my child has silent reflux? Help!

[julie]

Hi,
My child is 3.5 months old. I believe she has silent reflux but not
sure. I did take her to GI ped. and he thinks it's silent reflux. He
put her on 1 ml of zantac twice a day (been 4 days now...) My child
refuses bottle when she sees it coming, even before she takes it. She
does not throw up but refuses the bottle. So, it's very hard for me to
feed her. The only time I can get her to feed is when she is deep
asleep. Therefore, I can't feed her in the daytime. It's a very
frustrating situation, because she is only taking maybe 10 oz in 24
hour period. I don't know what to do...do I need to tube feed her? I
do not want to force her to eat when she refuses, because I'm afraid
she might get food aversion and make situations worse. If you have any
suggestions, please help me. thank you.
Julie

[dragonlady]

In article >,
(julie) wrote:

> Hi,
> My child is 3.5 months old. I believe she has silent reflux but not
> sure. I did take her to GI ped. and he thinks it's silent reflux. He
> put her on 1 ml of zantac twice a day (been 4 days now...) My child
> refuses bottle when she sees it coming, even before she takes it. She
> does not throw up but refuses the bottle. So, it's very hard for me to
> feed her. The only time I can get her to feed is when she is deep
> asleep. Therefore, I can't feed her in the daytime. It's a very
> frustrating situation, because she is only taking maybe 10 oz in 24
> hour period. I don't know what to do...do I need to tube feed her? I
> do not want to force her to eat when she refuses, because I'm afraid
> she might get food aversion and make situations worse. If you have any
> suggestions, please help me. thank you.
> Julie

How is her weight? If you are breastfeeding (and I see by your
crossposting, that you are also posting there) how can you be sure she's
getting so little?

If her weight and energy level and all that are doing OK, I wouldn't
worry about the amount she is eating -- absent a serious problem, all
trying to force her to eat when she doesn't want to will accomplish is
to set food up as a power struggle. I know how hard it is to watch a
child that YOU think must be hungry not eat -- but it babies commonly go
through periods where you'd swear they are living on nothing but air!
(Breathaterians . . .) Trust her to know if she's hungry, don't try to
force her to eat, and pay attention to her general health, not to how
much she's eating.

meh
--
Children won't care how much you know until they know how much you care

[Leigh Menconi]

"julie" > wrote in message
om...
> Hi,
> My child is 3.5 months old. I believe she has silent reflux but not
> sure. I did take her to GI ped. and he thinks it's silent reflux. He
> put her on 1 ml of zantac twice a day (been 4 days now...) My child
> refuses bottle when she sees it coming, even before she takes it. She
> does not throw up but refuses the bottle. So, it's very hard for me to
> feed her. The only time I can get her to feed is when she is deep
> asleep. Therefore, I can't feed her in the daytime. It's a very
> frustrating situation, because she is only taking maybe 10 oz in 24
> hour period. I don't know what to do...do I need to tube feed her? I
> do not want to force her to eat when she refuses, because I'm afraid
> she might get food aversion and make situations worse. If you have any
> suggestions, please help me. thank you.
> Julie

As the GI doctor for a different medication if you think the medication
isn't working but you might want to give it another week or so on the zantac
because it's one of those things that you're not going to see an overnight
difference with. Zantac did absolutely *nothing* to help my daughter's pain
from the acid reflux and her prescribed regimen of giving it 1/2 hour before
meals and at bedtime was too difficult to follow given her strange
feeding/sleeping schedule. Prilosec can be compounded into a suspension
(but it's very expensive) and prevacid has a powder that can be mixed with
water into a yummy strawberry flavor. Both only have to be dosed about
every 12-24 hours. By the time my daughter was put on prilosec (she's now
on the prevacid), she was over 3 and had developed a nasty case of corrosive
esophagitis and was very averse to eating anything because of the pain she
experienced shortly thereafter. NG-tubes work well int he short-run (she
had one from 5mo-9mo then got a g-tube), but they can cause sensory issues
in oral-motor development that are sometimes difficult to overcome later
when moving on to table foods. (i.e., don't want anything coming near their
face like a spoon or fork during feeding or becoming averse to
toothbrushing, etc.)

Other general tips for helping keep the acid down is to put the baby in a
car seat or bouncy-seat for at least 1/2 hour after feedings to let the food
get past the stomach so that the acid doesn't come up. Even carrying the
baby around can exacerbate the problem during that first half hour.

