What Doctors Won't Tell You About Baby Reflux and Colic
Reflux, ranging from no vomiting (silent reflux) to competition-winning projectile vomiting, is distressing for the baby, mum and dad. The truth is, there are important things your doctor won't tell you about baby reflux. When we visit our doctors to ask for help, we are told that "reflux is normal", that "baby will grow out of it", and that we "don’t need to worry about it".
Yet the gut instinct that got us to visit the doctor regarding your baby's reflux in the first place is yelling “No!” about this. “No!” to letting our babies continue to suffer because we know it is not normal.
The reality is our doctors are not trained in baby reflux specifically. In fact, they can do no more than follow the guidelines that tell them to "watch and wait" and then to medicate, medicate, medicate.
The first fact your doctor won't tell you about baby reflux is:
1. Reflux is a symptom.
It’s a simple sentence, and at the same time, it's quite profound.
Western medicine tells us that babies "get" gastro-oesophageal reflux (GOR/GER) and that if it is causing distress, it becomes gastro-oesophageal reflux disease (GORD/GERD).
However, reflux is not something that a baby "gets" or even "has".
And it is important that we understand the better language to use.
Our bodies (those of everyone, from babies right through to adults) get reflux. It is something our stomachs do rather than have.
Reflux has no pathological cause. It is a symptom.
This means that it is present in our babies as a result of something else that is “wrong” or out of balance. It is important to understand this because your baby’s body is not "overproducing stomach acid."
Your baby does not have reflux because of a weak lower oesophageal valve (LES), the ring of sphincter muscle between the oesophagus (food pipe) and the stomach. I say this because all babies are born with a weak LES, and not all babies have reflux. Therefore, a weak LES is NOT the cause of reflux. If it were, all babies would reflux all the time.
Babies are born with lower muscle tone and strength in general, and as the LES is muscle, this applies there, too. The weakness in the LES makes it easier for food and stomach contents to come back up into the LES. However, on its own, it is not the cause.
The next thing your doctor won't tell you about your baby's reflux when they should is:
2. “I don’t know what's causing your baby’s reflux”
Your doctor is not trained to understand the symptoms and behaviours that go with reflux and probably (especially in the days post-COVID-19) does not have the time. There are over 80 different symptoms and behaviours that are needed to understand what the underlying pattern of your baby’s reflux really is.
Perhaps our expectations of our doctors are too high.
To support the health of a community, doctors must know a little about a lot. This means they cannot know everything about everything. That would simply take too long for them to qualify.
To combat this, guidelines for treatment are provided to all doctors. In the UK, these come from the National Institute of Clinical Health and Excellence, who derive their guidelines from the World Health Organisation.
When it comes to reflux, the guidelines advise the following stepped approach:
- Reassure parents that reflux is normal (as long as possible).
- Trial smaller feeds more frequently (2-week trial)
- Trial thickened milk or adding a thickener (2-week trial)
- Trial medication: alginate therapy (2-week trial)
- Trial gastric acid suppression medication (proton pump inhibitors such as omeprazole or histamine-2 receptor antagonists such as ranitidine) (4-week trial)
- Refer to a paediatrician.
If adhering to the guidelines, babies can wait 10+ weeks to get a referral to a paediatrician, then the wait for the appointment itself could be months away. Meanwhile, the baby, mum, dad and siblings are left struggling with the direct and indirect consequences of reflux.
The final thing your doctor won't tell you about baby reflux is:
3. Medication won’t resolve reflux for 80% of babies
Medication has a very important role to play for babies when it is used appropriately.
However, its rate of effectiveness is very low. In a survey of over 1,900 parents, less than 20% rated the improvements in their baby’s reflux as 8/10 or greater.
Babies are kept on medications for too long, increasing doses and adding more medications into the mix when it isn’t working. This poses longer-term risks to their health as these medications are supposed to be used only for the short term, as per the instructions for use from the manufacturers.
The gastric acid suppression medications that are prescribed for babies are designed for reflux in adults. The mode of operation of these medications assumes that there is too much acid in the stomach.
However, the only time this really occurs in babies is when their bodies are adjusting to or from these medications.
So what should we do?
To truly help our babies, we need to answer a different question.
What we really need to be asking is:
“What is causing their reflux?”
When we answer this seemingly simple question, we know, with confidence, what specific action to take to have each baby as an individual.
The challenge comes when we ask what is causing this symptom because it is a symptom of many things, including
Reflux is always a symptom of something else, and causes range across the following and more...
- Allergens
- Birth Trauma
- Breech presentation
- Cleft lip and palette
- Digestive Immaturity
- Excessive crying (could be due to reflux pain, or over tiredness, or overstimulation)
- Formula Ingredients
- Hiatal Hernia
- Histamine Sensitivity
- Latch Difficulty
- Lip tie
- Intestinal Blockage
- Oral Motor Dysfunction
- Pyloric Stenosis
- Small Intestine Bacterial Overgrowth (SIBO)
- Tongue tie
- Ulcers (in the stomach)
- Vaccines (I’m not getting into an anti/pro conversation; we can support babies around their jabs that minimise the impact and the resulting reflux that can happen.)
The list goes on.
When we figure out what's causing each baby’s reflux, we can take direct and quick action to resolve it... sometimes within days!
To know what treatment will be effective for each baby, we need to understand the specific cause for each baby first.
And the way we do that is by playing Sherlock Holmes. Being the detective and looking at the clues your baby is giving you every day.
How can I help?
In the 'Reflux Free Baby' Workshop, I walk you through all the symptoms you need to observe and record for your baby, what they mean, and how to use them as clues.
I tell you what the clues mean individually and when they occur with other groups of symptoms.
And this leads us to be able to say what is causing each baby's reflux with much more confidence.
Based on this, I tell you what specific action to take for them.
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