Presentation by Jessica Tovey and Dr
Naomi Farragher, with input from
Belinda Salter, Glenda Blanch, Trudi
Wynn, the Reflux Infants Support
Association Inc and members of the
RISA Administration Team.
Information primarily sourced from
‘Reflux Reality: A Guide for Families’,
and seminar presented by A/Professor
Peter Lewindon, Paediatric
Gastroenterologist, Royal Children’s
Hospital Brisbane (May 2010)
Mother of Cameron, 19 months
GP Registrar at Lowood Medical
Center
Volunteer with RISA Inc 1 year
Parent who survived a child with
severe reflux and cows milk
protein intolerance
Mother of Arabella, 4 years and Jordan, 11 months
Currently employed
by CCYPCG, and a Trainee Breastfeeding Counsellor
with ABA
Volunteer with RISA Inc for 4 years
Parent to two refluxers
What is RISA?
• Support/information non-profit community
group for those caring for babies and children
diagnosed with GOR and GORD
• Australia-wide, operating since 1982
• Parent forums, member library, newsletters,
Facebook site, phone and email contacts,
coffee meet-ups
• Advocacy
What is reflux?
• Stomach contents enter the oesophagus
• Vomiting or ‘silent’
• 50% infants < 3 months will reflux, 70% between
4 and 6 months, 5% at 12 months
• Can be very normal, but if it ‘causes symptoms
sufficient enough to interfere with normal life’
(NASPHGAN Guidelines), it becomes GORD
• Severity can depend on frequency and
composition of the contents rising
Why do infants reflux more?
• Body position
• Feed composition
• Increased number of episodes of TLOSRs
(transient lower oesophageal sphincter
relaxation)
• Shorter oesophagus
Symptoms of reflux
•
Irritability/crying/screaming
•
Constipation or irregular movements
•
Vomiting/regurgitating or posseting
•
Sleeping issues:
•
Appearing to be in pain
•
catnapping during the day
•
Repeated hiccups and wind
•
frequent night waking
•
Hoarse voice (damaged vocal cords)
•
•
Feeding problems:
easily disturbed from sleep, or
restless
•
•
•
refusal to feed or only taking a
small amount despite being hungry
•
comfort feeding- feeding
frequently
•
pulling away and arching their back
•
crying/screaming during or after
feeds
•
gagging/spluttering
Tooth decay and bad breath
Respiratory issues:
•
Choking
•
Wheezing/coughing
•
Recurrent chest infections
•
Failure to thrive or overweight
•
Recurrent ear, throat or sinus
infections
•
Congestion, ‘snuffling’ or appearing to
have a cold
Possible side effects of GORD
• Feeding problems such as feed
refusal, difficulty with certain
textures or gagging on feeds
• Weight loss
• Failure to thrive (tubes/tube
dependence)
• Comfort feeding leading to
weight gain
• Cyanosis (going blue), life
threatening events
• Sleep disorders
• Breathing issues such as
wheezing, stridor, aspiration
•
•
•
•
•
•
Chronic cough
Oesophagitis
Behavioural issues
Sleep disorders
Irritability
Constant vomiting/vomiting
blood (fundoplication)
• Seizure-like posturing
(Sandifer’s syndrome)
• Constipation (can worsen the
reflux)
• Emotional aspects –
relationship of carers,
treatment of baby/child
Some causes of GORD
•
•
•
•
•
•
•
•
•
•
Lower oesophageal sphincter (mal)functioning
Delayed oesophageal clearance
Delayed gastric emptying
Genetic (reflux can be an inherited condition)
Structural issues – e.g. hiatus hernia, pyloric stenosis
Prematurity
Neurological conditions – e.g. Cerebral Palsy
Food allergy/intolerance
Pain response (hypersensitivity)
Tobacco smoke, some foods, certain medications
Myths about reflux
1. Reflux is just another name for colic
2. All babies have reflux – it’s no big deal
3. If the parent/baby are having problems, it’s because you’re an
inexperienced/first time parent
4. Children have to look sick and cry all the time to have reflux (“But
she looks so happy/healthy”)
5. If an infant gains weight well, their reflux is not serious or worth
treating
6. Your child will eat when they are hungry; no child will starve itself
7. Medications such as Omeprazole (e.g. Losec) must be crushed for
a baby
Our advice to parents
•
Trust your instincts
•
Keep a symptoms diary, take photos or videos of baby crying, have a
specific list of concerns
•
GP first – find one who has experience with reflux and is supportive
•
Seek diagnosis, based on symptoms – could be other issue with similar
presentation (e.g. UTI, Pyloric Stenosis, neurological or metabolic disorder,
etc.)
