Reflux

Reflux or Gastroesophageal Reflux Disease (GERD)

Since both Jackson (diagnosed at 2.5 weeks old) and William (diagnosed at 3 weeks old) had reflux we have become resident experts on the subject. These are some of the things we have learned about GERD and what we did.

Signs and symptoms

  • Crying during feedings – arching back and moving away from the bottle
  • Spitting up and crying (most babies spit up, the key is are they bothered by it)
  • Eating a few ounces then crying out in pain

Medicines
The reflux medicines are designed to control the amount of acid in the child’s stomach, not stop them from spitting up. This way when they spit up it will not be acidic and cause problems in their esophagus, throat, nose or mouth.

  • Prevacid – we have been on 4 different variations of Prevacid. Jack was on the powder that I mixed with water, a pre-made suspension (formulated by the local medical arts pharmacy), capsules that I sprinkled in this food and solutabs that I dissolved in water in a syringe. He was on Prevacid until he was 4 years old, then we decreased the dose slowly to wean him off.
    Will has been on the solutabs that I dissolve in a syringe. His current dose is 22.5 mg/day.
  • Zantac – Jack started out on Zantac, but it didn’t work for him. Will was  on Zantac at bedtime weeks after birth.

One note on medicines, in our research there are different schools of thought on these medicines and how much is an appropriate dose for children. No clinical studies have been done in kids to provide dosing instructions, so the doses are extrapolated down from age groups that have been studied.

The wedge
Both Jack and Will slept on some form of a wedge. Jack moved out of his between 7-8 months. Will was in his until he was 6 months old. Jack’s was the full prescription wedge that had him at a 45 degree angle. For Will we made a modified one that had him about half of that angle. Both boys also loved to sleep in their swing, which was a good angle. For babies with reflux it is helpful to keep them upright for close to an hour after feeding. If they will tolerate a wedge for sleeping it makes it easier for them to keep all of the liquid in their tummy.

Reflux vs. colic
Most children are born having some amount of reflux (spitting up), it only becomes a problem when it starts to bother the children and interfere with eating or causes other issues. Some kids live with their form happily and require no medical intervention. Unfortunately that was not the case with my two.

Jack was diagnosed with “colic” too. When that word was used immediately Jim (aka Daddy researcher) set out to find out more about it. He found out that it is a term that doctors started using years ago when they couldn’t explain why a baby would cry. Since then nothing more has been done to define its symptoms (other than inconsolable, inexplicable crying), causes or treatments. We feel that colic is actually a combination of reflux and milk protein intolerance. It is also possible that generations of “colic” diagnoses may have actually been reflux but undetectable until recent advancements were made in GI diagnostic procedures.

Silent Reflux
Some kids (Jack for sure and Will to a certain extent) had what is called silent reflux. It means that they don’t spit up or only spit up small amounts. It is harder to detect because they don’t spit up the volumes that other kids are. The acidic formula/breastmilk just goes up and down in their throat and can cause more severe irritation, because it goes up and then back down, not up and out.

Breastfeeding with reflux
Yes you can. Unfortunately for me, both boys also had milk protein intolerance which made it impossible for me to breastfeed.

Tests
This is such an extensive category that I have a page specifically for it. Click here for more information.

Feeding aversions and feeding tubes
Sometimes reflux symptoms get so severe for the child that they start to refuse to eat. If this starts to happen a feeding aversion is being created. Don’t be alarmed — this happens over time, not overnight. If you are on top of it most of the time an aversion can be avoided. Unfortunately for us we couldn’t avoid it with Jack. Usually once an aversion is suspected you meet with a feeding specialist/therapist who will watch the baby/child eat and provide guidance on what to do. Our feeding therapist Robin Glass with Seattle Children’s Hospital was amazing and has seen both boys.

If the feeding aversion gets so severe that the child starts “failing to thrive” (a medical phrase often used), not gaining weight on their particular growth curve or is approaching dehydration levels, a feeding tube may have to be used. To read more about Jack’s feeding tube experience, click here.

Weaning off a feeding tube
This process is as individual as the child. Jack was 2.5 years old when we participated in a 2 week intensive feeding program run by Karen Quinn-Shea through Seattle Children’s, which Jim nicknamed it “Fun With Food”. Read about Jack’s experience here.

Growing out of reflux
Yes they will. Supposedly it peaks between 5-8 months and then gets better. For most kids it is gone or they can manage without the medicines by the age of 18 months to 2 years. Jack was on his medicines longer, because we were dealing with his feeding tube, feeding aversion and feeding program. We didn’t want him to have any lingering pain or muscle memory of his pain that would interfere with his progress. He was weaned off of the medicines after his 4th birthday.

 

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