dastardly devil: reflux

also called gastroesophageal reflux
is your baby-
spitting up frequently (more than 2 times a day);
fussy often throughout the day (specifically before, during or after eating)
refusing to eat,
fighting eating;
taking only small amounts of milk, regardless of the amount of time since the last feeding;
back arching during feedings;
choking or apnea during or after eating;
skin color turns pale or grayish during or after eating;

poor weight gain; and/or
having frequent respiratory infections.then they probably have reflux
here's what prematurity.org has to say on the subject..

Gastro means stomach, and esophageal refers to the esophagus, the tube inside the throat that connects the mouth to the stomach. A muscle at the top of the stomach (also called the Lower Esophageal Sphincter or LES) naturally opens and closes to allow swallowing, burping, and vomiting. Refluxing occurs when the stomach acid and partially digested food flow back up through the LES into the esophagus. All children and adults will naturally reflux throughout the day, especially after eating. However, if the muscle opens too frequently and refluxing occurs too often, complications can develop.
Premature infants have an increased risk of developing GER. There are several medical conditions that can cause reflux, but in preterm infants, the most common causes are immature muscles and abnormal breathing from chronic lung disease. If the lower esophageal sphincter is weak or underdeveloped, it can remain open when it should be closed, letting the stomach contents flow back up the esophagus. When an infant or child breathes abnormally because of chronic lung disease, the muscles used for breathing work harder. As these muscles work hard to breathe, they can pull on the muscles near the top of the stomach, stretching the sphincter and causing it to remain open.

so, duh... i think we all know most of this.. but if you didn't, now you do. the little bird has never had bad reflux to speak of. even now she only gets really upset about spitting up every few days or so. but she does spit up after almost every feed. (even when we elevate her after feeds and feed her slowly, etc.) so, you can imagine i have been against treatment for something that has basically no side effects. (being one of the "less intervention" mindset.) i was super jazzed when the doctor who did wren's follow up said that she wouldn't recommend meds until it was causing a weight gain problem, or causing more pain etc. great news!

then, we had our pulmonology appointment. the pulmonology doctor, (who, incidentally is an attending, and the other doc was a resident), said that she definitely recommends reflux meds if the babies have it at all. the reason being that the esophagus not only becomes inflamed, but if the spit up actually spills over into the airway it can cause inflammation in the airway/lungs as well. (and after all, she's already got damaged inflamed lungs- no need to add more to that.) after about 15 minutes describing everything in detail she had me sold. she also told me that prevacid has so few side effects that you could basically take it your whole life with no adverse effects. (unlike the diuretics she's on, where they have to monitor her electrolytes constantly.)

some things that us hippy mommas might try before meds are:
thickening the milk
elevating the little one after feeds (until almost the next feeding time), upright, not scrunched over

feeding slowly
burp frequently
use a bink (using the esophagus pushes the spit up back down)
don't move the babe around quickly, or press on the stomach

if all that doesn't work, and meds (such as prevacid, tagament, or zantac) don't work. you may have to have a little surgery to create an artificial flap over the esophagus. bummer!

i found this amazing contraption... SO great for those little pukers. it says 8lbs and above...but who's counting? i think all of us preemie moms have come up with creative ways to make full term baby products work for us... and our little three pounders.


Kathy said...

I wish I'd known about that chair sooner. I found out about it when Andrew was too old and could roll. We used a wedge and sleep positioner, but I think this would have been a lot better!

Lindsay H. said...

Both of my babies, though born at 37 weeks, experienced what we thought was reflux. The doctors were quick to put them on meds, but they did not seem to help much. My kidos were formula fed since I was not woman enough to keep up with feeding two of them. We tried things like thickening and even switching to soy. After about seven months of lots of puke, but fat babies, I finally switched to a lactose free milk based formula. Sure enough my kids both have a lactose problem (not milk, but lactose). The puke and tummy pains stopped within two days! So even for nursing moms check your milk intake to see if that could be the problem. Much easier than trying to get an infant to take meds!