER may be diagnosed by a single office visit, or a
referral may be needed to a pediatric gastroenterologist for further
evaluation. Your doctor or specialist will review your child's symptoms,
determine if her weight gain is appropriate, and possibly order special tests.
These tests may include an upper gastro-intestinal X-ray (UGI), a milk scan, a
24-hour pH probe, or an endoscopy.
My son was sent back to the NICU
(ugh!) and it was there that they started to run some tests on him. He was seen
by the Speech Therapist/ Feeding Specialist to see if it was his suck, swallow,
and breathe. It wasn’t. I told them that he was obviously uncomfortable and I
was convinced it was reflux. They don’t like to put babies on reflux meds but I
really pushed them to figure out what was going on. He went in for an Upper GI
(UGI) and they found that within a mili-second of him swallowing, the food came
back up and down over 7 times. Thankfully, he wasn’t aspirating (where the
liquid food comes back up and goes into the lungs). So it was then we got our
diagnosis of “severe reflux”.
TREATMENT:
Treatment of GER varies from simply
thickening formula, to medication, to surgery. Your doctor may begin with
thickening the formula and suggesting that your baby be in an upright position
most of the day, especially after eating. Try to hold your baby without putting
pressure on her abdomen. Burp your baby frequently (every 1/2 to 1 ounce) and
encourage her to suck on a pacifier between feedings. This helps to keep the
esophagus in motion, pushing anything in the esophagus back into the stomach.
If an infant is in pain, has slowed or
stopped eating, or has apnea or bradycardia that is caused from reflux, more
aggressive management needs to be done. Medications such as Zantac or Tagamet
or Prilosec that decrease or block the production of acid, and/or medications
such as Propulsid or Reglan that improve digestion, may be prescribed. These
medications are often used in combination with one another.
Most children will out grow GER by one year
of age. As children grow, their esophagus becomes longer and the stomach
naturally begins to wrap around the muscle at the top of the stomach.
My son had been put on Allimentum
formula prior to his initial discharge because of suspected Milk Protein
Intolerance. This seemed to help his reflux as well because often times reflux
and MPI go hand in hand. I stopped pumping, which for preemie moms and preemie
moms with reflux babies can be an extremely difficult decision. He was also
already on a low dose of Zantac. With the new diagnosis, we were to thicken his
formula with 1tsp of rice or oat cereal (alternating) per ounce of formula. He
was also put on Prilosec and Maalox (as needed). He was to be kept upright most
of the day. We got a GI specialist on our team and we checked in with him
monthly and adjusted his medications as he gained weight. He was very important
because a GI specialist will dose your baby at the highest dose as opposed to a
Pediatrician who tends to be more reserved.
I wish I could say that it fixed
everything immediately. It didn’t. We played with his medications and the
thickened feeds to find the right balance. He lived in a Moby Wrap or his
Fisher Price Rock n Play (please get one if your child has reflux, you will
thank me!) or his swing or his car seat! It took months for the pain to stop
when he ate but I can say that by the time he turned 1 adjusted, he was off of
all of his medications and we hadn’t been thickening his food for months. My son’s
reflux was one of the most difficult things that I have ever endured and it
wasn’t even me with the pai
ADDITIONAL INFO:
I mentioned that babies spit up. They do spit
up and if you have a happy spitter then there isn’t a real reason to put them on
medication for reflux. I would still talk to the pediatrician about it to let
them know what is going on and to check weight gain. The medication does not
STOP the reflux, it only makes it more comfortable for them.
The other thing I wanted to call attention to
is something called silent reflux. It can be scary to not know that your child
is refluxing. It is harder to detect because they aren’t spitting up. But here
are the symptoms for silent reflux:
•
poor weight gain or rapid
weight gain
•
gulping with a painful look on
the face
•
sour breath, wet sounding burps
•
persistent or chronic cough
•
frequent hiccups
•
sudden burst of painful crying
•
painful wakeups from sleep or
poor sleeping habits
•
poor feeding habits, possible
feeding aversions
•
neck or back arching during or
after feeding
•
excessive fussiness, crying or
colic
•
demands to be carried
constantly
•
red or salmon colored throat
•
blood in the stool or spit up
These last two signs are possible
indicators of Barett's Esophagus. The risk of Barett's Esophagus is slightly
higher with silent reflux because there is generally more damage to the throat
with silent reflux in infants, although it is still a fairly low risk.
HELP:
Having a child with reflux can trigger many
emotions. It is normal to feel anger, frustration, and sadness. Sometimes it
helps to talk with those who can empathize with you and understand your
feelings and concerns, such as other parents of children with reflux. You'll
need support to make it through these difficult days. A national parent support
group called PAGER (Pediatric Adolescent Gastroesophageal Reflux Association,
Inc.) can help you find any further assistance you might need. Their website
address is http://www.reflux.org or they are located at PO Box 1153,
Germantown, MD 20875-1153, (301)601-9541.
OR
E-mail one of the Resource Blog creators and
they can get you in touch with me!
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