Psychosocial Issues

Ger and GERD obviously have consequences for the children so afflicted, however an often overlooked consequence is what happens to the primary caregiver. If treatment for the conditions is ineffective or the children go untreated it is likely that the patient’s condition will lead to some level discomfort for the primary caregiver(s). Pediatric GERD caregivers are likely to experience report sleep loss and some level of psychological and physical stress as a result of ineffective or inadequate treatment of GERD. The effect on the caregiver can be profound and affect all aspects of their normal routine from sleep, and professional activities to family relationships and normal social interactions.

Medical Therapy

The treatment of reflux depends upon the infant’s symptoms and age. Some babies may not need any treatment, as GER can resolve in many cases without treatment. Healthy, happy babies may only need the feedings thickened with cereal and to be kept upright after they are fed. Over feeding can aggravate reflux, and your health care provider may suggest different ways of handling the problem. For example, smaller volume with more frequent feeding can help decrease the chances of regurgitating. If a food allergy is suspected they may ask you to change the baby’s formula (or modify the mother’s diet if the baby is breastfed) for one to two weeks. If a child is not growing well, feedings with higher calorie content or tube feeding may be recommended.

1.

When a child is uncomfortable, or has difficulty sleeping, eating or growing, the doctor or nurse may suggest a medication. Different types of medicine can be used to treat reflux by decreasing the acid secreted by the stomach. One class of these medications is the H2-blockers such as cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid) and nizatidine (Axid). Another type of medication is the proton-pump inhibitors such as esomeprazole (Nexium), omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex) and pantoprazole (Protonix).

2.

Very rarely do infants have severe GER that prevents them from growing or cause breathing problems. In some of these infants, surgery may be the best option.

Diet Nutrition and Lifestyle

Gastroesophageal Reflux (GER) occurs during or after a meal when stomach contents go back into the tube that connects the mouth to the stomach. GER occurs often in normal infants. Most infants with GER are happy and healthy even though they spit up or vomit. Spitting up tends to peak at 4 months and most infants stop spitting up by 12 months of age. If your baby is spitting up without discomfort and is making appropriate weight gains, then he or she is probably a normal spitter. Things that you can do at home to help reduce spitting up:

Avoid overfeeding

1.	Don't feed the baby again after he or she spits up - wait until the next feeding.
2.	Consult your doctor to see if the baby is taking appropriately sized bottles or nursing the appropriate amount of time. For formula fed infants, feedings can be thickened
3.	For formula fed infants, try a hypoallergenic formula for 2 weeks
4.	Keep infant upright for at least 30 minutes after meals
5.	Avoid car seat positioning in the home Avoid tight diapers and elastic waistbands
6.	Avoid exposure to tobacco smoke

Most infants with GER will be helped with the treatment mentioned above. If symptoms are severe or persistent then your primary care provider may consider treatment with a medication or referral to a pediatric gastroenterologist.

Signs and Symptoms and Diagnosis for Infants

Gastroesophageal Reflux (GER) occurs when stomach contents come go into the esophagus (the tube that connects the mouth to the stomach), during or after a meal. Most infants with GER are happy and healthy even though they spit up or vomit. An infant with GER may experience:

• Spitting
• Vomiting
• Coughing
• Irritability
• Poor feeding
• Blood in the stools

GER occurs often in normal infants. More than half of all babies experience reflux in the first 3 months of life. Only a small number of infants have symptoms due to GER. Most infants stop spitting up between the ages of 12 to 18 months.
In a small number of babies, GER may result in symptoms that are concerning. These include problems such as

• Poor growth due to an inability to hold down enough food
• Irritability or feeding refusal due to pain
• Blood loss from acid burning the esophagus
• Breathing problems

Each of these problems can be caused by disorders other than GER. Your health care provider needs to determine if GER is causing your child’s

For more information click on the links below go to the Patients and Parents site and check out the resources on Infant GER below

Genetics

In the past several years, there have been a number of research studies suggesting that GERD may be an inherited disease. In 2004 CDHNF kicked-off Family GERD Week with the release of findings from a survey of 200 pediatricians and family practitioners to determine their understanding of the possible genetic basis for GERD.

