Important Supplements
I’ll tell you what I’ve learned, from being in this ‘world’ for eleven (11) years now:
1) It’s Structural: the Lower Esophageal Sphincter (LES) is immature; the valve, the sphincter between the top of the stomach and the bottom of the esophagus isn’t yet fully developed, so the stomach acid comes up (and goes down) as it pleases.
a) Spitting Up: if there’s no pain, you’ve got what ‘they’ call a Happy Spitter and a Laundry Problem. If there’s PAIN, well, this is the burn of the acid and your baby is spitting it up and out.
b) Silent Reflux: isn’t silent at all! This is when there isn’t any spit up; your baby is bringing the acid up and swallowing it back down. This is a DOUBLE BURN! One mother writes: The Screams of Silent Reflux
2) It’s Related to Diet: i.e. a reaction to one, or more, PROTEINS in whatever it is that your baby is ingesting (formula or breastfeeding).
a) Milk Soy Protein Intolerance, MSPI: The ‘main’ proteins that babies react to are milk and soy. About 60% of babies (I’ve also read 40%; regardless, it’s a high percentage, hovering around 50%), who react to milk protein also react to soy protein.
A reaction to milk protein is NOT lactose intolerance! Lactose is milk SUGAR, and babies are ‘designed’ to ingest it (the principal sugar in human milk is lactose). Reaction/reflux due to diet has to do with proteins, milk and otherwise. Milk Names (also has soy names).
1) Some babies won’t need medicine! Their mother goes on a diet to make her milk void of the offending protein(s) and there is a vast improvement with baby’s reflux! Or, the baby is formula-fed and the parents find the right formula and there is a vast improvement with baby’s reflux!
2) Getting rid of the offending proteins helps, via mother’s diet or formula, and a big difference is seen with baby’s comfort and pain. However, medicine is still needed…
3) It’s Both Structural and Protein Related
2) Getting rid of the offending proteins helps, and a big difference is seen with baby’s comfort and pain. However, medicine is still needed…
Mild cases may be controlled with diet, unfortunately it isn’t always that easy. Once a baby is in that hyperacidity mode, the vicious cycle needs to be broken. Some babies (yes it’s possible) don’t even need medication for too long, they get back on track with it, and once diet is optimized they can get weaned from meds; some need medication longer. Also, it is not always diet causing it, in some cases it is anatomy, ex: enlarged pyloric valve or an LES that is too floppy. For these babies (anatomical issue) it is not manageable with diet alone, although it does helps in many cases to cut out milk protein, too, along with medication, however, they would be lost without an PPI until they outgrew their reflux. Some even require surgery at a point, but on the other side, surgery can be avoided if reflux is manageable with PPI; it all depends on the case. But to not medicate babies just out of sheer stubborness or fear or because of “assuming” they don’t need it, THAT is inhumane. Acid gives them pain, and they shouldn’t be in pain at all. (Anke Tillman, FB, 4/17)
GERD is often a combination of *multiple* issues! This is why we are so passionate about diet AND ties AND meds. Brittney Z. writes:
There seems to be this ever increasing assumption that “getting to the root cause of baby’s reflux offers a cure” that relies on misconceptions I think needs to be addressed.
You’ll see recommendations here such as “address diet (yours and babies), use proper medication, assess for ties using a preferred provider” and, while these changes may seem unrelated to your specific situation at first, you’ll see that these are in fact connected.
It seems assumed that baby’s reflux is caused by ONE factor and if found, removed, & addressed baby will be CURED of reflux.
While discussing this recently there was a reply that said, “But if we determine diet as the root cause and address it by removing the allergen then reflux will be cured and not an issue and so no need to use medications….” Unfortunately no. It doesn’t work that way.
I’m assuming this assertion comes from this idea that seems propagated by doctors implying that removing dairy, stopping nursing, or finding the “right” formula (which seems only to be a formula baby drinks and likes) will somehow “cure” baby of their reflux symptoms. So formula roulette begins by switching formulas too quickly and moving on after a few days when baby gets worse. This does not help get to the root of baby’s symptoms or pain.
So what will? What is the CAUSE? Why do our babies suffer?
There are multiple CAUSES potentially contributing to your baby’s symptoms.
*a weak LES (valve) that allows tummy contents to leave the tummy. This matures between 12-18 months. That’s how long it can take for baby to outgrow the symptoms. Not the 3-6 months our doctors tell us. So ONLY time helps here. There’s no way to FORCE baby to outgrow reflux any sooner.
*Allergies/Food intolerances. Diet IS a huge factor of most babies’ pain and symptoms. But rarely the ONLY factor. (*this is where part of the misconception seems to come from*) Diet can be MORE than one allergen. Many cut dairy as suggested by doc and that’s it. But what if soy is the problem? Or wheat? If diet is never right reflux will continue to flare even as baby gets older. Improper diet and allergens can actually impact baby’s ability to gain weight making it seem like there is something serious going on requiring feeds be fortified or solids be given early. Neither of which will help reflux or address the reason behind the weight issue.
*Ties. Most often only assessed (inadequately) for nursing babies. But can be problems for babies no matter how they’re fed. Tongue and lip ties can and will contribute to gerd symptoms. Ties MUST be checked by someone known as a “preferred provider”.
Neither the neonatologist in the NICU, hospital LC (who came by your room for less than 20 minutes to watch baby feed) baby’s Pediatrician, ENT, nor the Pediatric GI (you probably waited weeks if not months to see) are adequately trained to spot, diagnose, and revise ties.
{Also to note; Baby’s latch, the ability to transfer milk, the lack of maternal pain while nursing, appearance of the tongue or ability to stick tongue out are NOT adequate qualities to assess for the presence of a lip or tongue tie.}
As frustrating as it is to accept it is rarely feasible to find the MAIN root of reflux, remove it, resulting in a cure to reflux. Not when multiple factors can contribute to it. Weak LES? Ties? Diet? Something structural?
Our babies tend to have multiple factors causing their reflux symptoms and that’s why you’ll see it recommended here to address multiple areas simultaneously in order to get baby out of pain as fast as possible. Address diet without meds and baby stays in pain. Address pain with meds without addressing diet will keep the exacerbating proteins in diet leaving you just chasing symptoms (and your tail) with medication that won’t fully relieve pain. Ties are rarely the ONLY cause of baby’s GERD but it’s certainly worth it to have ties revised in order to remove the potential for exacerbating or causing reflux symptoms that ties present.
It’s rarely “just diet” or “just ties” or “just weak LES” (that doc says will function better when baby has solids and begins sitting so they push early solids). It’s likely a combination of ALL of those to some degree.
{For example my silent refluxer has suffered from reflux since birth. We were able to use meds only early on and avoid addressing diet. But finally saw diet would need to be addressed. Had both lip and tongue ties. She’s almost 2 and still has reflux symptoms when exposed to certain foods. So her root causes were a combination of all of them. Had we only addressed her pain and never looked at diet? Then we’d probably be dealing with a lot of issues now with feeding and solids. Had we never addressed ties? She’d have a gap in her front teeth and potential speech issues.}
So, use meds to get baby out of pain and keep baby comfy WHILE you work on diet (either maternal diet or formula) to remove any exacerbating diet issues (since diet can take a lot of time and trial and error) and Look into ties. No need for baby to stay in pain during that time.
Once reflux is WELL controlled and baby has an appropriate diet based on a baseline poop then you’ll be better able to ascertain what reflux looks like controlled vs uncontrolled.
There is a lot of information on the forum about this
