What exactly is GERD? How is it treated and diagnosed? If your baby has gastroesophageal reflux disease and you wonder if the crying and vomiting will ever stop, here are some strategies to help you cope with baby heartburn.
Television ads commonly show adults suffering with acid reflux or heartburn, but they seldom, if ever, show an exhausted parent walking the floor with an infant who is screaming, arching his or her back, and spitting up milk only to want to feed again, gulping it down quickly, and then vomiting it up once more. Yet, according to Susan Ornstein, a pediatric endocrinologist in Pittsburgh, five percent or more of babies born in the United States have gastroesophageal reflux disease—or GERD—which is the medical name for what we know as acid reflux or heartburn.
Acid reflux happens when acid, with or without partially digested food, flows backwards from the stomach and into the esophagus and sometimes the mouth. The acid burns when it touches the delicate membranes of these areas. Heartburn is just one symptom of GERD, but it is probably the one with which we are most familiar.
The regurgitation is due to a problem with a valve called the lower esophageal sphincter (LES), a circular muscle found between the esophagus and the upper part of the stomach. Normally, the LES tightens automatically after food and liquid enter the stomach so the contents, along with stomach acid, don’t flow backwards into the esophagus. But for various reasons, the valve doesn’t shut properly and reflux occurs.
Recognizing Acid Reflux in Infants
If you suspect or know your child has GERD, you may already have worried that something was wrong when your baby vomited shortly after feeding. But many babies spit up a lot. The difference, says Dr. Bruce A. Epstein, MD, a pediatrician in St. Petersburg, Florida, is that babies with acid reflux spit up most of their milk and don’t gain weight.
Other symptoms of GERD include:
- sudden and inconsolable crying
- bad breath
- frequent night waking
- noisy and difficult breathing
- failure to thrive
- swallowing problems
- arching as if to get away from the breast or bottle
- gagging or choking
- awakening with crying, quickly responding to feeding, then awakening again in one to two hours
How Acid Reflux is Diagnosed
If your baby spits up a great deal after an hour or two of feeding, or suffers two or more of the above symptoms, see your pediatrician. The doctor may elect to run a number of tests, including an upper GI diagnostic test in which the baby is given some chalky material called barium to drink. A radiologist then traces the barium as it goes through the digestive tract. If the baby is regurgitating the barium into the esophagus, it shows up on the X-ray.
Treatment for GERD
Fortunately, there are ways to treat GERD, including several types of medications and changes in the way you feed your baby. If you’re bottle feeding your child, your pediatrician may suggest adding a little rice cereal to the formula. The rice makes the milk thicker so it stays down, rather than being refluxed into the esophagus and causing the stomach acid to burn.
Moms who breastfeed their babies might benefit from a booklet produced by La Leche League International, called Breastfeeding the Baby with Reflux. For information on how to get a copy for $2.50, visit the website at www.llli.org.
Additional suggestions to help with feeding include:
- keeping the baby as vertical as possible
- gently burping the baby frequently
- trying not to rush a feeding, although that may be difficult when you have other children who need your attention, too
How Baby’s GERD Affects a Family
It’s difficult for families to cope with a baby with GERD because of the constant screaming and demands made on the parents. There’s a tremendous fatigue factor as well as an emotional drain as you worry about the future for your infant. Will the crying and vomiting ever stop? Will you ever have time to do anything other than clean up the mess from your baby’s spitting up? Will you ever have any leisure time again?
Fatigue and Frustration: Of course you’re tired … and frustrated. This is not what you expected when you had your baby. Friends and family may offer all kinds of suggestions that make you feel totally incompetent. You sometimes may feel like shaking the baby to get him or her to stop crying, but don’t. NEVER shake your baby! According to experts, the number one reason a baby is shaken is because of constant crying, and almost 25 percent of all babies with shaken baby syndrome die.
If you’re having a hard time coping with the crying, put your baby in a safe place, such as a crib or playpen, and leave the room for a few minutes. Close your eyes and take some deep breaths to get back in control. If that doesn’t work, call a family member or friend to come and relieve you for an hour.
Guilt: The guilt factor also may raise its ugly head, especially with mothers who worry that they may have done something wrong during pregnancy to cause GERD. Could it have been that one glass of wine? The night you made love shortly before going into labor? That last two-mile run before labor began? If you’re worrying you are somehow at fault, chase those thoughts from your mind—nothing you did caused your baby to have GERD.
Resentment: You also may find that the baby’s siblings grow resentful because you never seem to have time for them. What’s more, the darling baby brother or sister you promised them seems to be more of a screaming banshee. They may want nothing to do with the baby and don’t want you to either. What can you do? Don’t keep them in the dark. Explain in age-appropriate terms that when the baby throws up, the stomach acid being regurgitated burns his or her esophagus. It hurts the baby and that’s why the baby is screaming.
Ask for Help
This is not the time to feel self-conscious because your beautiful, much-anticipated baby has turned into a screaming, milk-spitting creature. Ask your friends and family for help. Encourage them to take the other children for an outing, to sit with the baby for even one hour so you can have a respite, or fix you an occasional dinner.
There also is a national non-profit support group called PAGER—Pediatric/Adolescent Gastroesophageal Reflux Association. Started by parents whose children had GERD, PAGER offers information and support to parents, patients, and physicians. You can contact them at www.reflux.org or by calling 301-601-9541.
Will My Baby Outgrow GERD?
While most infants do outgrow GERD, approximately five to eight percent continue to suffer from the condition into childhood and the teen years.
Remember that you are not alone as you struggle to cope with a baby with GERD. Check the Internet for additional information, contact the PAGER group, and read The Fussy Baby Book by Dr. William Sears, MD, The Reflux Book by Elizabeth Pulsifer-Anderson, or this author’s book Coping with Chronic Heartburn. The more you know, the more in control you’ll feel.