After getting many referrals for nutrition evals from several sources to
help babies with GER, I agree with Pat (from a Wisconsinite transplant
that took in the South).

> Sleeping on the back.
> > Ibuprophen use in the first 2 weeks
> > Ultrasounds in-utero
> > Caffeine use by mother
> > Car seat use throughout the day
> > High parental stress/fear
>
and Annie VerSteeg IBCLC's idea of IRON.

I can't say why the big concern over "spitting-up" being classified as
GER and actually medicating it!  I'm with Nancy about recommending meds
only with preemies that have serious lung function problems--"breath or
eat" problems and preventing aspiration.  Thickening formula really
doesn't work because the food stays in the stomach longer, therefore,
increasing the chance of spitting-up for an active or "floppy" baby.

The lower esophageal sphincter muscle (LES) is normally immature in
full-term infants, and matures slower in preemies because they are using
their stomachs earlier.  Of course the formula companies do NOT help by
offering AR (antireflux) formulas that have rice cereal mixed in them.

I counsel families on tips to do anti-GER:  positioning, small frequent
feedings and car seat back support--a rolled-up small towel placed in
the small of the baby's back in the seat, and looser clothing/diapers.
All tips are for reducing pressure on the LES, which are similar for
adults.

I don't hear too much about GER much with breastfed babies.  Then again,
I don't see many breastfed babies around here.

Diana M. Miller, MPH, RD
pediatric nutritionist
Rockingham, NC

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