Spitting up a lot in the healthy, happy baby is a non-issue.  Yes, it is
evidence of reflux, but it isn't bothering anyone so doesn't need treatment.
Painful reflux (silent -- without spitting or reflux with emesis) is an
important cause of failure to thrive in some infants, and contributes to a
lot of familial stress.  I think it is different from colic (which tends to
be observed in well-growing babies -- both breast and bottle-fed -- who have
some period of episodic crying each day.) Refluxing babies tend to be
unhappy all the time, to not grow well, and to have crying that is not
confined to a specific time each day.

 Poorly designed car seats cause babies to slump, thereby  increasing
abdominal pressure.  They may well make reflux worse.  It's better to use
open seating and burping positions (not bending baby over diaper waistbands)
to prevent increased abdominal pressure during or after feeds. Long feed
intervals probably also make reflux worse.  These long intervals promote
frantically hungry babies who feed by gulping lots of foremilk, and end up
over-feeding.   Feed frequently, thus insuring creamier feeds, smaller vols
at each feed and a baby who is less likely to cry a lot and gulp air and
milk.

 Additionally, sometimes stressful deliveries (really rapid or very long
deliveries) can cause painful  gastric ulcers in infants.  I lectured
recently with Maryelle Vonlanthen, MD (the pedi GI) and she mentioned this.
She emphasized that so many of these "mystery" disorders, from suspicion of
food allergy, blood in the stools, and things like suspicion of esophageal
damage from GERD can all be readily identified by scoping the babies.
During these proceedures, a specialist can visualize the rectum or the
throat and see if there is erosion, eosinophils (as allergy markers), or
infection.  Endoscopy involves looking down the throat, and a rectal scope
is a quick peak up the bottom.  These proceedures are momentarily invasive,
but are very brief.  Once you actually look, you know what you are dealing w
ith and the correct treatment or management can be then instituted with way
less trial and error and stress to the family.  I appreciate that some
families want to avoid tests, but face it, the easy fixes prob. don't have
much going on, and the persistantly crying, poorly growing baby with the
totally stressed family deserves a diagnosis rather than months of
inaccurate guess work.  I worked with a mom whose baby dropped over 4 months
from the 75th to below the 5th percentile in weight due to GER.  By the time
investigatory tests were finally performed, the baby had esophageal ulcers
and such an oral aversion due to her association of pain with eating that
(even with meds) she needed 3 months of fairly intense Occupational Therapy
in order to manage solids.

I think the overuse of meds and unnecessarily restrictive maternal diets to
treat these kids would be reduced if the diagnoses were more accurate.
Breastmilk feeds are always best, but management of overactive letdown,
oversupply, and foreign proteins in the milk provoking food intolerance sx
may be needed.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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