Leigh in raLeigh
mom to Aaron (8yo, ADHD) and twins
Edward (4 1/2) and Claudia (4 1/2, Down syndrome, reflux due to
hypotonia)

[Jeff]

"julie" > wrote in message
om...
> Hi,
> My child is 3.5 months old. I believe she has silent reflux but not
> sure. I did take her to GI ped. and he thinks it's silent reflux. He
> put her on 1 ml of zantac twice a day (been 4 days now...) My child
> refuses bottle when she sees it coming, even before she takes it. She
> does not throw up but refuses the bottle. So, it's very hard for me to
> feed her. The only time I can get her to feed is when she is deep
> asleep. Therefore, I can't feed her in the daytime. It's a very
> frustrating situation, because she is only taking maybe 10 oz in 24
> hour period. I don't know what to do...do I need to tube feed her? I
> do not want to force her to eat when she refuses, because I'm afraid
> she might get food aversion and make situations worse. If you have any
> suggestions, please help me. thank you.
> Julie

Call the doctor. Ask her what to do.

[PF Riley]

On Sat, 15 Nov 2003 18:35:44 GMT, "Leigh Menconi"
> wrote:
>
>Other general tips for helping keep the acid down is to put the baby in a
>car seat or bouncy-seat for at least 1/2 hour after feedings to let the food
>get past the stomach so that the acid doesn't come up.

This sounds like a good idea, as does the idea of strapping a child
onto a wedge at night, but I've read two studies that demonstrated
that at best it does nothing, at worst it makes reflux worse. I can
get the citations next week if you like.

PF

[Kathy Cole]

On Sun, 16 Nov 2003 02:00:24 GMT, (PF Riley) wrote:

> This sounds like a good idea, as does the idea of strapping a child
> onto a wedge at night, but I've read two studies that demonstrated
> that at best it does nothing, at worst it makes reflux worse. I can
> get the citations next week if you like.

Those sound very interesting (not to mention counter-intuitive). I'd
like to see those, especially if they also say anything with respect to
keeping the kid vertical as opposed to partially horizontal for that
half hour. Thanks PF.

[CBI]

"Kathy Cole" > wrote in message
...
> On Sun, 16 Nov 2003 02:00:24 GMT, (PF Riley) wrote:
>
> > This sounds like a good idea, as does the idea of strapping a child
> > onto a wedge at night, but I've read two studies that demonstrated
> > that at best it does nothing, at worst it makes reflux worse. I can
> > get the citations next week if you like.
>
> Those sound very interesting (not to mention counter-intuitive). I'd
> like to see those, especially if they also say anything with respect to
> keeping the kid vertical as opposed to partially horizontal for that
> half hour. Thanks PF.

The thinking is that many of these bouncy chairs and car seats allow the
kids to slide down in them and become "smushed". When you see one of these
kids in this position it is not hard to imagine that the intra-abdominal
pressure is increased. Presumably, something that keeps the head elevated
and the back straight, without folding over the middle, would be better.

--
CBI, MD

[Kathy Cole]

On Sun, 16 Nov 2003 19:01:05 GMT, "CBI" > wrote:

> The thinking is that many of these bouncy chairs and car seats allow the
> kids to slide down in them and become "smushed". When you see one of these
> kids in this position it is not hard to imagine that the intra-abdominal
> pressure is increased. Presumably, something that keeps the head elevated
> and the back straight, without folding over the middle, would be better.

That makes sense; the wedge part not helping doesn't make sense to me,
but I'd like to look at the studies. My youngest had what I understand
to be typical preemie reflux, and his isolette allowed his head to be
elevated, plus we used a firm wedge at the head of his crib mattress for
a while.

[PF Riley]

On Sun, 16 Nov 2003 14:39:17 -0500, Kathy Cole >
wrote:

>On Sun, 16 Nov 2003 19:01:05 GMT, "CBI" > wrote:
>
>> The thinking is that many of these bouncy chairs and car seats allow the
>> kids to slide down in them and become "smushed". When you see one of these
>> kids in this position it is not hard to imagine that the intra-abdominal
>> pressure is increased. Presumably, something that keeps the head elevated
>> and the back straight, without folding over the middle, would be better.
>
>That makes sense; the wedge part not helping doesn't make sense to me,
>but I'd like to look at the studies.

The wedge part would make sense if you presume that gastroesophageal
reflux is largely influenced by gravity. I honestly think it is not.