•
Take a support person with you to appointments (baby usually happy at
doctors)
•
Try medications – communicate regularly with GP
•
Get known at the local medical centre or specialists – be persistent for the
sake of your child
•
“Parenting is instinctual. Even with zero child/baby experience it still comes
naturally. If you know something isn't right, trust in that feeling and keep
seeking help. Too many parents start doubting themselves on their reflux
journey because they can constantly be undermined by people who just
don't understand it.”
Nicki, RISA Mum
Referrals
• Paediatrician – be prepared to find one who has
experience with GORD
• Paediatric Gastroenterologist – specialises in
digestive system disorders
• Paediatric Allergist
• Feeding Therapy Clinicians (e.g. Speech Pathologist,
Occupational Therapist)
• Specialist Dietitian
• Social Workers
• Counselling
Other management techniques
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Baby upright for 30 mins after feeds
Use a baby sling
Avoid slumping (e.g. baby capsules) that put pressure on the stomach
Elevate the head whenever lying down
Consider using a dummy
Avoid vigorous movements
Avoid tummy time after a feed
Change nappy before a feed (roll baby to side)
Avoid any tight clothing around the waist
Avoid exposure to smoke or dust
Rocking in a pram or rocker can be helpful
Use distraction – go outside, put music on, etc
Use a CD or white noise to prevent baby waking
Contact a support organisation for emotional support
Get out socially – find an understanding group
Lower expectations of what you can achieve (e.g. household tasks)
Feeding a refluxer
• Keep baby upright as much as possible
• Avoid overfeeding - if the baby vomits, wait until
the next feeding rather than feeding them again
• Experiment with feeding amounts and times
• Experiment with positioning and timing
• For a refuser, try feeding while just waking up or in
a quiet, dark room.
• Try thickening the feed (Infant Gaviscon or
Karicare thickener) after speaking to a medical
professional
• Bottle-fed - try AR (anti-reflux) formula, or a
hypoallergenic/soy one (after speaking to a medical
professional)
Introducing solids early?
• Some professionals will recommend introducing solids at 3
months of age. The theory behind this is thicker foods will
stay in the stomach easier and decrease the reflux
• Current research shows that the gut of a baby at 3 months
of age is not mature enough to digest food and introducing
at this early age can increase the risk of food allergies and
intolerance
• Recommendations are between 4-6 months of age (6
months if breastfeeding), when the baby shows signs of
being ready for food
• Many reflux parents have found that early introduction of
solids worsens the reflux
Allergies and sensitivities
• A lot of refluxers have food intolerances
• Cows milk protein intolerance/allergy is one of the
most common – approx. 40-50% of reflux babies/kids
(note: NOT lactose intolerance)
• There is a cross reaction with soy for over 50% of
babies with a cows milk protein intolerence/allergy.
• Introduction of solids can be difficult in sensitive
children and may need help from health professionals
• Elimination diets for breastfeeding mothers may be
required
• Having an infant with reflux and/or intolerances does
not mean you have to stop breastfeeding
Feelings parents may experience
• “This is not what I imagined it would be like” (mourning the loss of their
parenting dreams)
• “I am a failure as a mother, I am not cut out for this” (feeling like you are
not coping but should be)
• “Everyone else seems to like their baby more than I like mine” (no matter
how much you love your baby, not feeling happy around them is not
uncommon)
• “I just want to run away”
• “Everyone thinks I am a bad parent” (the feeling of being judged by other
parents, family members, friends and people in the medical profession)
• “Everything is a blur” (sleep deprivation may put a reflux parent into auto
pilot)
• “This will never end” (feeling positive about the situation can be hard)
• “My baby has been in pain everyday of his life” (it is devastating to a
parent to see their child in pain and feel helpless to do anything about it)
Thank you for your time
Any questions?
‘Reflux Reality: A Guide for Families’ can be
purchased from Michelle Anderson Publishing, by
emailing RISA on info@reflux.org.au, or through
various bookstores and online book sellers
Thank you for your time
Any questions?