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Bundle of Misery
The Diagnosis for an Inconsolable Infant Might Be Reflux, Not Colic Kim Fernandez Special to The Washington Post August 27, 2002; Page F1 this year in the Archives of Pediatrics & Adolescent Medicine, GERD "is a common weeks later. If Joseph was awake and not disease of infancy, with a prevalence as high as 18 percent in [otherwise] healthy constantly, he was howling, writhing and children." What complicates the picture is experience twice or more daily vomiting, Association. But only for some of those -- hours, he would often collapse into sleep, but only for an hour or two and only while distress or failure to thrive to move it into the disease category. Parent activists say the condition is underdiagnosed, and there's at Try Mylicon gas drops and bring him in the next morning. Her exam found nothing wrong. She told me to prepare myself for Society for Pediatric Gastroenterology and pediatricians better diagnose and treat the allowed for colic to run its course. She was nearly out the door when she paused. "gastroesophageal reflux (GER), defined as "Does he spit up a lot?" she asked. He did the passage of gastric contents into the almost every time he nursed. "It might be prescription for the acid inhibitor Zantac GER, are common pediatric problems." and an order for an upper GI series test. intentioned parents, provoking feelings of esophagus closed improperly, allowing his 22 months for a diagnosis while doctor after vomiting was more a laundry problem than stomach acid churning in his throat, which a medical one. He refused solid food until problems weren't over, he was lucky and so were we. -- Converted from Word to PDF for free by Fast PDF -- www.fastpdf.com -- during set times of the day, typically 5 p.m. to 11 p.m. Reflux babies, on the other hand, can hurt at any time, most frequently during were taken as signs she was lacking as a mother. "The doctor told me that I couldn' t "These are very irritable children," he says. "Unlike colicky babies, where taking problem was with me," she says. "He them outside in a car seat or sitting them on actually pointed his finger at me and said, top of a washing machine or dryer in a seat ' That' s the problem. You' re tired of it.' " might help calm them down, typical helpful. Parents of these babies are under a indication: more questioning of the term growing in clout. A study published last year "colic." According to William Cochran, in the Journal of Pediatric Gastroenterology percent of infants with colicky symptoms two studies, one of children with recurrent recurrent sinusitis, and found that a majority simply refers to a baby' s crying for more of both groups had reflux. Treatment for Bill Sears, associate clinical professor but only for a few weeks. The pediatrician of pediatrics at the University of California, Irvine, School of Medicine, agrees. "You several home remedies. When these didn't never accept the term ' colic,' " says Sears, work, we landed at the gastroenterology department of Children' s National Medical (When the first edition of his "The Baby Book" was published 10 years ago, it contained two paragraphs on GERD; the new version, slated for publication next throat. Under a specialist' s care, we tried chapter to the topic.) "One of the cliches is weeks after our initial consultation, we that colic is a five-letter word that means finally hit on the right one. At about 22 the doctor doesn' t know what' s wrong." marking the first time in many weeks that he had slept for more than an hour or two at a pediatrician "you' re not going to leave until time. they find out why your baby hurts." dismiss colic, and distinguish carefully as acid inhibitors fail to soothe a baby, tests between its symptoms and those of reflux. are often used to rule out other anatomical Sirlin, a former assistant professor of pediatrics at Children' s National Medical -- Converted from Word to PDF for free by Fast PDF -- www.fastpdf.com -- esophagoscopy -- placing a lighted tube in wait through two weeks of screaming, call the esophagus while the patient is under anesthesia -- the test is considered too pH probe, in which a small piece of tubing reflux babies. Some liken the experience to is placed down the baby' s throat for 12 to living with a volcano that can erupt at any time. Going out with the baby, even for a anesthesia is needed in what' s often an outpatient procedure. Another test, called becomes unmanageable. Parents often find a scintography, uses a computerized scan themselves terrified that their babies will choke to death when they do fall asleep -- a rare but possible occurrence -- and tune in themselves. "We worry very much about the families," says Beth Anderson, who runs the 60 to 90 minutes -- can contribute to GER. endoscopy -- inserting a tube through the advocacy group that provides information and support for reflux families. "We' ve had stomach and intestines to check for reflux- that they' ve hallucinated," says Anderson. "Parenting a child with reflux is definitely intensive-care parenting, and it' s 24/7." midmorning feeding so that he would drink siblings of refluxers. "Children of reflux do a bottle containing a barium solution while try the patience of a saint," says Anderson. "Every parent we' ve talked to has admitted that they had visions of throwing the baby through the window. They were scared that proved his reflux; he "refluxed" all over the they were borderline capable of doing that," technician. But more important, the test showed that his intestines and stomach were free of anatomical abnormalities that Prevacid, the drug that ultimately stopped his pain -- and his incessant screaming -- I left the house for an hour to get my hair cut. In the parking lot, I fantasized about running to see if medications we hadn' t yet tried away. For about five minutes, I sat in my car and sobbed, feeling like the worst mother in Prilosec, have to build up in the baby' s can gauge if they' re helpful or not. In nonstop. He takes a long nap every day and Joseph' s case, the first few drugs we tried sleeps through the night more often than after his Zantac stopped working didn' t do not. He still takes Prevacid once a day. The anything much for him. We' d start a drug, -- Converted from Word to PDF for free by Fast PDF -- www.fastpdf.com -- has dropped markedly. It gets worse right losing its effectiveness. She' s getting ready to take him to a speech therapist -- delays. The therapist will also teach him to accept different food textures -- another thing reflux has kept him from experiencing. old, is struggling with eating issues as continued treatment and working with a speech pathologist will help him overcome good job,' " she says. "That was the first Sidebar: For Parents: How to
Recognize The Problem and Help Treat
repertoire. However, persistent prolonged occurrences -- crying that feeding -- warrant a doctor' s attention. others advise parents to try them in the hopes of avoiding medical interventions. by pediatricians Bill Sears and Scott Sirlin: Reflux Association, a Germantown-based advocacy group, possible signs of reflux in infants include the following: with rice cereal. The idea here is to enlist gravity to help keep formula down. -- Converted from Word to PDF for free by Fast PDF -- www.fastpdf.com -- count, there are only 11 in the Washington threatening or severely debilitating cases: doctors wrap a band of muscle around the • Ask Dr. Sears: Enter "reflux" Pediatric Gastroenterology and Nutrition, "in unusual Reflux Association, offers information and Maalox; acid inhibitors such as Zantac; acid blockers such as Prevacid or Prilosec; motility drugs, such as Reglan; anti-ulcer drugs, such as Carafate. consider insisting on a referral to a specialist, advises Scott Sirlin, a Children' s National Medical Center gastroenterologist. approach: Because of the small pool of pediatric gastroenterologists -- by Sirlin' s -- Converted from Word to PDF for free by Fast PDF -- www.fastpdf.com --

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