PF

[Leigh Menconi]

"PF Riley" > wrote in message
...
> On Sun, 16 Nov 2003 14:39:17 -0500, Kathy Cole >
> wrote:
>
> >On Sun, 16 Nov 2003 19:01:05 GMT, "CBI" > wrote:
> >
> >> The thinking is that many of these bouncy chairs and car seats allow
the
> >> kids to slide down in them and become "smushed". When you see one of
these
> >> kids in this position it is not hard to imagine that the
intra-abdominal
> >> pressure is increased. Presumably, something that keeps the head
elevated
> >> and the back straight, without folding over the middle, would be
better.
> >
> >That makes sense; the wedge part not helping doesn't make sense to me,
> >but I'd like to look at the studies.
>
> The wedge part would make sense if you presume that gastroesophageal
> reflux is largely influenced by gravity. I honestly think it is not.
>
> PF

I do think it is largely *influenced* (not caused) by gravity since in many
cases, the problem is the immaturity or hypotonia of the sphincter between
the stomach and esophagus. A child whose sphincter closes off properly
after feeding would not have problems in a horizontal position. In my
daughter's case (hypotonia related to Down syndrome), her entire digestive
system is slow due to the hypotonia so the acid remains in her stomach even
longer than most (which is why she suffers from constipation on the other
end). I agree that an improperly seated child (car/bouncy seat) could slump
down and this slumped position could exacerbate the problem; proper
positioning and propping up with rolled up towels to prevent that solve that
problem.

Leigh

[Herself]

julie > wrote:

> If you have any
> suggestions, please help me. thank you.

I've heard a lot of people say the same thing, and their kids were
diagnosed with a milk/dairy allergy. Maybe get that checked out?
--
'Tis Herself

[PF Riley]

On Mon, 17 Nov 2003 14:41:33 GMT, "Leigh Menconi"
> wrote:
>"PF Riley" > wrote in message
...
>>
>> The wedge part would make sense if you presume that gastroesophageal
>> reflux is largely influenced by gravity. I honestly think it is not.
>
>I do think it is largely *influenced* (not caused) by gravity since in many
>cases, the problem is the immaturity or hypotonia of the sphincter between
>the stomach and esophagus. A child whose sphincter closes off properly
>after feeding would not have problems in a horizontal position.

Reflux occurs when the smooth muscle of the stomach contracts. The
idea is for the stomach contents to go through the pylorus into the
duodenum. If the pseudosphincter at the gastroesophageal junction is
loose (as it is physiologically in normal infants), some material will
also reflux upwards into the esophagus. (Think of squeezing a tube of
toothpaste with a hole poked in the back.) This muscular action is
largely unaffected by gravity. Perhaps the position of the infant will
affect how far up the esophagus the refluxed material actually goes
(possibly turning frank spitting-up into "silent" reflux), but the
reflux still happens nevertheless.

PF

[happy mom]

(julie) wrote in message >...
> Hi,
> My child is 3.5 months old. I believe she has silent reflux but not
> sure. I did take her to GI ped. and he thinks it's silent reflux. He
> put her on 1 ml of zantac twice a day (been 4 days now...) My child
> refuses bottle when she sees it coming, even before she takes it. She
> does not throw up but refuses the bottle. So, it's very hard for me to
> feed her. The only time I can get her to feed is when she is deep
> asleep. Therefore, I can't feed her in the daytime. It's a very
> frustrating situation, because she is only taking maybe 10 oz in 24
> hour period. I don't know what to do...do I need to tube feed her? I
> do not want to force her to eat when she refuses, because I'm afraid
> she might get food aversion and make situations worse. If you have any
> suggestions, please help me. thank you.
> Julie

My son was originally put on zantac which made his stomach hurt.
Then after getting a competint Dr. and a specialist he was put on a
combination of Prilosec and reglan and carafate. it helped but he
still wasnt eating or nursing. Reflux is often mis diagnosed as
allergies or asthma (my son frequently had aspiration pneumonia)Only
an endoscopy can tell you exactly if it is reflux and there is a fix
for it! My son was severe! and he also had a hiatal hernia. My son
suffered with mis diagnosis for 7 1/2 years! at 8 1/2 he only weighs
41 pounds but he had a surgery called a laproscopic nissen
fundoplication and has been PERFECTLY HEALTHY for 1 year and 1 month
exactly!
he used to throw up at least 10 times a day. and has not thrown up,
been on medication or had any kind of stomach pain period! He has
started eating and enjoying food and has gone from 25 pounds and very
mal nourished to healthy happy and 41 pounds in just about a year and
a half!

if you are leaving the Dr. office unsure or with unanswered questions
please find another Dr. that can get you the answers and one that can
get your son healthy fast!
My heart to you and your son!

[Beth Kevles]

Hi -

Did your doctor tell you to go completely dairy-free for a few weeks to
see if it helps? It's a standard elimination for breastfeeding moms of
reflux babies, and it often (but not always) helps.

If you need to know HOW to go completely dairy-free, visit my web site.

--Beth Kevles

http://web.mit.edu/kevles/www/nomilk.html -- a page for the milk-allergic
Disclaimer: Nothing in this message should be construed as medical
advice. Please consult with your own medical practicioner.

NOTE: No email is read at my MIT address. Use the AOL one if you would
like me to reply.

