BabiesHealthPseudoscience

Reflux: This Ain’t your Average Spit Up

I get thrown up on a lot.

Last night, my one-year-old son, M, smiled at me over his high chair tray and vomited his dinner.  Mashed potato and peas spewed down his shirt, and tumbled in a growing river down his chest before pooling in the footrest of his high chair. The second wave pushed it to the floor along with partially digested milk from this afternoon.

I cleaned him up, and he did well until about an hour after bedtime, when he woke up screaming and inconsolable because of the bile burning his throat. It was just another evening with a reflux baby.

We’re on the tail end of my sons’ reflux journeys, their GI doc is letting M outgrow his Prevacid, and his brother J outgrow his Zantac a bit more slowly.  Last night made clear that M is not done yet, but at the same time, that he is doing much better than a few months ago.

J has had mild reflux since he was 6 months old, while M has had reflux since he was 4 months old and had an ostomy reconnection surgery.  Though he was otherwise healthy, reflux kept M in the NICU for 3 extra weeks because his pulse dropped every time he refluxed. When he came home, he threw up several times a day, a number that has tapered to a few times a week now that he’s bigger.

What is Reflux/GERD?

baby vomiting

(credit: Deek, all rights reserved)

Reflux (GERD) is often misunderstood. It’s sometimes mistaken for colic because in both cases babies are miserable, but colic is more of an umbrella diagnosis for inconsolable babies, while reflux has a specific cause: digested food and stomach acid flowing back up into the esophagus (parents.com). People assume it’s “spit up,” and the most common response I get when I mention M’s reflux is a variation of “oh, my baby spits up too! I know what you’re going through!”

But, this is not spit up.  This is spit up’s bully of a big brother after a few too many drinks.  This is Godzilla to your kid’s pet lizard.   More clinically, spit up produces “wet spots,” while reflux babies throw up in geysers, arch their backs in pain, are miserable eating, and gag (parents.com).

Reflux is entire afternoons spent in the bathtub with a kid doing his best impression of Old Faithful, and not bothering to dress him or you because, really, what’s the point?

Reflux is a child who wakes up gagging and crying inconsolably in the middle of the night because the bile he’s coughed into his throat burns.

Reflux is propping your half-naked baby on a towel covered boppy to keep him comfortable between inevitable bouts of projectile vomit and gagging.

Reflux is more than a mere annoyance, but it is not a life-threatening condition. So I can see where it seems like I’m overreacting.

NICU Baby with head elevated to help with reflux (credit Deek, all rights reserved)

Reflux baby with head elevated in the NICU
(credit Deek, all rights reserved)

But I’m not. My twin sons are former 24-week preemies (I’ll save you the math, that’s 3 weeks before the start of the 3rd trimester).  At just under 1.5lbs at birth, they have faced down a host of life-threatening medical problems and beaten overwhelming odds more times than I can count. So, I know what scary awful is, and I know that this is not as bad as that. Unfortunately, the effects of reflux spread to aspects of babies’ lives far beyond digestion so it’s not just an annoyance either.

Because his reflux is worse, M is behind his twin developmentally in every way. He has gross and fine motor delays, as well as speech and learning problems, all of which can be traced back to reflux.

M couldn’t do tummy time because of the stomach pain and bile, which has meant that he does not yet crawl, roll over, stand, or pull himself up to a sitting position. There was a tense period when neither boys gained weight, and we faced a “failure to thrive” diagnosis and feeding tube for each of them.

M didn’t babble until he was almost a year old, and required occupational therapy to do so, because kids with GERD learn to associate moving their mouths with pain. We had to go McGuyver on both boys’ toys to make them work with a sitting baby rather than one lying down.

For months the entire household revolved around feeding M and keeping some of the food down so he could gain weight. It helped that I worked at home. As he gets bigger, the reflux gets better, and the magic moments when he’s able to be active are getting longer and longer, which lets him work more with his physical and occupational therapists so he can eventually catch up.

