Brittney Zarwel, March 2020

How Do You KNOW It’s Reflux?

I wanted to talk about some common questions I see fairly often; I’m sure I must have had the same thoughts early on in this reflux journey: “How do I KNOW that the issues my baby is having are from reflux and not something else more benign? Like gas? Which symptoms are indicative of reflux/pain and which symptoms might be normal? How do I know medication is necessary if these symptoms could be caused by any number of issues?”

We try to rationalize our concerns about how our babies are doing like this:

Well, he’s pretty fussy, but babies do cry a lot and some more than others
She wants to feed constantly, but she’s just going through a growth spurt
He doesn’t sleep great, but I think he might be teething (sidenote: teething makes reflux worse!)
She is super cranky all the time, but she’s going through a mental leap right now

While these statements may be an accurate assessment to some degree, they don’t take the whole picture into account. Thoughts like this are trying to compartmentalize a baby’s troubles into separate boxes/categories and I think they cause us to overlook the big picture.

Our experience for background reference:

My daughter came home at 5 weeks old and EVERY evening around 7-8pm she was MISERABLE and she stayed miserable for hours. Feedings were awful! We didn’t even have to look at a clock and we knew the time. We had to walk and bounce and rock and walk some more. She hated a carrier so that didn’t work.

Here’s the thing: She never spit up so I never considered reflux a potential issue. Plus she had just spent 35 days in the NICU and no one mentioned reflux. I honestly didn’t suspect a problem. I just thought she was an unhappy, high maintenance baby. (Click here for a comprehensive list of Signs & Symptoms; there are many besides spitting up!)

She wanted to eat all the time; it was impossible to track her volume and frequency because I felt like she was always eating.
She was somewhat calm during the day compared to evenings and night anyways.
She would nap as long as I held her but she was very easily startled (and had been since the day she was born!) so we got a sound machine and I made sure NO ONE knocked on our door or rang the bell during the daytime.
She gagged and almost sputtered during feeds to the point that I sat with a bowl of different sized nipples so I could change them during feeds. (Click here to learn more about ties).

Despite all that, not once during our first two weeks home did I ever consider she had reflux. She didn’t spit up and that’s all I knew about it.

We tried gas drops and gripe water to make her more comfortable. The ONLY thing that seemed to help her relax was a bath. So she got a warm bath nightly but it only worked so long as she was in the bath. Then the pain took over and she was screaming again. I truly resented her. This wasn’t how it was supposed to be. My husband kept asking me “what is wrong with her?” And I would scream back, over her screams, “I DON’T KNOW!”

So, we went to the pediatrician for her first appointment and within a few short questions about her feeding issues she voiced her concerns that it was silent reflux. But at the time she wanted to hold off on medication. She wanted to go the natural route first. Thickening. Probiotics. Elevate during and after feeds. And I was ok with that… at first. I mean no one wants to put their newborn on meds and especially meds that have such a reputation as reflux meds do. So, we went maybe 3 weeks. We never thickened with cereal. Don’t do it! It’s dangerous! (Click here and here and here for research about thickening). I was never told to change my diet (later the nurse did mention this but at first it wasn’t brought up). We were just told to use Gerber Soothe Probiotics; probiotics do absolutely nothing for pain. (Click here for more info about probiotics and reflux). None of these suggestions helped anything.

After 3 weeks we hit a weekend where she began to refuse feeds. She would scream and claw at her chest in agony and hunger but the second she latched and sucked she popped off and screamed in agony again. (Click here for more information about breastfeeding and here for more information about formula feeding). It took her 8+ hours to drink 4oz, and at that point I knew we were in need of medication. I wish I had known more about the meds and about what was happening at this point but I didn’t. (Click here for more information about reflux medications.) So we went the Zantac route which worked for barely a week before it began wearing off an hour AFTER a dose. It was increased and no change. During this time I was watching for symptoms like arching, screaming, lots of gulping and hearing her reflux. When that was happening i knew she was in pain and that it wasn’t working anymore. (Click here for information about arching and reflux.)

She was on a properly dosed ppi by the time she was 3 months old, and began sleeping all night and in the car, and was almost fully symptom free. She’s now 20 months old and is doing so amazingly!

Now, let’s address the common lines of thinking listed above one by one.

What if my baby just has gas?

Let’s take a look at some of the causes of gas in infants. Did you know that many symptoms of gas actually overlap with reflux symptoms? Spitting, trouble sleeping, and pain/discomfort can all be attributed to either or both common issues in babies.