[Robyn Kozierok]

In article >,
happy mom > wrote:
(julie) wrote in message
>...
>> Hi,
>> My child is 3.5 months old. I believe she has silent reflux but not
>> sure. I did take her to GI ped. and he thinks it's silent reflux. He
>> put her on 1 ml of zantac twice a day (been 4 days now...) My child
>> refuses bottle when she sees it coming, even before she takes it. She
>> does not throw up but refuses the bottle. So, it's very hard for me to
>> feed her. The only time I can get her to feed is when she is deep
>> asleep. Therefore, I can't feed her in the daytime. It's a very
>> frustrating situation, because she is only taking maybe 10 oz in 24
>> hour period. I don't know what to do...do I need to tube feed her? I
>> do not want to force her to eat when she refuses, because I'm afraid
>> she might get food aversion and make situations worse. If you have any
>> suggestions, please help me. thank you.
>> Julie
>
>My son was originally put on zantac which made his stomach hurt.
>Then after getting a competint Dr. and a specialist he was put on a
>combination of Prilosec and reglan and carafate.

fwiw, zantac worked wonders for one of my kids with reflux. I
wouldn't necessary assume a doctor was incompentent for trying
it, even thought it doesn't work for everyone.

--Robyn

[chiam margalit]

(Robyn Kozierok) wrote in message >...
> In article >,
> happy mom > wrote:
> (julie) wrote in message
> >...
> >> Hi,
> >> My child is 3.5 months old. I believe she has silent reflux but not
> >> sure. I did take her to GI ped. and he thinks it's silent reflux. He
> >> put her on 1 ml of zantac twice a day (been 4 days now...) My child
> >> refuses bottle when she sees it coming, even before she takes it. She
> >> does not throw up but refuses the bottle. So, it's very hard for me to
> >> feed her. The only time I can get her to feed is when she is deep
> >> asleep. Therefore, I can't feed her in the daytime. It's a very
> >> frustrating situation, because she is only taking maybe 10 oz in 24
> >> hour period. I don't know what to do...do I need to tube feed her? I
> >> do not want to force her to eat when she refuses, because I'm afraid
> >> she might get food aversion and make situations worse. If you have any
> >> suggestions, please help me. thank you.
> >> Julie
> >
> >My son was originally put on zantac which made his stomach hurt.
> >Then after getting a competint Dr. and a specialist he was put on a
> >combination of Prilosec and reglan and carafate.
>
> fwiw, zantac worked wonders for one of my kids with reflux. I
> wouldn't necessary assume a doctor was incompentent for trying
> it, even thought it doesn't work for everyone.

IIRC, Robyn's son and my daughter went to the same gastroenterologist
and he also put my daughter on Zantac after Tagamet didn't work well,
and this guy was about as competant as a doctor can get, in fact I
consider him to be a miracle worker because he literally saved a
former M.K. poster's sons life. Besides the fact that he helped my
daughter, friend's kids, and Robyn's son.

Marjorie

[PF Riley]

On 18 Nov 2003 10:46:28 GMT, (Beth Kevles) wrote:
>
>Did your doctor tell you to go completely dairy-free for a few weeks to
>see if it helps? It's a standard elimination for breastfeeding moms of
>reflux babies, and it often (but not always) helps.

Read her disclaimer below carefully.

It is NOT "standard" treatment to eliminate dairy in lactating mothers
of babies with reflux. It rarely helps and there is a risk of dietary
deficiency in the mother from elimination diets.

>If you need to know HOW to go completely dairy-free, visit my web site.
>
>--Beth Kevles
>
> http://web.mit.edu/kevles/www/nomilk.html -- a page for the milk-allergic

Now at least we see the admittedly honest and well-meaning bias.

> Disclaimer: Nothing in this message should be construed as medical
> advice. Please consult with your own medical practicioner.

In other words, pay no attention to her advice that she dispenses
nevertheless despite her disclaimer.

PF

[Hillary Israeli]

In >,
PF Riley > wrote:

*On 18 Nov 2003 10:46:28 GMT, (Beth Kevles) wrote:
*>
*>Did your doctor tell you to go completely dairy-free for a few weeks to
*>see if it helps? It's a standard elimination for breastfeeding moms of
*>reflux babies, and it often (but not always) helps.
*
*Read her disclaimer below carefully.
*
*It is NOT "standard" treatment to eliminate dairy in lactating mothers
*of babies with reflux. It rarely helps and there is a risk of dietary
*deficiency in the mother from elimination diets.

Elimination diets for mothers with colicky or refluxing babies are
commonly recommended. I certainly do not know what the "standard of care"
is in this regard (I'm neither a pediatrician nor a lactation consultant)
but I think these recommendations would fall within that umbrella term.