What Doesn’t Work? GERD Quack Medicine

The problem with having children whose conditions are a serious form of something common is that people are quick to advise things that “worked” when their child spit up.

Some suggestions have been helpful in conjunction with medication:  elevating his head during sleep, small meals, and making formula ahead, holding him more upright when breastfeeding. Even using a rock ‘n play VERY carefully is useful, though I chose not to because of the mold recall and continued reports and the very slight potential SIDS risk. Many people suggest dietary changes, which are useful if the problem is a food allergy or lactose intolerance, which this isn’t. But, I do modify my food choices for him to ensure they hurt less on the way back up.

Quack Medicine

Quack Medicine

Other suggestions are sheer quackery. At their best they have no reliable scientific studies supporting their use, and at their worse have killed or hurt children. The quackery is easiest to spot because it’s often prefaced by assertions that as a loving parent, I would never want to pump my helpless baby full of chemicals, or the advising person has a blanket distrust in doctors, “big pharma” or “modern medicine.”

Many people suggest infant chiropractic care, but I include chiropractic care for infants with reflux in the quackery category because chiropractors have caused serious injury to babies, such as an incident when a chiropractor in Australia broke a baby’s neck (The Age Newspaper).

Even the American Chiropractic Association thinks chiropractors should treat only “back pain, neck pain and headaches. . . a wide range of injuries and disorders of the musculoskeletal system, involving the muscles, ligaments and joints“ and provide counsel on other conditions. (ACA Today).  Though the ACA is totally fine with treating children despite concerns by others in the medical community, reflux is a digestive disorder, and therefore beyond the scope listed.

The list of organizations speaking out against chiropractic care for children (nevermind infants) is long, so here are a few:

  • American Academy of Pediatrics published a meta study that concluded “Serious adverse events may be associated with pediatric spinal manipulation” (January, 2007)
  • Real Clear Science summarizes the danger, saying “The cartilaginous growth centers in the spines of infants are very vulnerable and simply should not be subject to spinal manipulation, no matter how gentle the manipulations may be” (May, 2012)
  • The fine folks at Science Based Medicine explain “legitimate properly-controlled studies have failed to support the claims of chiropractors who treat children for organic ailments.” (May, 2010)

Another common suggestion is the colic treatment, Gripe Water. Unfortunately for reflux sufferers, research shows that the only reason it’s effective for colic is the sweetener not any other magical ingredients, which is why it doesn’t work for reflux. This does not stop several medical websites from recommending it, such as healthline.

Then there’s the idea that putting something on M’s outside will cure his reflux inside. There are necklaces made of hazelwood that magically solve the problem. According to sites that sell them, wearing this necklace can “help neutralize the body’s acidity level,“ a claim that is also used for amber teething beads, and refuted over at Skepticon far better than I ever could (April, 2012).

But these necklace websites insist that government organizations such as Health Canada approve of them.  Yet a quick search turns up only articles about the choking hazard of teething necklaces, and Health Canada has issued warning, after warning. For a detailed analysis of why these are a bad idea, check out the East England Skeptical Society blog.

Then there’s the idea that rubbing essential oil on my baby will cure his reflux. Oil. I kid you not. I could find no  controlled peer reviewed studies supporting the use of essential oils in treating infant reflux. Science Based Medicine states “There is no good evidence to support the use of essential oils for health purposes” (January, 2013). So no. . .essential oils smell lovely, but don’t replace real medicine.

Although the suggestion is much less frequent, and has never come from anyone who personally knows me, homeopathy occasionally rears its head. The thing that freaks me out about homeopathic remedies is that they’re not branded to look like real medicine, and sometimes even sit sneakily on the drugstore shelf (yeah, Zicam, I’m lookin’ at you). I have never used or supported homeopathic medicine, and Quackwatch and Science Based Medicine rip the pro-homeopathy arguments apart well.  So, no, fairy dust and wishful thinking ain’t enough for my kid.