There are many ways that gas and reflux are connected. For example:

Baby has pain from reflux → baby cries excessively → excessive crying can cause baby to struggle with gas later.
Baby has pain from gas → baby cries excessively → excessive crying causes more gas → extra gas causes or worsens reflux.

An additional cause of gas in infants is their immature GI tracts. This is also the reason that most babies have at least some degree of reflux. It stands to reason that there may be a correlation between a more immature GI tract causing both worse gas and worse reflux.

Another factor here is constipation. When diet is not being tolerated properly, it can cause or worsen reflux. It can also cause constipation. Constipation leads not only pain but also gas. The vicious cycle of gas → pain → crying → more gas/reflux repeats.

How do I know my baby is in pain? Aren’t some babies just fussy?

Some may believe that medicating a baby just because they cry excessively or don’t sleep well is unnecessary. According to KellyMom, infant fussiness increases around 2-3 weeks old, peaks around 6-8 weeks, and then gradually decreases around the 3-4 month mark. It also states that it’s “normal” for a baby to cry for up to 2-4 hours per day and that these fussy periods supposedly occur at the same time at the same intensity and will respond to the same tricks at calming baby; i.e. motion/holding, bouncing, frequent feeding.

Now, we know that reflux symptoms can occur at any time following birth. Some doctors will claim that it’s impossible for a newborn to have reflux prior to 6 weeks of age, but this isn’t accurate. For many babies it seems that diet issues and reflux tends to peak or intensify around 3-4 months as opposed to the normal fussiness mentioned above which should ease up around that point. Now, I include all of that to say that for almost 2 weeks I believed my daughter was just colicky. Colic not a diagnosis by the way! (Click here for information about Colic vs. Reflux.)

Trying to distinguish between or categorize a “true” reflux symptom from gas or from teething or a food intolerance is only going to make you crazy. Regardless of the root cause of what baby is going through, there are any number of factors that can aggravate reflux. It’s all interconnected. And so when dealing with GERD you want to focus first and foremost on baby’s pain. Medication will help keep the baby comfortable WHILE you work to determine what the root cause is and correct it.

Should I just change baby’s diet?

Diet is key in all of this. It is imperative to remove any offending proteins that may be contributing to baby’s reflux, pain, and/or constipation, all of which cause pain. (Click here for more information about allergies and intolerances). Furthermore, be sure baby doesn’t have any tongue or lip ties that could be contributing to any of these symptoms. A poor latch is a sign of ties and will also contribute to excess gas. In these cases you wouldn’t want to only treat gassiness without also taking into account how it is all connected and contributing to reflux!

Overall

So to answer the question regarding whether or not baby’s issues are from reflux or food intolerances or gas or ties or teething or normal fussiness… And how to know if meds are needed or if an increase is needed… I say you have to look at the big picture.

Look at diet. Is poop baseline?
Look at symptoms? Is there pain? Are there signs of pain or discomfort that could be associated with other issues but are also reflux symptoms?
How are they ALL affecting baby overall? Is it impacting feeding and sleep?
Is baby developing well? Meeting milestones?

If you’re questioning whether your infant is really struggling with reflux please take a look at the symptoms list. It doesn’t matter if some of those symptoms on their own can be attributed to gas or if some can be attributed to a food intolerance. Look at the big picture. If baby is in pain then medication is necessary.

If you’re questioning whether your 8 month old still needs the medication please look at the symptom list. Even if baby isn’t screaming and arching all day doesn’t mean baby is ready to come off meds. Symptoms of pain change and babies will present with pain differently as they get older.

If you’re not sure if your 1 year old is waking at night due to teething or reflux and whether or not meds need to be increased please look at the list of symptoms. Is baby waking a lot at night? Is baby not at a baseline poop? Does baby have chronic congestion and ear infections? Then that points to reflux and would most likely need starting or increasing medication.

For me, when my daughter is exhibiting ANY signs of ANY pain I automatically blame it on reflux and bump her dose. The reason for that is because we know she suffers from GERD and therefore any signs of pain I am going to assume are associated with GERD/food intolerances over any other possible reason.

It’s all about the big picture. You can get the big picture into focus by addressing the pain and removing exacerbating factors, then you can get on top of baby’s symptoms and it’ll be less of a question when changes do occur down the road.

If you are looking for more information or personalized help, click here to look into a phone consult.