Check out these references:

http://www.askdrsears.com/html/4/t041200.asp - IMO Dr. Sears is
practically mainstream these days, and his suggested elimination diet is
not only dairy free but free of a lot of other things as well.

http://www.parentsplace.com/expert/lactation/qas/0,,166426_106348,00.html
The author of this article states that the AAP recommends "that nursing
moms with allergic babies try altering their diets to eliminate cow's
milk, eggs, fish, peanuts and tree nuts such as pecans, almonds and
walnuts, since a very small percentage of babies are allergic to these
proteins in their milk." Since the signs of such allergy in tiny babies
are not always straightforward, this recommendation could certainly apply
to a baby who seems to have reflux.

This article suggests that the risk of dietary deficiency from a dairy
elimination diet in a breastfeeding mother is not a concern for the short
term:

Clin Exp Allergy. 2001 Jan;31(1):88-94. Related Articles, Links


Do combined elimination diet and prolonged breastfeeding of an atopic
infant jeopardise maternal bone health?

Holmberg-Marttila D, Sievanen H, Sarkkinen E, Erkkila A, Salminen S,
Isolauri E.

Department of General Practice, Medical School, University of Tampere,
Finland.

BACKGROUND: Prolonged breastfeeding, and intervention in the maternal diet
during breastfeeding, have been suggested as a means to treat atopic
symptoms of infants. The impact of these actions on the mother's skeletal
health has remained unclear. OBJECTIVE: The purpose of this study was to
determine factors that are associated with bone mineral density (BMD) and
serum lipid fatty acid profile in mothers of atopic infants. METHODS: BMD
at the lumbar spine, right femoral neck and dominant distal radius of 24
mothers of atopic infants (study group) and 25 mothers of healthy infants
(control group) were measured with dual energy X-ray absorptiometry
postpartum after the resumption of menses. In addition, the fatty acid
profile of their serum cholesteryl esters was determined. RESULTS: A
systematic trend for 4-6% lower BMD was observed in the study group, but
this difference was mainly attributable to a difference in body weight
between the groups. In addition, the omega (omega)-3 fatty acid metabolite
EPA showed a positive association with femoral neck BMD. Mothers of atopic
infants had a significantly lower proportion of omega-6 fatty acid parent
LA and a higher proportion of omega-6 fatty acid metabolite GLA than the
control mothers. These differences were associated not only with dietary
factors but also with the duration of postpartum amenorrhea and total
lactation. CONCLUSIONS: Neither the breastfeeding nor the mother's
short-term elimination diet per se seemed to be associated with low BMD in
the mothers of atopic infants. Thus, if an elimination diet benefits the
infant, it can be recommended for a limited period. However, it may be
advisable to give special dietary counselling, especially to low body
weight mothers, in order to ensure adequate nutrient intake and to
minimize the possible risk of potential bone loss.


--
hillary israeli vmd http://www.hillary.net
"uber vaccae in quattuor partes divisum est."
not-so-newly minted veterinarian-at-large :)

[PF Riley]

On Wed, 19 Nov 2003 18:48:40 +0000 (UTC), (Hillary
Israeli) wrote:

>In >,
>PF Riley > wrote:
>
>*On 18 Nov 2003 10:46:28 GMT, (Beth Kevles) wrote:
>*>
>*>Did your doctor tell you to go completely dairy-free for a few weeks to
>*>see if it helps? It's a standard elimination for breastfeeding moms of
>*>reflux babies, and it often (but not always) helps.
>*
>*Read her disclaimer below carefully.
>*
>*It is NOT "standard" treatment to eliminate dairy in lactating mothers
>*of babies with reflux. It rarely helps and there is a risk of dietary
>*deficiency in the mother from elimination diets.
>
>Elimination diets for mothers with colicky or refluxing babies are
>commonly recommended. I certainly do not know what the "standard of care"
>is in this regard (I'm neither a pediatrician nor a lactation consultant)
>but I think these recommendations would fall within that umbrella term.

The original suggestion was that elimination diets are standard
treatment for reflux, not colic or food allergies. Gastroesophageal
reflux is a normal, physiologic occurrence that happens to all babies.
It is incredibly unlikely for reflux to be the sole manifestation of a
food allergy, as a true allergy will usually cause other symptoms such
as bloody stools, diarrhea, irritability, or eczema.

Thus, in a breastfed infant with excessive reflux, eczema, and
diarrhea, one might recommend a trial of dairy elimination for the
mother, but this is NOT a "standard" for a newborn with just reflux,
or else over half of the moms in my practice would be off dairy!

>Check out these references:
>
>http://www.askdrsears.com/html/4/t041200.asp - IMO Dr. Sears is
>practically mainstream these days, and his suggested elimination diet is
>not only dairy free but free of a lot of other things as well.

