At one of the hosp I work
>in as an LC, it's common practice for the ped to refer to
>pedgastroenterologist, who then prescribes CEREAL, Reglan and/or Tagamet.  It
>
First of all, what is Reglan?? Cereal and other thickeners are not usually
used in Western Australia by paeds. Usually, positioning is used as a first
treatment (baby kept with head/chest higher than abdomen all the time,
during feeds, sleep, changing nappies etc) If that is not successful, then
an antacid with an alginate 'raft' effect such as gaviscon in powder form
is used prior to feeds in a small amount of ebm. This helps many infants
and avoids anything which is absorbed systemically. Another benefit
over other antacids is that it does not contain aluminium. In cases which
don't respond to posture and gavistcon, a drug called cisapride (brand name
 prepulsid in Australia) is used. This
acts to increase the muscle tone of the gastro-oesophageal sphincter, and
thus prevent reflux. The major side effect can be increased tone of all
gut muscle, with some cramping or 'diarrhoea', but most babies seem to
cope well with few problems (even in the very young). Drugs such as Tagamet
have fallen out of favour in some circles as they have the potential for
more side effects and don't seem to work as well as cisapride does in most
cases. Very occasionally, I have seen a paed use both drugs together,
usually after scoping the baby and finding ulcers etc in the oesophagus.
 Naturally, in all
cases the diagnosis would have to be made before launching into any type
of pharmaceutical treatment, but I have used either gaviscon or prepulsid
as a diagnostic tool when a baby is very fussy, fretful and yet breastfeeding
seems to not be the problem. The diagnosis is harder to make in the baby
who does not actually spit up a lot, and often parents have coped with
a very 'difficult' baby for some time, being told it is colic, wind,
bad temper etc etc before finding that the poor little thing had terrible
heartburn (no wonder they cry!).  Hope this helps :)

(PS, does my 'signature' appear on these postings - I have a feeling my
computer is forgetting to put my name etc on these notes, could somebody
let me know??)