Gastroesophageal reflux (GER)

What is Gastroesophageal reflux?
This is a condition in which the contents of the stomach "backwash" up into the esophagus and/or throat. It occurs because the ring of muscles that separates the top of the stomach from the esophagus isn't working properly. When this ring is weak and doesn't close tightly over a full stomach, stomach contents can leak back up.

This constant leaking irritates the esophagus (the tube between the stomach and the throat), causing a constant burning sensation and discomfort. If the leaking stomach contents back up all the way to the throat, there is frequent spitting up. The contents also can enter the infant's airway and cause choking, coughing, difficulties with breathing, and, under some circumstances, lung infections

How Does GER Affect My Child's Eating?
The constant burning, spitting up, or choking caused by GER can come to be associated with mealtimes. Some children may refuse to eat, stop eating after only a small amount of food, cry, become irritable, or use other methods of communicating their discomfort. Weight gain may become a problem.

But for some children, the problem is more severe. Parents continue to report spitting up after most meals, poor weight gain, irritability, and mealtime stress. Below are some common recommendations for control of reflux.

Medical Intervention
First and foremost, contact your child's doctor. Together you can determine an appropriate plan of action. Sometimes this plan includes changes in formula consistency or in body positioning. Othertimes, medication may be used. If the complications of your child's reflux are of some concern, farther medical studies may be recommended to determine how much reflux is occurring, how often, and if stomach contents are entering the airway.

Positioning
All of the problems associated with GER are exaggerated when babies spend a great deal of time lying flat. As these babies leam to move around on their own, changes of position also can cause excessive spitting up. There are a variety of opinions on the value of controlling GER through positioning. However, it generally is believed that keeping children in a more upright posture all the time helps.

This can be quite a challenge with a very young baby or a very mobile one. Babies with GER should be positioned so they are at a 30° angle or greater at any time. This can be done by sitting or propping your baby in a more upright position during the day, and using a foam wedge in the crib for sleeping.

You'll have to be vigilant about positioning during the day. The child should be upright, not slouching or leaning in the infant seat or swing.

This can be accomplished by placing towel rolls, stuffed toys, or a cut-out piece of foam around the baby.When infant seats or car seats are used, it's important to roll a small towel and place it behind your baby's back at waist level to keep the back straighter. A front pack carrier also can be used to provide close touch and upright posturing. Your child's doctors or feeding therapist can help you determine the most appropriate posturing.

Thicken Formula
Some doctors recommend thickening formula, in hopes that the heavier liquid will settle better in the stomach and be less likely to come back up. To thicken formula, add 2 tablespoons of dried baby rice cereal to each 4 ounces of formula. To accommodate the thicker formula, you'll need toenlarge the nipple hole slightly. Some parents make a small slice or cross cut in the top of the nipple, while others purchase commercially available cross-cut juice nipples. You'll know if the liquid flow is too slow because the baby will take too long to suck the formula and become frustrated. If the flow is too fast, the baby will choke, cough, or gag. Make nipple adjustments accordingly.

Hang in There
The problem of reflux is a frustrating one for both parents and babies. Seek support from your baby's doctor and feeding therapist to find the combination of recommendations that works best for you and your baby.

Resources
Danny slings are available through GER Devices, Inc., 14 Fairfield Street, Lowell, MA, (508) 452-6100.

Parent Support:

American Pediatric Gastroesophageal Reflux Association
c/c Patricia DeLuca
106 Babcock Avenue
N. Weymouth, MA 02192
(617) 331-2238.

References

Glass, R. P., and L. S. Wolf. Clinical management of gastroesophageal reflux: A guide for parents. Seattle, WA: Children's Orthopedic Hospital and Medical Center.

Wolf, L. S., and R. P. Glass. 1992. Feeding and swallowing disorders in infancy: Assessment and management. Tucson, AZ: Therapy Skill Builders.