Dr. Sears may be mainstream to you, but the "reference" you quote here
is about a lactation specialist he knows who recommends an elimination
diet for colicky babies (not babies with reflux) based on a book (not
peer-reviewed original research, natch) by William G. Crook, who
recommends through his series of books elimination diets for treatment
of autism, ADHD, chronic fatigue syndrome, or whatever else may ail
you. (Has he ever bothered to put his theories to the test and
actually publish them in the scientific literature, or will he just
continue to write monographs as long as they sell, truth be damned? We
shall see...)

>http://www.parentsplace.com/expert/lactation/qas/0,,166426_106348,00.html
>The author of this article states that the AAP recommends "that nursing
>moms with allergic babies try altering their diets to eliminate cow's
>milk, eggs, fish, peanuts and tree nuts such as pecans, almonds and
>walnuts, since a very small percentage of babies are allergic to these
>proteins in their milk."

Again, this article is about colic and allergies, not reflux. And note
she advises against willy-nilly food elimination.

And she probably is quoting this Policy Statement from the AAP about
allergies, not reflux:

http://www.aap.org/policy/re0005.html

>Since the signs of such allergy in tiny babies
>are not always straightforward, this recommendation could certainly apply
>to a baby who seems to have reflux.

Except that it doesn't.

Here's an excerpt from the recommendations on treatment of reflux from
the North American Society for Pediatric Gastroenterology and
Nutrition, endorsed by the AAP:

http://www.naspghan.org/sub/position_papers/GERD.pdf

"In the infant who has uncomplicated GER, parental education,
reassurance and anticipatory guidance are recommended. Generally no
other intervention is necessary."

>This article suggests that the risk of dietary deficiency from a dairy
>elimination diet in a breastfeeding mother is not a concern for the short
>term:
>
>Clin Exp Allergy. 2001 Jan;31(1):88-94. Related Articles, Links
>
>Do combined elimination diet and prolonged breastfeeding of an atopic
>infant jeopardise maternal bone health?

The abstract you cited says that moms on elimination diets are thinner
and have decreased bone density -- it's just not SO bad that, if the
elimination diet is helping, it's OK to stay on it, but they should
have extra dietary counseling in order not to get too skinny or have
too much thinning of the bones! Is this something we want to do to a
mom whose baby is normal to begin with? I think this abstract PROVES
my original assertion that "there is a risk of dietary deficiency in
the mother from elimination diets."

PF, whose 6-month-old son still barfs on him every time he holds him.

[Beth Kevles]

I re-checked the abstracts, and there does appear to be sufficient
evidence that dairy (non-human milk protein) can be implicated in reflux
(as well as in other allergic responses) that it does make sense to try
a dietary elimination. (Other foods could also be a problem, but far
less frequently.) Results are usually seen within a week, often less.
If the mother maintains a good food diary, so that results are "real"
rather than "wished for", then a week will net you an answer AND a week
isn't long enough to risk maternal nutritional health.

Multiple elimination diets (dairy and other items) are NOT recommended;
eliminating dairy is easy, and the calcium loss can be replaced with a
non-dairy based calcium supplement.

--Beth Kevles

http://web.mit.edu/kevles/www/nomilk.html -- a page for the milk-allergic
Disclaimer: Nothing in this message should be construed as medical
advice. Please consult with your own medical practicioner.

NOTE: No email is read at my MIT address. Use the AOL one if you would
like me to reply.

[Hillary Israeli]

In >,
PF Riley > wrote:

*The original suggestion was that elimination diets are standard
*treatment for reflux, not colic or food allergies. Gastroesophageal
*reflux is a normal, physiologic occurrence that happens to all babies.

I agree that ger is normal and physiologic in infant mammals, with which I
have a lot of experience. There is, however, a syndrome in which it occurs
in human infants to a pathologic extent. At least, according to most
pediatric gastroenterologists there is. Like I said, I'm not a
pediatrician.

*It is incredibly unlikely for reflux to be the sole manifestation of a
*food allergy, as a true allergy will usually cause other symptoms such
*as bloody stools, diarrhea, irritability, or eczema.

Well, probably that is the case, but IMO reflux *could* be due to a
dietary intolerance rather than IgE mediated allergy. That's what has been
suggested to me by the pediatricians with whom I have informally discussed
the subject.

*Dr. Sears may be mainstream to you, but the "reference" you quote here

"reference" ?? Um, it is a reference. It is something to which one may
refer. It does not require quotation marks. I never said it was a citation
from the medical literature, just a reference. Sheesh.

*Again, this article is about colic and allergies, not reflux. And note
*she advises against willy-nilly food elimination.