It revealed that 89 percent of the physicians surveyed believe that GERD may be an inherited condition, and over 70 percent of respondents also recognize that serious complications from heartburn, such as erosive esophagitis, Barrett’s esophagus and esophageal cancer, also likely have an inherited basis. However, only 48 percent of respondents routinely inquire about family history. The survey clearly showed that while the genetic relationship of these diseases is still being studied, it is necessary for physicians to be more cognizant of family history when diagnosing patients with GERD.

Know the Symptoms of Acid Reflux In Babies

It’s very frustrating to be a parent or caregiver whose baby is upset and crying if you don’t know what is wrong. Your infant does not have any other way to communicate yet, so crying is the main sign of hunger or discomfort. Learning about all the various issues that the average baby or toddler may suffer from can help, however, as the more you know, the more you can help your child to feel better. One subject that many parents and caregivers don’t know much about is how to recognize the symptoms of acid reflux in babies.

Yes, even tiny infants can suffer from acid reflux. In fact, it’s quite common, as the digestive symptom in infants is not yet fully developed. They also have no capacity yet to tell when they are full, nor to communicate this to their caregivers. What this means is that babies cannot always keep the foods and liquids they’ve been fed inside their stomachs. In addition, most infants spend a majority of their time lying down, which, as any adult sufferer of acid reflux will tell you, only aggravates the symptoms of acid reflux. In babies this is no different, so if your child seems to be suffering from acid reflux-related discomfort, try putting him or her in a seat or carrier that allows an upright position for a larger portion of the day.

It is very important to know the symptoms of acid reflux in babies, as failing to deal with them can lead to failure to thrive, due to the baby not getting enough nutrition. Allowing the esophagus to be continually exposed to the stomach acids can also lead to tissue damage or even scarring, and possibly to breathing problems later in life.

But it can be difficult to tell the difference between normal infant vomiting & crankiness and the more serious symptoms of acid reflux in babies. It’s perfectly normal for babies to spit up their food, due to the same immaturity of the digestive system that causes the symptoms of acid reflux in babies in the first place. And since they cannot yet communicate, they are unable to express just why they may be feeling uncomfortable or even in pain. If your infant’s vomiting seems to be occurring after every meal, or if he or she is also having breathing difficulties, you should consider that these might be symptoms of acid reflux, and see your pediatrician.

Treatment of the symptoms of acid reflux in babies may range from simply feeding your baby different foods and adjusting his or her sleeping conditions to prescription medications. Whatever treatment your doctor prescribes, be sure to follow instructions carefully, as symptoms of acid reflux in babies can quickly lead to more serious conditions.

Are Too Many Babies Taking Antireflux Medications?

Spitting up is a common, albeit messy, part of being a baby. But some little ones have a harder time keeping their early diets down than others. So, infants these days are often prescribed medications to help keep their spit-ups — and the discomfort that can come with them — at bay. But now a new study is questioning whether many of the babies taking these drugs really need them.

Focusing on 44 infants with ongoing spitting up or vomiting problems, researchers used a test to measure the reflux (or regurgitation) of acid from the stomach into the esophagus. What they found: The vast majority of the babies couldn't technically be diagnosed with gastroesophageal reflux disease (GERD), a condition that's different from regular old reflux. Reflux is very common in infants, but it usually doesn't cause any health problems and stops before a baby's first birthday. Doctors diagnose GERD when a child's reflux is causing complications, like irritation of the esophagus due to refluxed stomach acid, poor weight gain, or breathing problems due to spit up spilling over into the child's lungs.

Although almost all of the 44 babies tested were on antireflux medications (42, in fact), only 8% of them could be considered to have GERD. And when the babies who didn't appear to have the condition after all were taken off the medications, the reflux symptoms in most of the babies improved or didn't get any worse.

So, why the large number of babies getting antireflux medications? The researchers say the high number of prescriptions could be because:

• Primary care doctors don't have a simple way to distinguish simple reflux from GERD, so they may prescribe the medication to see if it helps.
• Parents may become anxious and worried about their baby's ongoing problems and request a prescription. (The researchers note, though, that parents' reports of vomiting and spitting up are often highly exaggerated — often as much as five to six times more than the amount the baby is actually throwing up.)

Acid Reflux Disease in Infants & Babies

Acid reflux in infants is very common. At least half of all infants are born with some degree of reflux simply from immaturity of the the lower esophageal sphincter (LES). The LES is a valve at the bottom of the esophagus which opens to let food and liquids into your stomach and then closes again so it doesn't come back out. Acid reflux happens when this valve does not close properly, causing stomach contents to reflux back into the esophagus.