I, too, have seen babies with histories of inconsolable crying who were
ultimately evaluated with swallowing studies and found to have reflux. Two
of these babies had esophageal ulcers from the acidity of the gastric
contents of the stomach refluxing back into the throat. So while I want to
avoid over-diagnosing the 'spitty' baby -- who I agree is just presenting
parents with a laundry problem -- I don't want to dismiss the idea that
reflux can be a very painful problem for some babies.
Two new ideas that I got from Wolf and Glass's book, Feeding and Swallowing
Disorders in Infancy:
One is the idea that caffeine and theophylline (often given directly to
infants with respiratory problems) contribute to decreased lower esophageal
sphincter tone (LES). This thereby increases gastroesophageal reflux (GER).
(pg 340) I wonder if cutting out caffeine in nursing moms with colicky
babies would be useful, since we know infants can be exposed to caffeine
thru the mother's milk. (Not ususally a problem in reasonable quantities,
but maybe it is for the refluxing infant).
Also, they cite a study by Orenstein that suggests that non-nutritive suck
(NNS) affected the incidence of GER depending on the infant's position.
NNS increased the frequency of reflux episodes slightly in prone, but
slightly decreased the frequency of reflux episodes in sitting. (pg 341) So
maybe NNS in car seat with baby well supported by foam wedge would help some
infants obviously in pain.
They go on to discuss Orenstein's observations that the sitting position is
often used to help refluxing babies, but that small infants slouch down so
much in infant seats which placed the entry of the esophagus into the
stomach below the level of the stomach and increased the intra-abdominal
pressure, causing more reflux and increased crying. I have noticed this
myself. Parents with real spitty, colicky babies are often aggressively
trying to burp the babies. They sit them upright, bend them slightly
forward. Close observation reveals this jams the edge of the diaper into
the baby's gut. Baby looks pained. I usually suggest a more upright
burping position over the shoulder with baby more extended with just gentle,
diffuse pressure from shoulder on baby;s abdomen. Parents can also learn to
keep baby's trunk elevated at a 45 degree angle and avoid marked hip flexion
during diapering, etc. to decrease abdominal pressure.
My test for whether it's reflux or benign wet burping: If baby looks just
about as happy as it comes up as he did when it was going down, it isn't a
pathological condition. Crying is a stress cue. Extreme crying indicates
extreme stress and should never be ignored.
Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html
***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