Wouldn't everyone advise against willy-nilly anything??

*"In the infant who has uncomplicated GER, parental education,
*reassurance and anticipatory guidance are recommended. Generally no
*other intervention is necessary."

That is in reference to UNCOMPLICATED GER. I thought we were discussing
kids who had some kind of PROBLEM associated with their GER. I mean, as
already discussed, GER is a normal physiologic occurence of no
consequence. But if the child is having a PROBLEM and the
gastroenterologist says it is due to a pathologic degree of reflux, that
is a different story.

--
hillary israeli vmd http://www.hillary.net
"uber vaccae in quattuor partes divisum est."
not-so-newly minted veterinarian-at-large :)

[Robyn Kozierok]

In article >,
Beth Kevles > wrote:
>
>I re-checked the abstracts, and there does appear to be sufficient
>evidence that dairy (non-human milk protein) can be implicated in reflux
>(as well as in other allergic responses) that it does make sense to try
>a dietary elimination. (Other foods could also be a problem, but far
>less frequently.) Results are usually seen within a week, often less.
>If the mother maintains a good food diary, so that results are "real"
>rather than "wished for", then a week will net you an answer AND a week
>isn't long enough to risk maternal nutritional health.

As an anecdotal data point, when my 2nd son had reflux, it was suggested
that I try cutting ot dairy, but it wasn't clearly explained to me that
it needed to be a very careful and complete elimination for at least 1-2
weeks to really determine if it would help.

I did a rather careless milk elimination, and concluded that it
wouldn't help.

Shortly thereafter, my son also began exhibiting blood in his stool.
This lead to a GE referral where I was advised to try a more careful
dairy elimination. It still didn't help, but on the advice of the GE I
began experimenting with multiple eliminations until we found the
combination that *did* help -- elimination of milk, soy, peas and
peanuts (the latter was purely precautionary based on the reactions to
soy and peas and the general advisability of avoiding peanuts in
allergic kids).

This cured not only the bloody stool, but also the reflux. He outgrew
these allergies shortly after his first birthday, and now has no food
allergies.

Although allergic babies usually do (eventually) show other symptoms,
I would agree that a week or two-week dairy elimination is a very
reasonable thing to try for reflux alone. It can't hurt, and it might
help. Yes there is some inconvenience to the mother, but there
certainly is no real medical risk from a short trial, and, as we all
seem to agree, if a long-term elimination is found to be called for, it
has been shown to be "safe enough" to continue.

--Robyn

[CBI]

"PF Riley" > wrote in message
...
>
> PF, whose 6-month-old son still barfs on him every time he holds him.

Hmmm.....6 months old and already making political statements. Look forward
to having your hands full.

--
CBI, MD

[CBI]

"Hillary Israeli" > wrote in message
...

> *"In the infant who has uncomplicated GER, parental education,
> *reassurance and anticipatory guidance are recommended. Generally no
> *other intervention is necessary."
>
> That is in reference to UNCOMPLICATED GER. I thought we were discussing
> kids who had some kind of PROBLEM associated with their GER. I mean, as
> already discussed, GER is a normal physiologic occurence of no
> consequence. But if the child is having a PROBLEM and the
> gastroenterologist says it is due to a pathologic degree of reflux, that
> is a different story.

I think that is the question. When does normal GER become problematic GERD?
Certainly, having to change your shirt and shampoo the rug more often than
you would like is not the definition (although I think most parents who seek
advice on the topic fall into this category). On the other end of the
spectrum are kids who are having pulmonary and growth manifestations who
clearly have a medical disorder requiring treatment. In between it is not
always easy to draw the lines.

--
CBI, MD - who held off buying the new carpet until after we figured out if
my son would take after my daughter in this regard.

[CBI]

"Robyn Kozierok" > wrote in message
...
>
> Shortly thereafter, my son also began exhibiting blood in his stool.

IOW - there was a lot more going on than just normal baby reflux.

--
CBI, MD

[Robyn Kozierok]

In article . net>,
CBI > wrote:
>
>"Robyn Kozierok" > wrote in message
...
>>
>> Shortly thereafter, my son also began exhibiting blood in his stool.
>
>IOW - there was a lot more going on than just normal baby reflux.

Yes, and the "normal baby reflux" was the first (and only painful)
symptom.

--Robyn

[CBI]

"Robyn Kozierok" > wrote in message
...
> In article . net>,
> CBI > wrote:
> >
> >"Robyn Kozierok" > wrote in message
> ...
> >>
> >> Shortly thereafter, my son also began exhibiting blood in his stool.
> >
> >IOW - there was a lot more going on than just normal baby reflux.
>
> Yes, and the "normal baby reflux" was the first (and only painful)
> symptom.

