Date: Wed, 23 Jul 2003 12:58:41 -0400
From: Mary Jozwiak IBCLC <[log in to unmask]>
Subject: Re: GERD
I have felt for the last few years that "reflux" is the new trendy
diagnosis of the early 21st century, similar to what "ear infections"
were in the 1980s and early 1990s.
Dear Mary (and everyone else in this interesting discussion),
I couldn't agree with you more about GERD being the "flavor of the
month" when it comes to crying babies. I know that when I was starting
my pediatric training 30 years ago in NYC, I was taught to prescribe
paregoric (a mix of alcohol and opium!) to crying babies...today, if I
tried that I would be put in jail for child abuse.
Then came anti-spasm medicines. These were sold in millions of doses
until some babies went into coma and died as a side effect of these
medicines (these medicines were probably working because they had a
strong sedative effect, not because the baby had intestinal spasm).
Next, we were pushing colic drops of simethicone (2 double blind studies
have shown these to be no more helpful than drops of plain water).
There are no great figures about the frequency of pain from reflux in
young infants, but the little that there is points to an incidence of
perhaps 2-3% of fussy babies (that's perhaps 1/200 of all babies).
Spitting up is normal! However, there are definitely some babies who
have pain or poor weight gain from GERD.
Studies show that an upper GI is a waste of time in diagnosing these
kids (the UGI may be abnormal in a normal baby and normal in a baby with
bad GERD). Even putting a tube down a baby's esophagus to check for
acid reflux is an unreliable test for GERD.
Furthermore, many babies with GERD do not respond to the usual
antireflux medicines...so it's hard for doctors to know what to do
sometimes.
Since my book came out last year, I have received many letters from
parents whose babies screamed, were put on anti reflux medicine and
continued to scream, only to be quickly calmed by the 5 S's.
And, I have received letters from parents whose babies definitely
improved on antireflux medicine , but also improved with the 5 S's and
were able to get of the medicine once their parents got good at the
calming technique.
It seems that some babies are sooo sensitive to the normal sensations of
digestion (a little gas, a little acid, a little burp) they just throw
themselves into hysteria...and once they get upset they don't have the
ability to soothe themselves back down. That's why so many kids squirm
after eating. It is NOT because the have acid burning their esophagus,
it's because they are supersensitive to the normal "gastro-colic reflex"
(that's the baby reflex that makes their intestines get active and make
them poop right after they eat). You can be sure it isn't pain when the
baby calms in seconds with the 5 S's.
In one major pediatric hospital in LA, doctors now do the 5 S's on all
young babies (under 3 months) who come to the ER because of persistent
crying. They do them before doing any other tests because babies who are
not ill calm down quickly with this simple approach and the doctors are
able to avoid having to do expensive and invasive tests like spinal taps
and blood studies.
I have begun a campaign to educate pediatricians about colic and the 5
S's. I hope to persuade doctors to try this simple approach before
telling parents their baby has a disease and trying them on medicine.
Harvey Karp, MD
UCLA School of Medicine
Author, The Happiest Baby on the Block
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