Mellanie posted about the baby who <"thrashes and arches and fights his
way through every feeding......kicks, flails and arches his back
throughout the entire feeding. . . .Other pertinent information: The baby
has severe reflux that caused him to be re-admitted to the hospital at 1
week because he would stop breathing while refluxing.  He was on zantac
and reglan until 3 months.  At 3 months mom took him off reglan (after
discussing with her pediatrician) because he would not
sleep for more than 30 minutes at a time and was only sleeping a total
of about 8 hours per day.  His sleep greatly improved after the reglan
was discontinued.>

Just after reading her post, I turned to catching up on Medscape, and
found this interesting article:

Gastroesophageal Reflux in Infants: A Primary Care Perspective

Pediatr Nurs 30(1) 2004
Amy Lynn Arguin; Martha K. Swartz

". . . . .Nevertheless, the pediatric nurse should also be able to
distinguish GER from gastroesophageal reflux disease (GERD), which is a
pathologic process in infants associated with poor weight gain, signs of
esophagitis, persistent respiratory problems, dysphagia, and changes in
neurodevelopmental patterns.

Uncomplicated GER implies a functional or physiological process in a
healthy infant with no underlying systemic abnormalities . . . . .GER
that is not complicated by excessive crying, irritability, disturbed
sleep, feeding impairment, poor weight gain, or respiratory complications
can usually be diagnosed clinically without extensive evaluation. For 85%
of infants with uncomplicated GER, the condition is self-limited and
usually disappears between ages 6 and 12 months (Sondheimer, 2003).
GERD is a pathological process in infants manifested by poor weight gain,
esophagitis, occult blood loss, . . . . . . Arching and torticollis
(Sandifer syndrome) are believed to be related to the esophageal
discomfort induced by GERD, as the posturing may help clear esophageal
acid (Yellon & Goldberg, 2001). Childhood diagnoses associated with
increased risk of GERD include esophageal atresia with repair,
neurological impairment and delay, hiatal hernia, bronchopulmonary
dysplasia (related to prematurity), asthma, and cystic fibrosis (Jung,
2001).

Positioning
Holding the infant in a head-elevated position for 20-30 minutes after
feeding may reduce GERD (Farivar, 2001). The prone position has also been
shown to reduce reflux, aspiration, and crying time and speed gastric
emptying (Sherman, 2001). According to Borowitz (2002), after meals, the
best position to place a baby with reflux is lying prone with the head of
the bed raised about 30 degrees. Parents should be cautioned that placing
the infant in a prone position should only be done when the child is
awake and can be continuously observed. Prone positioning during sleep is
only considered in unusual cases where the risk of death from
complications of GER outweighs the potential increased risk of SIDS
(Rudolph et al., 2001). The semi-supine position after feeding, such as
when placing the baby in an infant car seat, exacerbates GER and should
be avoided (Rudolph et al., 2001; Sandritter, 2003)."
This mom is to be commended for hanging in there, but it sounds as if the
poor baby is miserable. If the positioning idea above has not been tried,
it is at least free.
Jean
************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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