When people make these quack medicine based suggestions, I remember that a retired pediatrician friend once told me that he would go through all the treatments for reflux over several months—lifestyle changes, medicine A, medicine B, medicine C, and by the time he had run through all of the treatments, the baby would have grown out of his or her reflux. Often parents lauded the last treatment they tried as the “cure” when really, all that happened was that the baby grew.

I have to wonder how many of the cures suggested “worked” due to the same happy coincidence of timing.

What Actually Works? Lifestyle Changes and Real Medicine

The Baby's Bottle, by Robert Vonnoh

The Baby’s Bottle, by Robert Vonnoh shows upright feeding

The best cure for reflux is growth and time, and the goal is to minimize the vomiting and pain of reflux while they’re in that process through medicine and lifestyle changes. No lifestyle change “cures” GERD, and that’s a big difference between it and spit up.

In the end, what worked best for my children was a combination of lifestyle changes and  modern medicine. For M especially, the combination of these two elements was key – either element alone was completely ineffective.

The personality of the baby involved seems to have an effect on the types of lifestyle changes that are most effective. M is a very chill baby when he’s not in pain, so he tolerates having his head elevated, cold bottles, and other less comfortable changes well.

Changes that worked for us were:

  • Elevating M’s head during sleep with books under his crib mattress at the recommendation of his doctor helped reduce his painful night wake ups. When M decided he hated his crib and moved to a floor bed, it was easy enough to build a small, safe “nest” to raise his upper body.
  • Now that he can eat, M eats very small meals in small bites. If he takes 10 half-sized bites of his meal, I am thrilled. He eats more frequently than his brother, but it stays down better as a result.
  • When M was on formula, we made it ahead of time and stored it in the fridge.  A friend whose son had equally bad reflux swears by this because she feels that it allows the bubbles from shaking it up to settle.  Though I’m not sure whether it is this or the cold, I saw a noticeable difference when he had premade formula from the fridge than freshly made formula.
  • We found success in holding M more upright when breastfeeding so that instead of laying down his position was more similar to sitting. It took some adjustments to get a comfortable hold, but it seemed to help.
  • Our pediatrician had us add a tiny amount of rice cereal to his bottles and burp him more often than normal. Luckily for me, M burps like a truck driver (I realize that this does not bode well for public politeness in his childhood, but we’ll cross that bridge when we come to it).

The other half of the equation for us was legitimate, scientifically tested and peer-review studied medicine.

Medicine means that he can spit up and not spend the next 15 minutes crying hysterically enough that he induces another session of vomiting. It means that there is a window each day when we can do his physical and occupational therapy without worrying that the entire rest of the day will be spent in a cycle of vomit and tears. It means that he can slowly develop the muscles he needs to sit up, lean forward, and eventually stand.  It lets him enjoy story time, impromptu dance parties, and playing with his brother.

And, selfishly, M’s reflux medicine means I get to cuddle my son. During the height of our reflux misery, I couldn’t hold M facing me.  We paced the house or did laps outside with him facing out and me gently bouncing him – never touching his sensitive stomach.

He could not snuggle to sleep on my chest, and could not be rocked.  He did not like hugs, and he had to be laid down to sleep alone and could not sleep in my lap. As he grows bigger and the medicine does its work, he hugs his father and me, falls asleep snuggled with his brother or in my arms, and likes to be carried in a Maya wrap. In short, he’s getting the comfort and stimulation a normal infant gets from the start because of his medicine.

If medicating my children means they get to go home from the hospital in my arms, then medicate away. If it means that they grow strong and start to catch up instead of getting a feeding tube, then hand me the Prevacid. If it means that M no longer associates eating, speaking, or lying down to sleep with pain, then sign us up.

Modern medicine and sensible lifestyle changes let my child grow up healthy and happy with a tested, proven treatment.  That’s something that pseudo-science hokum can never touch.

Update: added images to post, 9:24pm, January 8, 2014

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Deek

Deek

Deek lives with her husband, twin sons and two cats in the northwest. She teaches and writes about parenting in the NICU, her experiences as a parent of micro-preemies and skeptical parenting.

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