I’d like to say that it’s only the first 6 weeks with a new baby that are hard. Magical, wonderful, exhausting, surreal and… hard. But truthfully, every moment as a parent is filled with so many conflicting emotions. Whether or not you decide to bottle or breastfeed, baby wear or not, co sleep or not, one central aspect of parenting is always wanting what’s best for your child. We want our children to be happy and healthy.

A common question raised at most newborn check-ups is whether my baby is in pain. The thought of your little one in pain can be very distressing – and rightfully so, every parent wants to rule it out asap. The culprit most often blamed for apparent pain in babies is reflux.

Reflux in babies and infants has generally become a “hot topic”. It is often blamed for much that goes “wrong” with feeding, sleep patterns or general contentedness of our babies. Sometimes, reflux IS to blame, and other times it’s just an innocent bystander. I have dealt with reflux a lot – both as a paediatrician and as a mom. Two of my three kids suffered from Gastro oesophageal reflux disease (GORD) - my son’s was so severe that I had to be dairy free for 5 months, nut and egg free for 1 month,  all while he was on maximum nexiam doses and saw a physio weekly. It is stressful and heart-breaking. I am also quite aware and am honest with my patients that reflux is not the cause of everything.

When discussing reflux its important to highlight two terms – Gastro-oesophageal reflux (GOR) and gastro-oesophageal reflux disease (GORD). GOR is a normal process in babies. These children show no pathological symptoms of their reflux and are affectionately known as ‘happy spitters’. They feed and grow well and are mostly just a laundry issue due to frequently vomiting on their clothes. GOR is extremely common in healthy infants in whom gastric contents can reflux into the oesophagus 20 or more times a day. Babies are prone to GOR for a few reasons: their lower oesophageal sphincter can be weak (which strengthens over time), they have a short oesophagus, they feed 100% liquid diet and spend most of their first weeks asleep on their backs. Milk is bound to regurgitate into the oesophagus.

So, when does GOR become GORD? Your baby may have GORD if Your baby’s symptoms include any of the following:

• Poor feeding – small volumes frequently or food refusal
• Coughing with feeds
• Gagging with feeds
• Poor weight gain or weight loss
• Wheezing
• Arching of back right after feeds

If you are worried that any of these symptoms are present in your baby its best to see your Paediatrician. A general exam to rule out anything else more sinister (e.g.  sepsis, airway compromise etc) or to find clues as to underlying predispostions to reflux is essential.

The work up for GORD may include the following:

• Ph probe: This test checks the pH or acid level in the oesophagus. A thin, plastic tube is placed into your child’s nostril, down the throat, and into the oesophagus. The tube has a sensor that measures pH level. The other end of the tube outside your child’s body is attached to a small monitor. This records your child’s pH levels for 24 to 48 hours.
• Upper GI series or contrast swallow: This test looks at the organs of the top part of your child’s digestive system. Your baby will drink a substance called gastrograffin which then shows up white on subsequent x-rays. The contrast swallow gives us information about the anatomy of the GI Tract.
• Endoscopy: This test checks the inside of part of the digestive tract. It uses a small, flexible tube called an endoscope. This test if carried out by a gastroenterologist and is the last resort in those patients who are not responding to medical management.

Management is very much dependent on the individual:

• Ensuring a good latch, with good seal so as to limit air being sucked it
• Positional changes: keeping your little one upright for 30 mins post feeding helps improve reflux by allowing gravity to aid in keeping stomach contents in the stomach
• Good winding techniques
• Thickened formulas if not breastfeeding
• Exclusion of dairy from baby’s diet: (either mom goes dairy free for hydrolysed formula is used). Some studies suggest that up to 40% of infants with GORD have a food protein intolerance. The majority of these infants will be sensitive to cow’s milk alone, but a substantial number are also sensitive to soy proteins. About 30-50% of cows milk protein intolerant children with cross react to soy products
• Nexiam trial – this is when your paediatrician will forego reflux testing and will start Nexiam for a two week period. Symptoms are monitored to see if they improve. If they do, then the conclusion is made that GORD is present and the nexiam is continued for a specified time

Lots of grunts and groans and squirms are completely normal in the first 8 to 12 weeks. If, however you are worried about your baby and the potential of GORD, chat to your doctor – there are no stupid questions or unnecessary consults when your mom/dad sense is tingling.

Written By: Dr Kim Barnard - FCPaed(SA), MMed(Paeds)

Kim is a General Paediatrician in private practice, as well a mom of three – (almost) 6-year-old Lily and 16-month-old twins, Abby and Nate. Her scope of practise includes Neonatal ICU, paediatric ICU as well as consults in the rooms for all ages. Working with children has always been her happy place. She has a special interest in neonatology as well as childhood allergies. She works as part of a group practise in Bryanston and can be contacted on 011 706 1153 or www.drmikgreeff.co.za