I just read a great article about this topic:  Douglas, P. (2005).
Excessive crying and gastro-oesophageal reflux disease in infants:
misalignment of biology and culture. *Medical hypotheses, 64*(5), 897-898.
Abstract retrieved from
http://www.medical-hypotheses.com/‌article/‌S0306-9877(05)00008-3/.
 Basic premise:  humans were built to breastfeed frequently, while in close
contact with their mothers day and night.  Doh.  Interesting teaser:   "An
integrated clinical approach to crying babies less than three to four
months of age that considers feeding management (e.g., frequent feeds,
breast- or bottle-feeding technique, referral to a lactation consultant,
cow's milk allergy), parental responsiveness (e.g., prompt response to
infant cues), sensory nourishment (e.g., sling or backpack, walks, massage)
and sleep management (e.g., nocturnal co-sleeping) should, firstly,
decrease crying when applied to infants less than three to four months of
age, and secondly, decrease the incidence of GORD in these infants once
they are older than three to four months of age."

Cathy Genna's book "Supporting Sucking Skills" 2nd ed has a great couple of
pages on reflux ... and Bryan Vardebedian has a GREAT book aimed at
empowereinparents, called "Colic Solved."  Basic premise all the way
around: many infants have underdeveloped mechanisms for keeping stomach
contents in the stomach, and moving them through to the intestine.  Short
frequent feeds **controlled by the baby** (meaning feeds at breast),
followed by non-nutritive suckling and upright positioning, facilitate
comfort and trigger of ease of digestion (since suckling triggers
peristaltic motions down the esophagus).

Google up the many recent studies by Ruowei Li, Sara Fein and Laurence
Grummer-Strawn, who are mining the data from the government-run Infant
Feeding Practices Study.  They discuss the use of bottles -- even
containing expressed breastmilk -- and how that is tied to later obesity in
children.  No, obesity is not caused by reflux ... but these are nice
studies showing that bottle use -- even when there is expressed breastmilk
-- changes "who is in the charge" of the feed.  In other words:  we IBCLCs
know that the mouth, tongue and jaw all behave very differently when one is
BF vs. bottle-feeding, and these are some nice articles to emphasize that
very basic premise.

Taking a 35 weeker long-term NICU patient OFF the breast -- to use formula
which is inherently more difficult for the baby to digest, and will be
offered via a mechanical means that is strongly associated with difficulty
for reflux patients -- just does not seem at ALL sensible.


-- 
Liz Brooks JD IBCLC FILCA
Wyndmoor, PA, USA

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