Diane asked about the November 2007 Pediatrics study on reflux. I read
it when it first came out at the beginning of the month. Absolutely
fascinating article, IMO; I recommend it highly to everyone that deals
with reflux (which I suspect is most of us). Personally we see a lot of
babies being treated for reflux here in Miami.
As to breastfeeding: no it was not addressed in the article - not that I
can see. I just took another look at it to be sure. But it is relevant
to us anyway as the bottom line is the same, i.e., in this study MOST of
the babies being treated with prescription reflux meds DID NOT HAVE GERD
when actually tested for it.
Here is one useful sample from the study:
"On the basis of the data of this study, we believe that most infants
who had reflux symptoms and were referred to our pediatric specialty
service did not meet the strict diagnostic criteria for GERD yet had
received some anti-GERD medications. Withdrawal of the medications did
not result in any worsening in the majority of these infants. Only ~20%
of the infants in the study had evidence of an underlying pathology to
explain their symptoms, such as GERD, pyloric stenosis, or renal tubular
acidosis."
In their study, regurgitation alone was the symptom in the infants who
proved not to have GERD, if I am reading the study correctly. The ones
with abnormal pH-probe tests frequently had *additional* symptoms in
addition to regurgitation.
One thing this study has done has been to remind me to ask every client
whose baby is being treated for reflux if he has been tested for it. So
often the answer is no! And yet here they are, bottling their milk in
order to thicken it with cereal (don't get me started!) and giving the
baby prescription medication for it.
Another thing I found interesting was about the thickening of feeds -
according to the study authors it is being done incorrectly.
"Overfeeding and thickening of the formula were noted
frequently...thickening of feeds was commonly advised, but concomitant
reduction in the volume was not made, resulting in excessive
volume/energy intake. Overfeeeding results in gastric distension that
is a precipitating factor for inappropriate relaxation of lower
esophageal sphincter, a hallmark of reflux."
Isn't that lovely? Baby spits up. Baby is treated for this, in part, by
overfeeding, which...makes it worse!
I wish I could quote the entire article (hope I haven't quoted too much
already); this study hits a lot of my buttons and I have not hit all of
the highlights. Read it, folks!
Regina M. Roig-Romero, BS IBCLC
Senior Lactation Consultant
Miami-Dade County Health Dept WIC/Nutrition
Breastfeeding Program
7785 NW 48 ST, Suite 300
Miami FL 33166
(786) 336-1333 x162
(786) 336-1345 fax
(786) 336-1336 Breastfeeding Helpline
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