GERD – Reflux in Breastfed Babies;
Reflux in breastfeeding infants often goes undiagnosed. The reason for this is parents assume their baby is simply “colicky.” In my first book, the chapter devoted to GERD (gastro-esophageal reflux disorder) is called “Why has my baby turned into Oscar the Grouch?” These babies are simply uncomfortable throughout the day and need to be held as much as possible. They often have nasal congestion, hiccups, lots of spit-ups and constantly look and cry like they need to be fed. The thing to remember here is that babies comfort themselves by sucking. It’s not always that they want to eat more, but they want to comfort themselves and then the food actually exacerbates the problem. It’s a difficult but important diagnosis and differentiation to be able to make; comfort or hunger?
My advice is usually to avoid pacifiers until 40 days of age, when the mom’s milk supply is firmly established. Having said this, I sometimes break my own “rule” and actually recommend the pacifier, along with other methods, to comfort the baby.
Physiologically, reflux is when milk comes back up through the little valve that connects the esophagus (food tube) with the top of the stomach. Because the stomach is a naturally acidic environment, the acid mixes with the food and causes a burning feeling in the chest area (bottom part of the esophagus). This “aggravates” the diaphragm (in close proximity) and causes hiccups. You may have noticed this same phenomenon after a glass of wine or when eating too quickly. You also know it’s not a great feeling.
So, what are we to do? Well, before making any big changes, it’s important to make sure your baby is gaining at least an ounce a day and will continue to do that as you start with adding the pacifier. Common sense would also have you consult your own pediatric practitioner before venturing out on working with this difficult diagnosis, so don’t jump to conclusions here. Pacifiers should only be used AFTER your baby is well fed and ONLY as a trial in helping you to figure out if you need to feed more or simply to comfort. I don’t want you to EVER deprive your baby of being fed (I’m sure you don’t either, but bear with me as based on working with babies for a VERY long time, I feel the need to say that).
Pediatrics is an odd specialty where, when treating babies, you never get to speak to them directly. This sometimes can be tricky to do as a large part of me feels like I have to “represent” the baby during a visit. I try to convince the mom and dad of what the baby is most probably experiencing
Following is a list of suggestions I use to alleviate some of the suffering reflux causes;
I first ask the parents if they themselves have ever suffered from reflux or GERD. Many moms, throughout their pregnancy will have experienced this discomfort. If you, the reader, can identify with this, then you know you feel like “doing something.” You may try a little food, milk, antacid or simply changing positions; all good ideas that may help or may exacerbate the uncomfortable feeling right in the middle of your chest. Once parents realize it’s real discomfort, they’re more likely to understand we have to help the baby feel better. It’s understandable that we don’t want to “medicate” our infants but we also don’t want them to suffer. It’s a balancing act.
With any treatment we offer to infants, the rule is “start low and go slow.” First we try positional changes like the “colic hold” featured in my first book, Start Here; Breastfeeding and Infant Care with Humor and Common Sense. This is a hold where the baby straddles your left arm and has his/her head higher than the belly. We use the left arm because it puts a little pressure on the tummy and helps babies burp and simply feels good.
Dairy can be temporarily removed from mom’s diet during the time when we start treatment. Keep in mind that the size of the protein molecule in cow’s milk products is roughly 47 times larger than the protein molecule in human milk. It’s easier for us, as adults, to digest because we’re roughly the size of a baby cow (no offenses here, lol). Babies have much more difficulty digesting because of their size and gut maturity.
As a trial, I occasionally use an over the counter antacid at a special dosage, which should be determined by a pediatrician or nurse practitioner. This will help me understand whether or not I need to prescribe Zantac. When I do prescribe Zantac, one of the most important things I tell parents, is to have the prescription filled at a pharmacy where they will compound it without alcohol and add banana flavoring. When prescriptions are taken to a chain store, Zantac (ranitidine is the generic name) is mixed with alcohol and then it has a minty flavor………yuk!!!! May as well give the kiddo a mint julep!
After two weeks (sometimes less), I bring baby back for a recheck. If we have not made enough progress, I recommend changing to Prevacid (lansoprazole).
Babies with reflux need frequent, small feeds, upright positions after feeding, a maternal diet that will not cause difficulty in digestion and sometimes an over the counter or prescription medication. They also feel a lot better when they sleep on their tummies, although because of the increased risk of SIDS in this position, they MUST be monitored.
The bottom line is that babies will grow out of this, as they gain weight and start sitting without support around six months of age.
We wean them off the medication by keeping the dosage the same as they grow, therefore reducing the effective dosage, which is calculated by bodyweight.
Somehow we get through these long days and sleepless nights and move onto the next challenge of parenting. We come away exhausted but wiser.