Sound Advice
Does your baby cry and fuss excessively, without apparent cause? Many babies labeled "colicky" actually suffer from treatable GI disorders such as infant GERD. Dr. Susan Edelstein is a recognized expert on infant digestive disorders: book a consultation with her if you’re worried about your baby’s constant fussing and need an expert diagnosis.
Symptoms
Typical symptoms related to gastroesophageal reflux disease (GERD) include:
- Irritability/crying associated with feedings
- Feeding difficulty – frequently pulls away from the bottle’s nipple or breast while feeding
- Frequent spitting up/vomiting even hours after meals
- Frequent wet burps
- Frequent arching of the back associated with irritability
- Weight loss
- Difficulty sleeping, never seeming to be comfortable
If any of these signs or symptoms occurs, a Pediatric Gastroenterologist should evaluate your baby.
Baby Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease (GERD) is a problem of tone and motility of the upper gastrointestinal tract. Other systemic contributing factors need to be considered, however, including neurologic and metabolic disorders.
Infants with gastroesophageal reflux usually have decreased tone of the sphincter connecting the esophagus and stomach (the lower esophageal sphincter). When this is too loose, stomach contents then can flow up and down in the esophagus.
Another factor that may contribute to an infant’s gastroesophageal reflux includes delayed stomach emptying. If an infant’s stomach does not empty at a normal rate, the stomach fills up with food and gastric secretions. When this occurs, the stomach will then empty along the path of least resistance, which is up the esophagus and out of the mouth.
Diagnosis
Typical screening tests for gastroesophageal reflux disease (GERD) include:
- Stool Studies – to assess for cells that may be associated with food allergies that may be exacerbating gastroesophageal reflux. Stool studies can also be used to screen for infections of the intestine that can worsen reflux.
- Upper Gastrointestinal Series – an x-ray that requires the patient to drink a small amount of contrast (usually barium) to assess the anatomy of the esophagus, stomach and proximal duodenum
More severe cases of GERD require further studies, including:
- Complete blood work screening.
- Gastric emptying study to assess how fast the stomach actually empties.
- 24-hour pH probe study to quantify and qualify the severity of reflux into the esophagus.
- Endoscopy with biopsies to assess the health of the mucosa (inside lining) of the upper gastrointestinal tract.
Fussy Baby Tips
Tips for Soothing a Fussy Baby:
- Swaddling
- Feeding your infant in a calm/quiet environment
- Frequent burping
- Slowing down the flow of milk/formula during feedings (adjusting flow of bottle nipple)
- Keeping your infant in a semi-upright position at all times, but especially during and after feedings and while sleeping
Your infant may ultimately require medications or diet modifications to treat gastroesophageal reflux disease. If the symptoms are intense and do not resolve, your infant should be evaluated by his or her Pediatric Gastroenterologist to rule out more acute problems.