"Normal baby reflux" isn't painful.

--
CBI, MD

[Robyn Kozierok]

In article . net>,
CBI > wrote:
>
>
>"Robyn Kozierok" > wrote in message
...
>> In article . net>,
>> CBI > wrote:
>> >
>> >"Robyn Kozierok" > wrote in message
>> ...
>> >>
>> >> Shortly thereafter, my son also began exhibiting blood in his stool.
>> >
>> >IOW - there was a lot more going on than just normal baby reflux.
>>
>> Yes, and the "normal baby reflux" was the first (and only painful)
>> symptom.
>
>"Normal baby reflux" isn't painful.
>

The gastric juices that are brought up can burn the esophagus. At
least that is what was going on with my son -- I had him medicted for
the pain he was in, until we figured out the root cause (allergies).
He never spit up, so it wasn't a laundry issue for me. He just brought
up his stomach contents partway and then swallowed them back down. The
OP said she thought her child had "silent reflux" which is a term I'm
not familiar with but which I guessed to mean the same symptoms my son
had.


--Robyn (mommy to Ryan 9/93 and Matthew 6/96 and Evan 3/01)

[PF Riley]

On Thu, 27 Nov 2003 15:21:15 GMT, (Robyn
Kozierok) wrote:

>In article . net>,
>CBI > wrote:
>>
>>"Robyn Kozierok" > wrote in message
...
>>>
>>> Yes, and the "normal baby reflux" was the first (and only painful)
>>> symptom.
>>
>>"Normal baby reflux" isn't painful.
>
>The gastric juices that are brought up can burn the esophagus. At
>least that is what was going on with my son -- I had him medicted for
>the pain he was in, until we figured out the root cause (allergies).
>He never spit up, so it wasn't a laundry issue for me. He just brought
>up his stomach contents partway and then swallowed them back down. The
>OP said she thought her child had "silent reflux" which is a term I'm
>not familiar with but which I guessed to mean the same symptoms my son
>had.

I would agree with CBI, then, that this was not "normal baby reflux."
A baby with normal reflux is "the happy spitter" where the baby spits
up part of his feeding, it doesn't bother him or cause other health
problems, and it's not caused by underlying pathology. What you
describe is gastroesophageal reflux caused by a food intolerance
resulting in reflux esophagitis. This is not "normal baby reflux."

PF

[Hillary Israeli]

In >,
Robyn Kozierok > wrote:

*In article . net>,
*CBI > wrote:
*>>
*>> Yes, and the "normal baby reflux" was the first (and only painful)
*>> symptom.
*>
*>"Normal baby reflux" isn't painful.
*>
*
*The gastric juices that are brought up can burn the esophagus. At
*least that is what was going on with my son -- I had him medicted for
*the pain he was in, until we figured out the root cause (allergies).

If he was in pain, it wasn't "normal baby reflux." It was pathologic baby
reflux, which you figured out because you noticed his pain, and you got
treatment for. THis is probably a matter of you guys talking at cross
purposes.

Almost all babies have reflux. You might call it "silent" reflux, because
there are no clinical signs associated with it. These babies are not in
pain. They aren't suffering long-term complications. They aren't acting
like anything but normal babies. They reflux because their lower
esophageal sphincters are incompetent. This is NORMAL and EXPECTED in
babies.

Some few babies have a problem resulting in pain associated with reflux.
These babies do not have "normal baby reflux." They have a problem which
requires treatment. This is where your baby fits in.

:)
--
hillary israeli vmd http://www.hillary.net
"uber vaccae in quattuor partes divisum est."
not-so-newly minted veterinarian-at-large :)

[CBI]

"PF Riley" > wrote in message
...
> >>>
> >>> Yes, and the "normal baby reflux" was the first (and only painful)
> >>> symptom.
> >>
> >>"Normal baby reflux" isn't painful.
> >
> >The gastric juices that are brought up can burn the esophagus. At
> >least that is what was going on with my son -- I had him medicted for
> >the pain he was in, until we figured out the root cause (allergies).
> >He never spit up, so it wasn't a laundry issue for me. He just brought
> >up his stomach contents partway and then swallowed them back down. The
> >OP said she thought her child had "silent reflux" which is a term I'm
> >not familiar with but which I guessed to mean the same symptoms my son
> >had.
>
> I would agree with CBI, then, that this was not "normal baby reflux."
> A baby with normal reflux is "the happy spitter" where the baby spits
> up part of his feeding, it doesn't bother him or cause other health
> problems, and it's not caused by underlying pathology. What you
> describe is gastroesophageal reflux caused by a food intolerance
> resulting in reflux esophagitis. This is not "normal baby reflux."

What he said.

--
CBI, MD