My 6 week old grandson Mason has been struggling with severe case of GERD that actually landed him in a local hospital for six days. What was once thought to be pyloric stenosis or an anatomical obstruction of some sort, ended up being diagnosed by a pediatric GI specialist, as a powerfully projectile case of GERD.
It is common for infants to spit up after a meal, but frequent vomiting among infants may be caused by GERD (gastroesophageal reflux disease), the upward movement of stomach content, including acid, into the esophagus and sometimes into or out of the mouth.
Often, reflux in infants is due to a poorly coordinated gastrointestinal tract. Babies born before full term can have body systems that are not fully ready for life outside the womb. Many infants with the condition are otherwise healthy; however, some infants can have problems affecting their nerves, brain or muscles – all of which are necessary for efficient digestion.
GERD is more common in some families than in others.
In young infants and children, some problems may be associated with GERD and include:
- Colic (frequent crying and fussiness)
- Feeding problems
- Recurrent choking or gagging
- Poor growth
- Breathing problems
- Recurrent wheezing
Most babies outgrow infantile GERD. This is a very important fact.
Treatment approaches for infants:
- Elevate the head of the baby's crib or bassinet
- Hold the baby upright for 30 minutes after a feeding
- Thicken bottle feedings with cereal or other thickening agent (do not do this without a doctor's supervision)
- Change feeding schedules (discuss with the child's doctor first)
- Try solid food (discuss with the child's doctor first)
- Use medication when prescribed by the doctor
The focus of this article is the use of drugs. Clearly, we do not support the idea that a drug should be used over long periods. Chronic conditions are not a drug deficiency. Nevertheless, there is an important role for drugs and medicines in the treatment of disease and chronic conditions. That role is to help the person conquer the underlying causes.
Judicious use of medicine can help the child digest his/her food. At a time when the infant needs to put on weight in order to thrive, constant vomiting clearly should not be tolerated. When a medicine can help it should be used, but only until it is no longer needed. Be certain to only use medicines that are prescribed by your baby’s doctor.
How do you stop using a drug that has been prescribed by your doctor?
Prescriptions are written with an allowed number of refills. For the most part, they can be refilled for one calendar year. That does not always mean that it must be refilled repeatedly. However, how can you know when to stop - or even how to stop?
This discussion is about GERD in infants. There are a number of drugs that can be ordered to treat GERD, and the choice is up to the doctor. Use the medicine as prescribed and follow the doctor's guidelines about feeding amounts and times. Nobody knows more about these details than the doctor does.
Because the doctor is not with your child as much as you are, it is up to you to make adjustments in the doses and then stop altogether - when the time is right. If you are uncomfortable initiating this approach on your own, talk to your doctor. Your focus should be to use the prescribed medicine only as long as it is needed.
Here’s a suggested plan for tapering off a medicine.
- Give the medicine in the dose and at the times ordered.
- Continue for 3 to 10 days.
- Reduce the dose by 25% for a few days and "see what happens".
- If the GERD is under control, keep reducing the amount and the frequency by small amounts.
- At some point, you will be able to stop completely.
- This may take several weeks of trial and error, but it is worth it when your baby no longer needs to use a drug.
Time and maturing will make the need for a drug unnecessary.
The amount of time and the level of maturity are completely subjective. They depend on your child and his/her level of gastric difficulty.